Congestive Heart Failure

Congestive Heart Failure: Overview

Alternative Names: Cardiac Insufficiency

Congestive heart failure (CHF) is a serious condition in which the heart is not pumping well enough to meet the body's demand for oxygen.  This condition has its name due to the heart failing to pump efficiently, which often results in congestion of the lungs.  As a result, the heart tries to overcompensate for the problem, which only makes the problem worse.

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Incidence; Causes and Development

According to statistics from the American Heart Association, 550,000 new cases of CHF are diagnosed in the United States every year, including 1% of people over the age of 65.  Of all newly diagnosed patients, 50% of CHF patients die within 5 years of diagnosis.  Males and females appear to be affected about equally, but somewhat more women die from the condition.

Conditions that can lead to CHF include coronary artery disease, hypertension, heart attacks, cardiomyopathy, heart valve disease and infections, congenital heart disease and pulmonary hypertension.

Signs and Symptoms

The initial symptoms of CHF, such as swelling of the ankles, seems so minor that patients may not seek treatment until significant heart damage has already been done.

Treatment and Prevention

A number of different conventional treatments may be prescribed.  These include medications such as diuretics and invasive procedures such as a balloon angioplasty with coronary stenting.  Severe cases may require surgery.

Signs, symptoms & indicators of Congestive Heart Failure:

Symptoms - Abdomen

Mild abdominal discomfort or moderate abdominal pain

Accumulation of fluid (due to congestive heart failure) in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

Symptoms - Food - General

Weak/loss of appetite

Accumulation of fluid (due to congestive heart failure) in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

Symptoms - Gas-Int - General

Occasional/regular/frequent unexplained nausea

Accumulation of fluid (due to congestive heart failure) in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

Symptoms - General

Counter-indicators
No/past history of being fatigued

Fatigue is a sensitive indicator of possible underlying congestive heart failure.

Symptoms - Metabolic

Edema of the ankles/lower legs

Edema of the ankles is a common manifestation of failure of the right ventricle related to both venous congestion and salt and water retention.  Those experiencing constant or worsening swelling of the feet or legs should see a doctor for a heart evaluation.

Edema of the feet

Due to weakened heart muscles, blood supply to the kidneys may be reduced, which in turn impairs their ability to excrete salt and water.  As a result the body retains more fluid, some of which may accumulate in the extremities, resulting in edema of the ankles and/or feet.

Edema of the abdomen

The weakened heart muscles may not be able to supply enough blood to the kidneys, which then begin to lose their normal ability to excrete salt (sodium) and water.  This diminished kidney function can cause the body to retain more fluid.

Symptoms - Nails

Symptoms - Respiratory

Shortness of breath when at rest

Congestive heart failure leads to reduced blood supply to the kidneys, which leads in turn reduced kidney function, and in turn excess fluid retention (edema).  The lungs may become congested with fluid (pulmonary edema) and thus the ability to exercise is decreased.

Symptoms - Sleep

Waking up with choking sensation

Fluid may accumulate in the lungs, causing shortness of breath particularly during exercise and when lying flat.  In some instances, patients are awakened at night, gasping for air.

Conditions that suggest Congestive Heart Failure:

General

Organ Health

Enlarged Spleen

In severe failure of the right ventricle, elevated venous pressures are transmitted to the portal system, leading to congestion of the spleen and splenomegaly.

Kidney Disease

Renal insufficiency due to underperfusion from a failing heart is more widespread than commonly thought.

Respiratory

Symptoms - Cardiovascular

Uro-Genital

Nocturia

Edema fluid that collects in tissues during the day due to heart failure can result in increased night time urination.

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Risk factors for Congestive Heart Failure:

Lab Values - Scans

Counter-indicators
Normal chest X-ray

A chest X-ray of a patient with congestive heart failure may show an enlarged heart and/or fluid buildup in the lungs (pulmonary edema).

Metabolic

Hemochromatosis (Iron overload)

Congestive heart failure occurs in about 7% of symptomatic patients with hemochromatosis.  If untreated, patients may develop an acute onset of severe congestive heart failure with rapid progression to death.

