This article was originally published in the fall of 2017.
Heart failure is a rising issue in the U.S., and recognizing the symptoms and altering lifestyle choices may mean the difference between life and death.
Dr. Kamala Tamirisa, a ProMedica physician in Toledo who specializes in cardiology, spoke with HealthScene Ohio about the types of heart failure, how it can be treated and how to avoid this increasingly-common condition.
HealthScene Ohio: What is congestive heart failure, and how does it occur?
Dr. Kamala Tamirisa: Congestive heart failure means that the heart muscle can’t pump blood properly and efficiently, and the rest of the body does not get enough blood or oxygen.
HSO: What are the different types of congestive heart failure?
KT: One type of heart failure is Systolic Heart Failure (HFrEF), or heart failure with reduced ejection fraction. Ejection fraction is how well the heart is pumping blood; normal ejection fraction is around 55-65 percent. Here, the heart muscle does not contract or squeeze, effectively, so less oxygenated blood is pumped out to the body.
Another type is called Diastolic Heart Failure (HFpEF), or heart failure with preserved ejection fraction. Here, the heart muscle squeezes or contracts normally, but the ventricles don’t relax enough, which prevents them from filling completely. So, the body fails to get all the blood it needs.
HSO: What are some common symptoms?
KT: The most common symptom of heart failure is shortness of breath. This may occur at rest, with activity or exertion, while lying flat, or even while awakening from sleep. This occurs due to fluid, mainly water, accumulating in the lungs, or the inability of the heart to pump blood to the rest of the body.
Another common symptom is chest pain, especially in patients with coronary artery disease. Edema and weight gain due to excessive fluid, fluid accumulation in lower extremities or sacrum or abdomen, is also a common symptom. More common symptoms include worsening fatigue, dizziness, reduced appetite and weight loss.
HSO: Why has congestive heart failure become such a major problem?
KT: In the U.S., nearly 6 million people are living with heart failure. One out of every five people will develop heart failure over the course of their lifetime. Heart failure is the most common cause of hospital admissions in people over 65. Some causes of heart failure include coronary heart disease and heart attacks, valve disease, high blood pressure, diabetes, alcohol, illicit drugs, familial, post-pregnancy, systemic lupus, amyloidosis and sarcoidosis, and irregular heart rhythm.
HSO: What is the diagnostic process?
KT: To diagnose someone with heart failure, you would look at their health history, looking for the causes and their symptoms. You would also do a physical exam looking for edema, enlarged liver, and fluid in the abdomen. An EKG, chest X-ray, echocardiogram, nuclear test/MUGA scan, stress tests and blood tests such as CBC, creatinine, liver function tests and other tests specifically looking for an elevated BNP level are also a part of the diagnosing process.
HSO: How can people avoid chronic congestive heart failure?
KT: Certain lifestyle choices increase the risk for heart failures, such as smoking and eating foods that are high in salt, fat, and cholesterol, as well as being sedentary and overweight. People can decrease their risk of heart failure if they maintain a healthy lifestyle and regularly check their blood pressure and cholesterol.
HSO: Are there medications that should be avoided if someone has been diagnosed?
KT: Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided. These include ibuprofen, Advil, Motrin, Aleve, Toradol, and Celebrex. These medicines hold fluid and cause swelling, which can harm your kidneys. We also don’t recommend cold and cough medicines with pseudoephedrine or phenylephrine, or Alka-Seltzer because it contains too much sodium. A few others include Metformin, Thiazolidinediones, androgens, antihistamines, theophylline and calcium channel blockers, such as diltiazem (Cardizem) or verapamil (Calan or Verelan). These lessen the heart’s ability to pump if you have systolic heart failure, though they may be used if you have diastolic heart failure.
There are also certain chemotherapy agents, anti-arrhythmic medications, anti-depressants, and herbal supplements we do not recommend.
HSO: What kinds of surgeries can be done to cure or improve this condition?
KT: Ventricular Assist Devices (VAD), which are implanted pumps that help improve the squeezing function of the heart, can help improve heart failure. Additionally, cardiac transplantation can be done at the end stage of the disease.
HSO: Can congestive heart failure lead to other medical complications? If so, how are those treated?
KT: Congestive heart failure can lead to liver shock due to edema and high pressure in the liver vessels, which leads to digestion problems, reduced appetite, cardiac cachexia and jaundice, which all leads to failure to thrive. This is seen in end-stage heart failure and right heart failure.
CHF can also lead to kidney problems. Low perfusion of the kidneys leads to abnormally elevated kidney function tests, and some patients end up needing dialysis. This is again seen in end-stage heart failure. This is called cardiorenal syndrome. The management of this can be challenging.
Edema in the lungs and swelling and high pressure leads to coughing up of blood due to congestion (hemoptysis). Mental confusion due to low perfusion and increased stroke risk due to concomitant atrial fibrillation is also seen.
Lydia Freudenberg is a contributing editor. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Kamala P. Tamirisa, MD, FACC, FHRS, is fellowship trained in Cardiology and Cardiology/Electrophysiology at the University of Michigan in Ann Arbor, Michigan. She is board certified in both internal medicine and cardiovascular disease. She trained at St. Louis University School of Medicine, St. Louis, Missouri, where she also served as a Chief Resident in Internal Medicine. In addition to being an advocate for women’s heart health, Dr. Tamirisa has special interest and expertise in electrophysiology, radiofrequency ablation for arrhythmias including atrial fibrillation, pacemaker, defibrillation, defibrillator and bi-ventricular insertion for heart failure, medical management of arrhythmias, and cardiac MRI.
