Signs and Symptoms of Congestive Heart Failure [Dr. Cathy Leadabrand]

Congestive heart failure, it sounds like a scary term, but it's more just a condition where the heart is not pumping blood like it should.

What signs and symptoms indicate congestive heart failure?

People who have heart failure often will come in and say, "I've just gotten much more short of breath. It's a lot harder to take out the garbage or climb the stairs, and then getting winded." They might have to sleep with more pillows at night because it's harder to breathe when they lay flat. Often, they'll notice that they're not eating more, but they're gaining weight and might notice that their legs are swelling. Some other times, they'll come in with an irregular heart rhythm. Other times, if a heart attack or poor blood flow, the heart is the cause of the failure, they might be having some chest pain or anginal type symptoms.

How is congestive heart failure diagnosed?

A lot of the diagnoses are evident from just talking to a patient and getting a good history. So we ask them questions, sometimes their family will help fill in. Then our exam gives lots of clues. You look for are the veins in the neck swollen? Do you hear fluid in the lungs? How is the heart beating? Is it enlarged? Is there a lot of swelling in the legs? And then you start to do testing such as a chest X-ray that might show that fluid or a heart tracing, an EKG. But probably the gold standard would be an ultrasound of the heart or what we call an echocardiogram, where you sound waves to see how well the chambers are pumping. And you can get an idea of the blood that's in the chamber, in the main chamber, the left side, how much of that is pumped forward.

Who is at risk?

Smokers can be at risk, people with diabetes are at risk. Some of the ones that we don't always realize are people who drink a lot of alcohol because we know that alcohol harms the liver, but it often can harm the heart too. Another one that gets missed often is the sleep apnea. If you have sleep apnea, the pressure in your lungs increases, so that puts a lot of pressure on the heart. That can cause certain types of heart failure. Viruses can damage the heart. So, another risk factor would be high blood pressure. That's a biggie. And then people with high cholesterol who get narrowing of the arteries that supply blood to the heart, that's a big risk factor. And then family history can certainly contribute too.

Can congestive heart failure be reversed?

Often, once you have congestive heart failure, it can't be completely reversed, but it can be very well controlled. And when it's due to alcohol, it sometimes will fully reverse. Sometimes if a person has a viral type of heart failure, it will reverse. People with heart attacks that have damaged the muscle, that muscle doesn't become undamaged. So, they'll often have some permanent decrease, but if they control their risk factors, some of the injured muscle can heal. And so, it can always improve. And then there's all sorts of medicines we can give to try to optimize the function.

What are the best prevention methods?

You have to look at the factors that are beyond your control and then try to control the ones you can. So, certainly, minimizing or stopping smoking, minimizing alcohol, following a healthy diet and keeping weight down because that's a risk factor for sleep apnea and for high blood pressure. And so by treating obesity and controlling your blood pressure, treating sleep apnea, those are all things you can do. Exercising strengthens the heart muscle too, so that's a big important part.

What treatments are available?

The people in the hospital are often quite ill and often are struggling to breathe, and maybe have severe swelling. So, a big part of it is trying to get some of that fluid moved out and that's usually with what we call a diuretic or a water pill, and we give it often through the IV in the hospital. So, that's sort of the bandaid, though. That helps get the fluid off, but the real bang is in the medications that will help optimize the heart functions.

A big part is addressing the risk factors. While they're in the hospital, we try to educate about that, such as quitting smoking. We often will check cholesterol and add medication to get that down. If the diabetes is under control, we will try to address that. Many people present with heart failure don't realize they had diabetes. So, that's often something we diagnose in people that come in with that. And then high blood pressure, trying to get that to safer ranges that don't put so much strain on the heart.

How is congestive heart failure treated after leaving the hospital?

A big part of the treatment is just educating the patient on their disease. And there's some lifestyle and things that can really help. Diet, and limiting salt, and sometimes limiting fluid intake can help. They often need to help weigh themselves and monitor that.

And then many people in the hospital will be introduced to cardiac rehab representatives and that's an excellent program where it helps in a supervised setting where you can monitor patients' heart rhythm and their symptoms. You can exercise, and the hospital has a facility where they can walk and use exercise equipment and at the same time, that education is reinforced. So, that's a big thing that after people leave the hospital often is encouraged and including following up with their doctor, but can really help them feel better and have more quality of life.

What goals must congestive heart failure patients reach before leaving the hospital?

If their oxygen was low because of the heart failure exacerbation, we usually try to have them improved to the point where they're not needing oxygen anymore. We want to get their fluid... If they're not at what we call their dry weight or the weight where they don't have a lot of excess fluid, at least they're going in the right direction. And they're doing that on oral pills that will help to continue as they get out of the hospital, help them improve. We want them to be strong enough to be able to take care of themselves and get around the house at least to meet their needs and to generally be not in pain or struggling to breathe.

Why should patients choose Brookings Health System?

Brookings has an amazing team of people that their main goal is for the patient to get better, feel better, and have a great quality of life.