LIVING SUCCESSFULLY WITH HEART FAILURE

What is Heart Failure?
Heart failure is defined as a condition where the heart is unable to provide enough blood flow to the vital organs to satisfy the body’s demands. Physical activities such as walking briskly, carrying a heavy object, or doing work in the garden can outstrip the body’s capacity to handle the task. When this happens symptoms such as shortness of breath, fatigue, feeling drained and exhausted can occur. When heart failure is severe even very minor activities may cause severe breathlessness and exhaustion. Common causes of heart failure include high blood pressure, heart attacks, smoking, diabetes, and many other causes. Unfortunately heart failure is quite common among seniors. Studies estimate the prevalence of heart failure at 6 to 10% in persons 65 years or older.

How does Heart Failure occur?
In heart failure, the heart performs at less than its normal capacity; this is often due to a weakened heart muscle or narrowed or leaky heart valves. The heart cannot produce enough forward blood flow to keep up with the needed circulation. Inadequate circulation to the kidneys sends the kidneys a false signal that the body is dehydrated. In response, the kidneys retain salt and water, and a condition of fluid overload is created. Treatment for heart failure counteracts the body’s retention of water and improves forward circulation. Dietary changes to limit salt intake are a key component in treatment.

How is Heart Failure treated?
The goals of treatment are directed at reducing symptoms and improving long term outcome. The optimum treatment includes medications, lifestyle changes to control fluid retention, and appropriate physical activities to strengthen the body. When a heart failure patient understands the various components of his/her treatment and is able to follow them carefully, heart failure is often controlled well.

What are the important components of heart failure treatment?

1. Medications. The doctor usually prescribes several medications for heart failure. Certain medications have been shown to control heart failure and prevent death when compared with patients who do not take these drugs (i.e. ACE Inhibitors, Betablockers, Aldactone). Other medications are given for fluid control (i.e. diuretics) to help reduce shortness of breath; digoxin maintains heart health and prevents a patient from slipping into heart failure. Each of these medications is important as it contributes to stabilization of the heart. Medications need to be taken regularly as instructed so they may do their job. It is important to communicate with your doctor if the regimen prescribed does not fit your schedule. Often the schedule of medications can be changed to fit individual needs.

2. Weight control. As the body wants to retain salt and water, weight can increase rather rapidly. When weight increases symptoms of heart failure often develop. An increase in weight of more than 5 to 8 pounds suggests a decompensation of heart failure may be occurring; it should prompt a call to the doctor. To keep a record of your weight, measure your weight daily and write it on a calendar. Then you can see whether your weight changes over time.

3. Diet. Salt restriction is a cornerstone in the treatment of heart failure. If little salt is consumed in the diet the body cannot accumulate salt and water. A reduction of salt in the diet will often reduce the need for diuretics; i.e. it is a stabilizing force. Usually the salt intake is limited to 2000 milligrams per day. How do you reduce salt intake? The first step is to remove the salt shaker from the table. Salt substitute is a good alternative but even salt substitute should be used sparingly. Read labels on food products; labels contain the salt content of foods. When heart failure is severe, fluid intake may need to be limited as well. In addition, avoid eating rich and fatty foods, i.e. meat, cheese, or gravy. Rich foods are hard to digest. Circulation is already stressed due to heart failure and rich foods represent an additional stress.

4. Physical activity. Daily physical activity is strongly encouraged to maintain muscle tone. Aerobic activity (involves movement) is generally recommended. Physical activities, which require holding your breath (i.e. heavy weight lifting), may be detrimental. Exercise is tiring but with recovery, the tiredness should recede and an improved sense of vigor should be experienced. If excessive fatigue persists into the next day, you have exercised too long or too heavily. It is important to listen to your body and make adjustments to your activities.

5. Non-smoking. Smoking represents a serious stress factor to the whole body. In heart failure, the circulation is already inadequate. Smoking reduces the oxygen delivery even more as chemicals in smoke prevent the release of oxygen from the red blood cells. Smoking should be stopped as soon as possible.

In summary, treatment of heart failure requires adjustment of several aspects of lifestyle in addition to taking regular medications. Indeed, heart failure is often successfully controlled if one adheres closely to lifestyle changes. Much about living successfully with heart failure is in the patient’s control.

Dr. Georg Emlein, MD, FACC is affiliated with the Sacramento Heart Center. For more information about the Sacramento Heart Center, visit their web site at www.sacheart.com or call (916) 830-2080 and request information be mailed to you. Please address your cardiology-related questions to “Ask the Cardiologist”, 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future articles.