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Heart Failure

What is this condition?

In heart failure, the heart cannot pump enough blood to meet the body's needs. Usually, failure occurs in the left ventricle (the heart's main working chamber). But sometimes the right ventricle fails­either on its own or as a result of left-sided failure. Sometimes, both sides fail at the same time.

Although heart failure may be acute if it's caused by a heart attack, it's generally a chronic disorder associated with sodium and water retention by the kidneys.

New diagnostic tests and treatments have greatly improved the outlook for people with heart failure. But the prognosis still depends on the underlying cause and how it responds to treatment.

How heart failure progresses

When the left ventricle doesn't pump enough blood, compensatory mechanisms kick in to make sure that vital organs get enough blood. For example, the heartbeat grows stronger and faster, blood pressure rises, and venous return and blood volume increase.

But as left-sided failure worsens, these mechanisms fail. The left ventricle then enlarges and starts to malfunction, allowing blood to pool in the ventricle and another heart chamber, the atrium. Eventually, sodium and water enter the lungs, causing a buildup of fluid there known as pulmonary edema, a life-threatening emergency.

What causes it?

Causes of heart failure include:

.  abnormality of the heart muscle, as occurs in a heart attack

. too little blood flow to the heart due to hardening of the arteries or disease of the heart muscle

. mechanical disturbances that impede filling of the ventricle (for instance, narrowing of a heart valve due to rheumatic heart disease or another heart disorder)

. disturbances in blood circulation that impair the heart's pumping ability (such as excessive workload from too much blood volume or pressure).

What are its symptoms?

Left-sided heart failure primarily causes respiratory symptoms; right­sided heart failure causes symptoms throughout the body. However, heart failure often affects both sides of the heart.

Symptoms of left-sided heart failure include shortness of breath, difficulty breathing except when upright, wheezing, coughing, oxygen shortage in the body, pale or bluish skin, palpitations, irregular heart rhythm, and increased blood pressure.

Symptoms of right-sided heart failure include swollen legs, liver and spleen enlargement, swollen neck veins, fluid buildup in the stomach, a swollen abdomen, slow weight gain, irregular heart rhythm, nausea, vomiting, appetite loss, weakness, fatigue, dizziness, and fainting episodes.

How is it diagnosed?

To diagnose heart failure, the doctor orders an electrocardiogram and a chest X-ray. The electrocardiogram usually reveals heart strain, an enlarged heart, or poor blood supply to the heart. It may also indicate an enlarged atrium, a fast heart rate, and premature heartbeats. A chest X-ray may show an enlarged heart, swelling of the space between tissues, and other characteristic findings.

To monitor the person's status, the doctor usually inserts a thin, hollow tube through the heart and into the pulmonary artery to monitor various pressures.

How is it treated?

The aim of treatment is to make the heart pump more effectively. To do this, the doctor tries to reverse the compensatory mechanisms that are causing the symptoms. To control heart failure quickly, the doctor may use the following treatments:

. diuretics (drugs that increase urine formation and excretion) to re­duce total blood volume and relieve congestion in the circulation

.  prolonged bed rest to rest the heart

.  Lanoxin to strengthen the heart's contractions

.  drugs that increase the heart's pumping capacity

. elastic support stockings to improve blood flow and prevent blood clots in leg veins.

What can a person with heart failure do?

. Avoid foods high in salt (sodium).

. Take Lanoxin exactly as prescribed. Watch for and immediately report signs of toxicity, such as appetite loss, vomiting, and yellow vision.

. If you're taking a potassiumlosing diuretic, be sure to take a prescribed potassium supplement and eat high-potassium foods, such as bananas, apricots, and orange juice.

. Notify the doctor promptly if your pulse is unusually irregular or drops below 60 beats per minute, or if you experience dizziness, shortness of breath (especially at night), blurred vision, a nagging dry cough, palpitations, increased fatigue, swollen ankles, decreased urine output, or a rapid weight gain (3 to 5 pounds [1.35 to 2.25 kilograms] in a week).

. Get regular medical checkups.

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