In the course of an average lifetime, the heart beats an estimated three billion times. Over the years, this labor produces some wear-and-tear changes in the heart's structure. But such changes--which come with normal aging--are quite different from congestive heart failure. Heart failure--a breakdown in the heart's ability to pump blood--is usually produced by disease. While it occasionally occurs suddenly, it more typically emerges slowly and insidiously over time. As the heart fails, circulation becomes impaired, producing a succession of increasingly painful and often disabling symptoms, which are highly treatable, but can result in death if uncorrected.
Causes of Congestive Heart Failure
The normal heart is usually able to meet any temporary extra demand by simply beating faster and more vigorously. Jogging, swimming and other physical exercise, for example, create extra burdens that any healthy heart can respond to immediately and with ease. The danger arises when a burden becomes continuous or excessive, as in cases of sustained high blood pressure (hypertension), where the effort to keep pushing blood through inelastic blood vessels so overtaxes the heart that it begins to fail. Any local insult to the muscle of the heart, such as would result from a blockage in a coronary artery (a heart attack), can weaken the strength of the heart's contraction and thus produce heart failure. Heart failure can also result from damage or a structural change in one of the heart valves, which may have been caused by rheumatic fever or a bacterial infection and may lead to internal obstruction or to valvular leakage. Even disorders that are not directly related to cardiac function can result in heart failure. A case in point is severe anemia, a problem that decreases the blood's oxygen supply and may dangerously overwork the heart by forcing it to circulate under-oxygenated blood around the body at an increasingly exhausting pace. Severe vitamin B deficiency has also been implicated in heart failure, as has a hyperactive thyroid. In an already weakened heart, chronic infection with recurrent fever may also produce heart failure.
Symptoms of Congestive Heart Failure
As the heart's pumping action grows weaker, blood no longer circulates in an adequate flow to the body's major systems. The result is a series of increasingly debilitating symptoms, many of which seem to have little to do with heart disease. Some problems originate in the brain, where the body's respiratory centers, lacking adequate oxygen, begin malfunctioning. The kidneys, too, may no longer effectively filter excess fluid out of the blood. Or the fault may be with the damaged heart itself, which is unable to move the now increasingly waterlogged blood at its usual brisk pace through the circulatory system. Consequently, the water begins backing up into the lungs, liver and tissues of other organs, producing one of the most telltale signs of heart failure--congestion. This is why physicians often refer to the disorder as congestive heart failure. Its most common symptoms include:
Shortness of breath. Medically, this symptom is known as dyspnea, and it is often the earliest warning signal of heart failure. Usually, it appears gradually. In fact, the patient rarely notices it, until the first time he is left breathless by climbing a flight of stairs or must stop at the end of a short walk to catch his breath.
Rapid heartbeat. At about the same time, he may also notice that his heart occasionally beats very rapidly. This is called tachycardia; it is another early symptom of heart failure, and it occurs because the overtaxed cardiac muscle attempts to compensate for its inability to pump the normal amounts of blood per beat by beating more frequently.
Swelling. Caused by the buildup of fluids, this symptom announces itself by an unexpected and seemingly unaccountable weight gain of 5, 10 or 15 pounds. Usually, the ankles are the first place the swelling shows up; typically, they become puffy and bloated during the day, then return to normal with sleep. As the swelling increases, excess weight may also become noticeable on the arms and legs.
Nocturnal breathlessness. This occurs in two forms, both of which are associated with the later stages of heart failure. The less serious and less dramatic type is related to sleep position: If a person lies flat on a bed with only a single pillow, he may awake coughing and choking. Far more terrifying, however, is to be awakened by a feeling of imminent suffocation. Known as paroxysmal nocturnal dyspnea, this sensation is usually accompanied by a racing pulse, and it may last anywhere from a few minutes to an hour or more.
Treatment of Congestive Heart Failure
As with most disorders, the earlier that congestive heart failure is diagnosed, the more likely treatment will succeed. This is why it is important to be able to spot the first signs of the disorder and to seek prompt medical attention when they appear. More than likely, your doctor will recommend on or more of the following steps.
A complete physical. Often, the most effective way to treat congestive heart failure is to treat its underlying cause, and the chief purpose of a thorough examination is to identify that cause. If the cause is high blood pressure, for example, lowering it will almost automatically make the heart failure more amenable to treatment. On the other hand, if the underlying problem is a heart attack, bed rest and a program of coronary care may be instituted.
Drugs. An effective treatment of progressive heart failure is a drug called digitalis. When given in small doses, digitalis not only slows the heart's rate but also increases the force of each beat, so that each of these beats can move more blood. In certain cases, nitroglycerin may also be prescribed to ease the discomfort. New vasodilator drugs to widen the blood vessels are also increasingly used for easing the load on a failing heart. Diuretics are used to reduce fluid retention.
Life-style factors. When appropriate, a physician may also recommend weight loss, suggest that salt intake be restricted since it promotes water retention and urge that the individual rest frequently during the day.
Summing Up
Congestive heart failure--related to a relative breakdown in the heart's ability to pump blood--is a highly treatable condition when its symptoms are recognized promptly and brought to a physician's attention. In most cases of early detection, it is a reversible syndrome that can be improved with proper treatment and life-style adjustments.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
