John Everett, MD, Cardiologist, Heart Clinics Northwest
My doctor told me I have congestive heart failure, what do I do now?
When a doctor tells a patient they have congestive heart failure (CHF) oftentimes that patient assumes it is due to a weak heart resulting from a heart attack, or some other condition that attacked or weakened the heart muscle. Sadly, once they have a diagnosis of CHF, many people also assume that their life is nearly over. Some believe they’ll be too weak to do anything during the time they have left. Both of these assumptions are frequently wrong.
A weak heart, which contracts poorly, is the most common form of CHF in younger patients. However, for elderly patients diagnosed with CHF, 50 percent of them have normal or even super-normal squeezing function of their hearts. The heart failure is not due to the squeeze function being weak, but it is due to the heart being stiff and unable to relax. A well-functioning heart has to quickly relax in order to fill up with blood for the next cardiac cycle.
When the heart is stiff, it is like a brand new party balloon that was really hard to blow up the very first time it was used. Just as it was difficult to fill the brand-new party balloon with air, it is difficult to fill the stiff heart with blood. Unlike a party balloon, a stiff heart does not loosen up over time. Eventually, the stiffness in the heart becomes so bad; the blood will back up behind the heart, into the lungs and cause congestive heart failure.
Figuring out which type of heart failure a patient has is difficult. Usually, a patient with CHF gets an ultrasound of their heart which helps determine what type of heart failure is present. An echocardiogram will also help determine the next steps in the diagnosis of what caused the CHF and the best medical therapy to treat it.
Regardless of whether heart failure is due to a heart being weak and unable to squeeze properly, or the CHF is due to the heart being stiff, the treatment goals are the same: patients need to be compliant with medications, limit their fluid and sodium intake and keep track of their weight.
Total fluid consumption of any kind (not just water) should be limited to 8 to 10 cups per day. Salt consumption should be limited to less than 2,000 mg, and patients should weigh themselves several days per week. An abrupt weight gain of 2 or 3 pounds is often a sign of congestive heart failure developing, and if treated early you may avoid hospitalization.
Restricting fluid consumption will help prevent shortness of breath at night, and swelling. Properly prescribed medications can help restore heart function if heart function is weak, and may potentially help improve the stiffness in CHF patients with normal squeeze function. With medication compliance, watching fluid and salt intake, and looking for signs early signs of fluid retention by using a scale at least several days per week, most patients with congestive heart can live a long time with good quality of life.
