Managing Heart Failure

Managing Heart Failure

I would like to take some time in this video to explain a medical condition called congestive heart failure.



This is actually not one condition alone, but rather an end result of a few different disease processes. Most people with congestive heart failure are likely to have a history of heart disease, high blood pressure, or atrial fibrillation - though there are a number of other causes as well.



Heart failure sounds like a terrible diagnosis, but in reality most cases can be managed in a way that can keep a person living every bit as long as those around them. To be honest, a better term for this would probably be something like “heart weakness”. So, to understand what is going on here, I’ll first explain how the heart normally works:

Think of the heart as a pump. Any well-functioning pump requires a successful filling stage and then an ejection phase: an ideal pump will fill and empty with a regular rhythm. If there’s a problem with the filling or emptying phase of the pump, there can be a backlog (in the heart’s case this would be a backlog of blood that does not get circulated throughout the body efficiently). That backlog of blood squeezes out into the tissues as extra fluid and can accumulate in several different places in the body, but the two most common types of congestion happen in the lungs and in the lower legs.

If the left side of the heart cannot keep up, fluid would accumulate in the lungs, whereas fluid would accumulate in the legs if it’s the right side of the heart that’s not pumping blood efficiently.

Why does this happen? Well, a heart that has lost some of its flexibility or stretch will become stiff and therefore may not fill properly. Or, a heart that beats too fast may not be allowing enough time to fill properly, and that reduces the amount that can get pumped out. It’s also common that after heart muscle gets damaged or stretched out, the actual strength of the heart is insufficient to empty the heart as much as before, leading to backlog.

Ordinarily, if the body accumulated fluid the kidneys would get rid of that extra fluid. However, with heart failure the kidneys often do not do what’s best for you (due to a hormonal misunderstanding between the heart and the kidneys) and instead contribute to fluid being retained.

The point here is not necessarily to get your blood pressure and heart rate below a certain number, though that is part of it, but to make sure we can get you at what are called “target doses” of these medications: doses that have been shown to prolong life and reduce the risk of you having to go to the hospital. But it is difficult for us to recommend using these medications, and/or increasing them, when we do not know what your blood pressure and heart rate is doing.

Given that, for some of us, accumulated fluid in the legs or in the chest is not obviously noticeable, one of the most sensitive ways to figure out whether or not you are accumulating fluid is simply by hopping on a scale every day. If you gain or lose 5 or 10 pounds over a few months, that could very well be related to eating too much or not exercising enough. But gaining 3 to 5 pounds or more in as many days will usually indicate a fluid change, and this should be addressed quickly. So, you should always let us know ASAP if you change weight that fast.

The medications that we commonly use to treat heart failure include beta-blockers, ACE inhibitors or ARB’s, and water pills like spironolactone or furosemide. I will get into how and why each of these is used, but I do first want to talk about how you can monitor the situation to help keep things under control.

All of the medications used to treat heart failure affect your blood pressure, and some of them affect your heart rate, so knowing your typical and recent blood pressure and heart rate is essential for allowing us to adjust your medication.

It’s helpful to know some of the different medications for congestive heart failure, and how they work:

Beta-blockers like metoprolol and bisoprolol help the heart pump slower, which gives it more time to fill, and helps it work more efficiently and effortlessly than would be possible if it were going too fast. It’s not unusual for us to aim for heart rates below 50.

ACE inhibitors like ramipril or perindopril, or ARB’s like irbesartan or candesartan, help the heart and kidneys work better together (as the communication system between these important organs sometimes gets mixed up) and also lower blood pressure: all of which helps improve the effectiveness of the heart.

Diuretics like spironolactone help the kidneys manage salt and fluids better over the long run, while a diuretic like furosemide is often used to get rid of excess fluid when the above medications happen to not be working very well (either temporarily, or sometimes long-term).

Content

Source: https://www.youtube.com/watch?v=-47EUVcET6E