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Congestive Heart Failure (CHF)

heart and stethoscope

What is congestive heart failure?
Congestive heart failure (CHF) is a very serious heart condition in which the heart cannot pump enough blood to meet the body’s circulatory needs. Even though the condition typically worsens over time, it is possible to live with the disease for many years.

What are the symptoms of congestive heart failure?
As a result of congestive heart failure, fluid may collect in the lower legs, causing swelling, or in the lungs, causing shortness of breath. Other symptoms may include:

  • Fatigue and weakness, particularly during physical exertion as a result of insufficient oxygen reaching the muscles.
  • Swelling in the lower extremities. If the right side of the heart is affected, fluid builds up in the feet, ankles and legs. Left-sided heart insufficiency can cause fluid retention in the lungs, leading to shortness of breath.
  • Wheezing, or in severe cases the coughing up of pinkish phlegm.
  • Dizzy spells.
  • Rapid weight gain due to fluid retention
  • Loss of appetite
  • Need to urinate at night
  • Waking up after a few hours of sleep due to shortness of breath

What are the causes of congestive heart failure?
 CHF can stem from any condition that leads to a change in the heart’s pumping power including damage to the heart muscle as a result of a heart attack, or thickening and hardening of the heart muscle as a result of longstanding high blood pressure, diabetes, or improperly functioning heart valves. When it is constantly overworked, the heart becomes larger and thicker than normal - as would any muscle that is consistently exercised beyond its normal workload.  These changes compromise the heart's efficiency over time. Conditions that can contribute to congestive heart failure include diabetes, an overactive or underactive thyroid, emphysema, a viral or bacterial infection in the heart muscle, morbid obesity, high blood pressure and/or damaged heart valves.   

How is congestive heart failure diagnosed?
Doctors look for signs such as rapid or strained breathing, an irregular or rapid heartbeat, abnormal heart sounds, swollen legs, distended neck veins, abnormal sounds from fluid buildup in the lungs heard via a stethoscope, and swelling of the liver.

Tests commonly obtained to determine the presence of congestive heart failure include an electrocardiogram, a chest x-ray and an echocardiogram, which uses sound waves to create a detailed moving picture of the heart. Other diagnostic tests may include a cardiac stress test, heart catheterization, which involves passing a thin, flexible tube into the right or left side of the heart, usually from the groin or the arm; an MRI of the heart (here, powerful magnets and radio waves create pictures of the heart); and nuclear heart scans, non-invasive tests in which radioactive tracers are used to illuminate changes in the heart. Blood tests can help determine whether damage to heart muscle has occurred, detect how well the kidneys are functioning, determine whether a person is anemic, and assess sodium and potassium levels as well as brain natriuretic peptide (BNP), a substance secreted by the lower chambers of the heart in response to the development or worsening of heart failure.

What is the conventional treatment for congestive heart failure?
Need to decide if we want to mention pulmonary edema, where CHF has gotten so bad that fluid has built up to a dangerous point in the lungs requiring urgent / emergent intervention.

The most important thing that can be done for heart failure is prevent it in the first place by following healthy diet and lifestyle measures throughout your life. Treatment of established congestive heart failure focuses on keeping the disease from worsening. This means controlling blood pressure via lifestyle measures such as diet and exercise, or with medication if diet and exercise don’t help. Drugs may be prescribed to slow the progression of the disease by improving the heart’s ability to pump blood, decreasing stress on the heart and preventing fluid retention (which can lead to pulmonary edema, a condition in which fluid retention in the lungs has become so severe that emergency intervention is required). These medications may include ACE-inhibitors, beta blockers, digoxin, diuretics and, if needed, anticoagulants to thin the blood. Individuals with heart failure should avoid taking non-steroidal anti-inflammatory drugs, most antiarrhythmic agents unless absolutely necessary (often used to help correct abnormalities in the rhythm and rate of the heartbeat), most calcium antagonists, decongestants (they make the heart work harder) and antacids containing sodium, which can cause fluid retention.

What therapies does Dr. Weil recommend for congestive heart failure?
Dr. Weil emphasizes the preventive importance of dietary changes to control obesity and diabetes, both of which are linked to the development of congestive heart failure. He advises consulting a nutritionist to develop a diet designed for individual situations and also recommends the following measures:

  • If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system.
  • Avoid salt. Sodium promotes fluid retention. Avoid high-sodium foods, heavily processed foods and unnecessary salt.
  • Take your prescribed medication. Diuretics ("water pills"), beta blockers, digoxin and others can reduce stress on the heart and make it work more efficiently.
  • Check other meds. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking.
  • Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems.
  • Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the heart work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath exercise can improve the oxygenation of blood and take workload off the heart.

Nutrition and Supplements
If you are coping with, or are at risk of congestive heart failure, Dr. Weil suggests trying the following supplements:

  • Coenzyme Q10 (CoQ10). This powerful antioxidant has been shown to benefit heart health by supporting the metabolism of the mitochondria in the heart cells, which is where energy for muscular action is created. CoQ10 is very important for the heart cells of patients with heart failure. It may also help lower blood pressure. Caution is advised for people taking the blood-thinning agent Coumadin / warfarin.
  • L-Carnitine. This amino acid is essential for energy metabolism in  heart muscle cells.
  • Hawthorn. This herb acts a little like digoxin, may increase heart-muscle strength and also provides a mild diuretic effect.

Dr. Weil recommends discussing the use of any supplement with your doctor so that your prescription drug dosages can be adjusted, if necessary, as these other measures take effect.

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