Evaluation and Management
What is Congestive Heart Failure?
Congestive heart failure (CHF) describes the inability of the heart to adequately pump blood, to meet the demands of the body. The most common symptom of heart failure is shortness of breath. With mild heart failure, shortness of breath occurs almost exclusively with exertion. As heart failure worsens, the shortness of breath occurs at lower levels of activity, or even at rest. In severe cases of CHF, the heart muscle function deteriorates so badly that fluid backs up into the lungs, creating a life-threatening condition called pulmonary edema.
Who Gets Congestive Heart Failure?
The most common cause of heart failure is damage to the heart from a heart attack. Other causes are also common – severe untreated high blood pressure, blocked or leaking heart valves, or damage to the heart from a viral infection.
How is Congestive Heart Failure Treated?
Excellent medications are available for heart failure. Patients with severe heart failure and symptoms that do not respond to medications are evaluated for a device to assist the heart in its role of pumping blood throughout the body.
Finally, there is the treatment of heart transplantation. However, there are nearly 6 million Americans with heart failure. The lack of donors limits transplantation to only a fraction of those patients with CHF. A surgically implanted mechanical device – that can take over the pumping function of the heart – called a Left Ventricular Assist Device (LVAD), is sometimes used to support sick patients until a donor heart becomes available. Increasingly, LVADs are now being used for patients who are not eligible for a heart transplant.
How can Congestive Heart Failure be Monitored?
CardioMEMS™ is a miniaturized, wireless monitoring sensor allowing us to successfully manage both patients with advanced heart failure — who already have a device implanted — and those heart failure patients who are unable to have a defibrillator or pacemaker. The minimally invasive low-risk procedure will allow patients to return home and once a day perform a five-minute computerized test. The data is sent to Deborah, and the team can monitor daily pulmonary artery pressure, which is an early indicator of worsening heart failure.
Are There Other Risks Associated with Congestive Heart Failure?
Individuals with CHF are at significant risk for abnormal heart rhythms, some of which can be fatal. More than half the deaths of patients with CHF are sudden – the result of a serious heart rhythm disturbance called ventricular fibrillation. While medication can lower the risk of ventricular fibrillation, the only effective treatment when it occurs is an electrical shock to the heart: defibrillation. An implantable cardioverter defibrillator (ICD), a device similar to a pacemaker, is often recommended for patients with CHF.
How can Heart Failure Treatment be Improved?
A significant gap exists in the treatment of patients with heart failure. Appropriate medication is prescribed in less than 75% of patients hospitalized with heart failure at the time of discharge. Even fewer receive the appropriate combination of medications at the doses shown to prevent repeat hospitalization and reduce the risk of death. Fewer patients still receive pacemakers to improve their heart’s pumping capacity or potentially life-saving treatment with a device that can shock the heart out of a life-threatening heart rhythm such as an ICD.
What can Deborah Heart and Lung Center Offer Me?
Deborah Heart and Lung Center provides comprehensive care to patients with all forms of heart failure. Our comprehensive team approach can treat patients with even the most advanced forms of congestive heart failure. Since so few patients with heart failure can be offered heart transplantation, the specialists at Deborah strive to maximize heart performance and minimize risk, using medications and specialized implanted devices. This is a unique approach to the management of heart failure and is not offered in such a coordinated fashion in most other hospitals and medical centers.
Patients with heart failure should know that with the right medications, their symptoms can improve. Over time, their physical function can significantly increase as well. With the appropriate medications and device therapy, patients can increase their activities of daily living and rest assured that they are protected from serious cardiac arrhythmias.