Symptoms - Food - Beverages

Counter-indicators
Low alcohol consumption

A study found that elderly people who drank at least 1.5 drinks per day had a risk of heart failure 47% lower than abstainers, regardless of age, race, blood pressure, history of diabetes, smoking and other factors.

Studies do not justify advising lifelong nondrinkers to start drinking for health, especially because most have good reasons for abstaining.  People with liver disease or a history of alcohol abuse should not drink at all, while those with diabetes and hypertension may partake in light alcohol consumption.

Tumors, Malignant

Carcinoid Cancer

Metastatic carcinoid disease can result in congestive heart failure by causing progressive fibrosis of the right-sided chambers and valves.

Congestive Heart Failure can lead to:

General

Excessive Fatigue

An early symptom of congestive heart failure is fatigue.

Organ Health

Kidney Disease

Renal insufficiency due to underperfusion from a failing heart is more widespread than commonly thought.

Recommendations for Congestive Heart Failure:

Amino Acid / Protein

Botanical

Hawthorn Berry Extract

In a sample of 1,011 patients with stage II cardiac insufficiency, a standardized hawthorn extract containing 84mg of oligomeric procyanidins improved ejection fraction and resting pulse rate, and produced a reduction in cardiac arrhythmias.  Duration of the study was 24 weeks.  [Eur J Heart Fail 2000;2(4): pp.431-7]

Clinical trials with an extract (WS 1442) have successfully demonstrated improved cardiac function and improved quality of life primarily in patients with early stage CHF.  For the treatment of early stage CHF, the effective daily dosage of WS 1442 (standardized to 18.75% oligomeric procyanidins) has ranged from 160-900mg per day, divided into 2-3 doses.  Benefit has been shown in the 160-480mg per day range.  [Fortschr Med 1996;114: pp.291-6]

Diet

Increased Fruit/Vegetable Consumption

Whole fruit and fruit and vegetable juice, both high in potassium, are recommended by some doctors for congestive heart failure (CHF).  This dietary change should, however, be discussed with a healthcare provider because several drugs given to people with CHF can actually cause retention of potassium, making dietary potassium, even from fruit, dangerous.  Bananas are a rich source of potassium and need to be avoided in persons taking potassium-sparing diuretics.

Drug

Diuretics

Potassium-sparing diuretics such as Aldactone or Dyrenium help the body to retain potassium and are often used in congestive heart failure patients, often along with the other two types of diuretics.  They do not significantly lower blood pressure.

Loop diuretics such as Lasix or Bumex are often used to counter congestive heart failure symptoms and are especially useful in emergencies.  They do not, however, significantly lower blood pressure.  Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to treat edema in heart failure.

Nutrient

CoQ10 (Ubiquinone)

CoQ10 is known to be highly concentrated in heart muscle cells due to the high energy requirements of this cell type.  The great bulk of clinical work with CoQ10 has focused on heart disease.  Specifically, congestive heart failure (from a wide variety of causes) has been strongly correlated with significantly low blood and tissue levels of CoQ10 [Proc.  Natl.  Acad.  Sci., U.S.A., Vol. 82(3), pp. 901-4].

The severity of heart failure correlates with the severity of CoQ10 deficiency [Drugs Exptl.  Clin.  Res.  X(7) pp.497-502].  This CoQ10 deficiency may well be a primary causative factor in some types of heart muscle dysfunction while in others it may be a secondary phenomenon.  Whether primary, secondary or both, this deficiency of CoQ10 appears to be a major treatable factor in the otherwise inexorable progression of heart failure.

The efficacy and safety of CoQ10 in the treatment of congestive heart failure, whether related to primary cardiomyopathies or secondary forms of heart failure, appears to be well-established.

Vitamins

Not recommended
Vitamin B6 (Pyridoxine)

High doses of B6 are not recommended for patients with coronary insufficiency.  [Sov Med (7): pp14-9, 1979 (in Russian)]

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