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Congestive Heart Failure

Congestive Heart Failure is degradation of the heart’s ability to pump sufficient blood to the tissues of the body to meet the metabolic supply chain and provide removal of byproducts of metabolism and carbon dioxide. When the heart is injured (heart attack, getting too thick to pump adequately, or too dilated and thin to pump adequately) the body’s compensatory responses to improve circulation just make the issue worse.

The body, in its attempt to restore normal volume of circulation, increases the heart rate (which decreases the amount of blood flow from each beat), increases the strength of contraction (increases oxygen requirements for the heart muscle), constricts the vessels trying to increase the pressure in the system, and directs the kidneys to retain sodium which will increase the volume in the circulatory system. Each of these actions, well intended, result in further degradation of circulation to the organs and tissues.

Patients, trying to compensate for decreased blood flow from the heart, (CHF) experience shortness of breath at rest; increased shortness of breath lying down due to water in the lungs; increased fatigue; decreased exercise tolerance (going up stairs very difficult), weight gain from increased water and ankle edema. As these get worse, the patient needs emergent intervention to provide adequate circulation to the organs and tissues.

So, if we can’t fix it, we must prevent it from occurring. As with obstructive coronary artery disease, prevention is the key to avoiding the miserable life of living with CHF.

Coronary Artery Disease, obstruction of the arteries feeding the heart, is the leading cause of heart attacks. Death of a segment of tissue in the heart decreases the ability of the heart to pump adequately and meet the metabolic needs of the organs and tissues. (See the Blog on CAD.)

Hypertension will result in a geometry change in the heart. As mentioned earlier, the body’s ability to compensate for abnormalities is far from sustaining so we must prevent the impact of hypertension (See Blog on Hypertension). When the pressures in the vascular system and the pressures within the heart increase the body will respond by becoming thicker (hypertrophic cardiomyopathy) or by dilating (dilated cardiomyopathy) and become very thin. Each of these compensatory mechanisms for increased pressure in the heart will permanently change the geometry of the heart and further impede the heart’s ability to pump adequately.

The primary treatment is to AVOID decreasing the pumping actions of the heart. Once someone has had a heart attack, or has had sustained hypertension that has compromised the heart’s output, healthcare providers work at stopping the compensatory mechanisms that are listed above.

A patient will usually be given supplemental oxygen. Medications are employed to reduce the circulating volume. Life style changes are needed in reducing salt in foods that can aggravate fluid retention and hypertension. Restaurants use salt and seasonings to make food taste better; soups, ketchup, and soy sauce and pickles contain clandestine salt.

Medications in the class of ACE inhibitors/ ARB’s (angiotensin blocking agents) and calcium channel blockers help relax the vessel to prevent further damage to the circulatory system.

The key is prevention of a disease we can’t adequately treat.

W. Lane Edwards, Jr. 1-28-22

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