Congestive Heart Failure: Prevention, Treatment and Research

Photo of Dr. Roger Scott Blumenthal

Congestive heart failure (also called heart failure) is a serious condition in which the heart doesn’t pump blood as efficiently as it should. Despite its name, heart failure doesn’t mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it can’t keep up with the body’s demand, and blood returns to the heart faster than it can be pumped out—it becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the body’s other organs.

The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contracts—but over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they don’t receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse.

More than 5 million people in the United States have congestive heart failure. It’s the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause.

“To avoid heart failure, there’s a need to prevent other heart problems,” says Johns Hopkins cardiologist Steven Jones, M.D.

Prevention

The best way to avoid congestive heart failure is to avoid the conditions that contribute to it, or to carefully manage these conditions if they develop, says Jones.

Diagnosis

There’s no one test to diagnose heart failure. Your doctor will consider your medical history, family history, a physical exam and the results of various tests. These tests can include:

Treatment

There’s no cure for heart failure. Treatment aims to relieve symptoms and slow further damage. TheI exact plan depends on the stage and type of heart failure, underlying conditions and the individual patient. Among the components of a treatment plan:

Lifestyle changes. These are the same changes as those for preventing heart failure. In addition, you may be advised to avoid salt (because of fluid retention) and caffeine (because of heartbeat irregularities). Your doctor will advise how much fluid and what kinds to drink, as sometimes fluid intake should be limited.

Medications. According to Jones, the types of medications typically prescribed include these:

Surgical procedures. In more severe cases, surgery is required to open or bypass blocked arteries, or to replace heart valves. Some congestive heart failure patients are candidates for a type of pacemaker called biventricular pacing therapy, which helps both sides of the heart work in concert, or an implantable cardioverter defibrillator, which shocks the heart into converting a potentially fatal fast rhythm to a normal one. Ventricular assist devices (VAD therapy) may be used as a bridge to heart transplantation or as a treatment in lieu of transplant, says Jones. A heart transplant is considered the last resort, with success rates of about 88 percent after one year and 75 percent after five years.

Other treatments. Because sleep apnea—a condition in which the muscles that allow air into the lungs briefly collapse—is linked to heart failure, you may be evaluated and treated for it.

Living With.

Here are some of the things you’ll want to do in addition to sticking to the lifestyle changes that can improve the health of a damaged heart:

Research

Johns Hopkins researchers are on the forefront of the study of congestive heart failure. Among their recent findings:

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