Heart failure: How to diagnose and treat it

Injil Abu Bakar, General practitioner, Boston, Massachusetts

Heart failure is a condition that affects nearly five million Americans of all ages and is responsible for more hospitalizations than all forms of cancer combined.

Over 400,000 new cases of heart failure are estimated to be diagnosed in 2002. Yet many people with heart failure are not aware they have it because some of the most common symptoms, such as feeling tired and being short of breath, are often mistaken for normal signs of aging. Also, people may try to avoid symptoms by making lifestyle changes such as taking the elevator instead of the stairs, sleeping with an extra pillow, or cutting back on their favorite sports.

What is heart failure?

Despite the way it sounds, heart failure does not mean that the heart suddenly stops working, or that a person who has it is in immediate danger.

Heart failure is a common condition that usually develops slowly as the heart muscle weakens and needs to work harder to keep blood flowing through the body. Heart failure develops following injury to the heart such as:

* Damage caused by a heart attack

* Long-term high blood pressure

* Faulty heart valves

* Cardiomyopathy (damage to the heart by a virus or a drug such as alcohol).

A weakened heart muscle is often not recognized until a more advanced stage of heart failure is diagnosed. It is commonly called "congestive heart failure" and may occur as fluid in the lungs, the swelling of feet, legs and in some cases the liver or abdomen.

Symptoms that may mean you have heart failure:

Heart failure can be difficult to diagnose because symptoms may be mild and are often mistaken for normal signs of aging. If you have any of these symptoms or face any of these risk factors, please tell your doctor.

* Breathing difficulties: 1. Shortness of breath (dyspnea) from climbing stairs or performing simple activities. 2. Trouble breathing when resting or lying down. 3. Waking up breathless at night (paroxysmal nocturnal dyspnea). 4. Needing more than your usual number of pillows to sleep. (orthopnea).

* Fatigue/Exercise Intolerance: 1. Tiring easily (this is usually the first indication that "something" may be wrong). 2. Swelling (edema) of feet, ankles or legs. 3. General feeling of fatigue.

* Coughing : 1. Frequent coughing. 2. Coughing that produces mucus or pink, blood tinged sputum. 3. Dry, hacking cough when lying flat in bed.

How is heart failure diagnosed?

Only your doctor can tell you if you have heart failure. When you visit the doctor, they should review your medical history and do a full physical examination. Your doctor may order tests.

The most important of these is an echocardiogram, a sound wave test that measures the condition of your heart. This is often measured as the ejection fraction, or "EF". EF is the fraction (portion) of blood in your heart that is pumped out with each beat.

The ejection fraction (EF) is a measurement of how well your heart is pumping. People with a healthy heart usually have an EF of 55 percent or more. Most people with heart failure (but not all), have an EF of 40 percent or less. Some people have heart failure with a "normal EF". It is helpful to know your EF.

How is heart failure treated?

There is no cure for heart failure, but early diagnosis and proper treatment can significantly slow down the disease process, keep you out of the hospital, and certainly save your life!

What are the treatments for heart failure?

Taking medication is an important part of your treatment plan. Medications work to prevent and relieve symptoms and may help your heart pump more effectively.

* ACE Inhibitors

Purpose: To open up the arteries and make it easier for the heart to pump. This class of medication helps to lower the likelihood of death from heart failure.

Possible side effects: May include coughing, dizziness, loss of taste, fever, skin rash and sore throat. The doctor may have to increase or decrease the amount of medication to get the desired dose. Achieving this may take several weeks.

* Diuretics

Purpose: To make the patient urinate more often so fluids do not collect in the legs, feet, ankles and abdomen. Getting rid of fluid makes it easier for the heart to pump.

Possible side effects: May include leg cramps, dizziness, accidental leakage of urine and skin rash. Diuretics can also wash potassium out of the body and potassium levels need to be monitored by blood tests.

* Beta Blockers:

Purpose: To protect the heart from further damage. Beta blockers help lower blood pressure and slow the heart rate. They may also improve the heart's pumping action.

Possible side effects: May include fatigue until the body gets used to this medication. The doctor may have to increase or decrease the amount of medication to get the desired dose. Achieving this could take several weeks.

* Digoxin (Digitalis)

Purpose: To make the heartbeat stronger and more regular.

Possible side effects: May include nausea, loss of appetite, blurred vision, mental confusion and irregular heartbeat. It may also slow your pulse. Tell your doctor right away if you have any of these side effects.

* Vasodilators (Hydralazine)

Purpose: To open up the arteries and make it easier for the heart to pump. ACE inhibitors are one type of vasodilators.

Possible side effects: May include headache that lessens as time goes on, as well as lightheadedness.

* Potassium Supplements

Purpose: To replace potassium that may be lost by taking diuretics. You may also need to eat food that is high in potassium.

Possible side effects: May include irritation of the stomach and intestines.

Food high in potassium include: Potatoes, sweet potatoes, spinach, Swiss chard, broccoli, winter squashes, parsnips, milk, yogurt, dry beans, peas, lentils, dates, bananas, cantaloupes, mangoes, plantains, dried apricots, raisins, prunes, orange juice, grapefruit juice.