Congestive Heart Failure (CHF) Overview (cont.)
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Congestive heart failure facts
- What is congestive heart failure (CHF)?
- What causes congestive heart failure?
- What are the signs and symptoms of congestive heart failure?
- What are the risk factors for congestive heart failure?
- How is congestive heart failure diagnosed?
- What is the treatment for congestive heart failure?
- What lifestyle changes can help treat congestive heart failure?
- Fluid regulation
- Maintaining weight
- What is the long term prognosis for patients with congestive heart failure?
- Can congestive heart failure be prevented?
- Find a local Cardiologist in your town
What is the long term prognosis for patients with congestive heart failure?
Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given individual, however, is extremely variable. Factors involved in determining the long term outlook (prognosis) for a given patient include:
- the nature of the underlying heart disease,
- the response to medications,
- the degree to which other organ systems are involved and the severity of other accompanying conditions,
- the person's symptoms and degree of impairment, and
- other factors that remain poorly understood.
With the availability of newer drugs to potentially favorably affect the progression of disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.
Heart failure is often graded on a scale of I to IV based on the patient's ability to function.
- Class I is patients with a weakened heart but without limitation or symptoms.
- Class II is only limitation at heavier workloads.
- Class III is limitation at everyday activity.
- Class IV is severe symptoms at rest or with any degree of effort.
The prognosis of heart failure patients is very closely associated with the functional class.
An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias. A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in individuals with severe congestive heart failure (defined by an ejection fraction below 30% to 35%) can significantly improve survival, and has become the standard of care in most such individuals.
In some people with severe heart failure and certain ECG abnormalities, the left and right side of the heart don't beat in rhythm, and inserting a device called a biventricular pacer can significantly reduce symptoms.
Can congestive heart failure be prevented?
Congestive heart failure is the result of an underlying illness, often atherosclerotic heart disease. Controlling those risk factors may help with congestive heart failure prevention. These include lifelong control of high blood pressure, high cholesterol, and diabetes and smoking cessation. High blood pressure and diabetes are independent risks for congestive heart failure. Alcohol and drug abuse may be a cause of heart failure.
Diastolic Dysfunction: This is a recently described form of CHF in which the heart muscle may be stiff. The pumping function is normal and the prognosis is excellent. The problem is that a stiff heart muscle fills with blood at a higher pressure, which is transmitted to the lungs resulting in shortness of breath.
Roger, Veronique L., et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. "Heart disease and stroke statistics -- 2011 update: a report from the American Heart Association." Circulation 123.4 (2011): e18-e209.
Ho, K. K., et al. "The epidemiology of heart failure: the Framingham Study." Journal of the American College of Cardiology 22.4 Suppl A (1993): 6A-13A.
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