Priming the Pump Upcoming HMC Program to Focus on Congestive Heart Failure

Congestive heart failure affects about 5 million Americans, and some 550,000 people are diagnosed with the condition each year. But with a wide range of possible symptoms, often very different from one patient to the next, how does someone know when to get checked for CHF?

That question, and many more about congestive heart failure, will be addressed on Tuesday, Feb. 16 at an informational program about the condition at Holyoke Medical Center. The free event will begin at 6 p.m. in the hospital’s Auxiliary Conference Center.

“Basically, congestive heart failure is increased pressure in the lungs because the heart is not able to do its job, whether it’s the heart not being able to pump or the heart not being able to relax itself,” said Dr. Nitin Bhatnagar, a cardiologist with Hampden County Cardiovascular Associates. Bhatnagar’s partner in the practice, Dr. Nirav Sheth, will lead the informational program.

CHF is a condition in which the heart can’t pump enough blood to the body’s other organs. According to the American Heart Assoc. (AHA), this can result from:

• coronary artery disease, or narrowed arteries that supply blood to the heart muscle;
• a past heart attack, which causes scar tissue that interferes with the heart muscle’s normal work;
• high blood pressure;
• heart valve disease due to past rheumatic fever or other causes;
• cardiomyopathy, a primary disease of the heart muscle itself;
• congenital heart defects present from birth; or
• endocarditis or myocarditis, an infection of the heart valves or heart muscle.

With CHF, the heart keeps working, but not as efficiently as it should. People with heart failure can’t exert themselves because they easily become short of breath and tired.

Meanwhile, as blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. This can cause swelling, often in the legs and ankles, but sometimes in other parts of the body. Fluid may also collect in the lungs and interfere with breathing.

Some of the long-term effects can include shortness of breath, increased weight gain, decreased level of activity, an inability to breathe properly when lying flat, and waking up at night with shortness of breath. The condition can, in turn, lead to high blood pressure, heart attacks, and valvular heart disease, as well as increasing the risk of sleep apnea, atrial fibrillation, and hypertension.

In the Flow

Although heart failure can strike any age group, it’s relatively uncommon under age 50, and is primarily a condition of the elderly. In fact, about 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of people age 75 or older suffer from it, with women’s cases slightly surpassing men among that age bracket.

When the heart can’t keep up with its workload, it tries to make up for this in one of several ways. The heart chamber might enlarge, stretching more and contracting more strongly, so it pumps more blood. The heart might develop more muscle mass because the contracting cells of the heart get bigger, allowing the heart to pump more strongly, at least initially. Or the heart might just pump faster, helping to increase its output.

The body also tries to compensate in other ways. Blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power. Meanwhile, the body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the heart and brain.

According to the AHA, these temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these substitute processes no longer work. Eventually the heart and body can no longer keep up, and the person begins to experience the fatigue, breathing problems, and other symptoms that prompt a trip to the doctor.

These natural compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline — a good reason to stay up to date with regular checkups with one’s doctor.

Depending on the specific cause and symptoms of each case, the AHA notes, congestive heart failure usually requires a treatment program involving rest, proper diet, and modified daily activities.

Various drugs are also used to treat congestive heart failure, each option performing different functions.

For example, angiotensin-converting enzyme (ACE) inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficient. Beta blockers can improve how well the heart’s left lower chamber pumps blood. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water.

When a specific cause of congestive heart failure is discovered, doctors say, it should be treated or, if possible, corrected. For example, some cases of congestive heart failure can be treated by tackling the issue of high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced.

If the heart becomes so damaged that it can’t be repaired, a more drastic approach should be considered. A heart transplant could be an option.

“The key is to figure out the cause of the heart failure,” Bhatnagar said. “Is it because of worsening heart function or an inability of the heart to relax?

“Depending on what we diagnose, a treatment can be formulated,” he continued. “For some, it would be lifestyle changes and medications, while some require further invasive or non-invasive testing.”

Lifelong Habits

Those lifestyle changes — whether they involve diet, smoking cessation, or something else — typically need to become permanent habits to stave off a recurrence of problems related to the heart failure, Bhatnagar said.

“You can lessen the symptoms, but you must always be wary of the symptoms returning, and try to keep the patient stable,” he said. “We encourage people to eat right, do more exercise, and control their salt intake.”

Although the Feb. 16 program is presented free of charge, pre-registration is necessary and can be made by calling Holyoke Medical Center’s Health Promotion Line at (413) 534-2789.