Heart failure, also known as congestive heart failure, is a common and chronic condition. It is usually the result of a weakened heart muscle. There are many causes of heart failure including valve problems, prior heart attack, long standing high blood pressure and many others. The general aging of the population and our success at treating acute heart emergencies such as heart attack are some of the reasons that heart failure is becoming much more common in our society. Fortunately, we are learning much about the nature and treatment of heart failure. We know of many treatments which are beneficial and many which are harmful. New drugs and other treatments are being developed which treat the complex changes that occur in this condition. By opening the first dedicated heart failure center in Bergen County, Cardiovascular Associates of Teaneck, has made a strong commitment to the best and most current care of patients with heart failure. The Center uses a multidisciplinary team approach to heart failure management. Please ask about this important program if you or someone you know may benefit from it.

The heart is a muscular pump. In fact, the heart is a double pump (a right pump and a left pump). The right pump sends blood to the lungs to pick up oxygen. The left pump sends this oxygen-rich blood to all parts of the body. By pumping blood in this way oxygen and nourishment are sent throughout the entire body.

Heart failure occurs because of a weakening of the heart muscle due to a disease of the heart or blood vessels, or due to damage to the heart muscle. The result is that the heart is less able to pump an adequate amount of blood to the various organs and tissues of the body. This means that parts of the body may not receive the flow of blood and nourishment they need to work properly.

Because the heart muscle is not strong enough to keep the blood flowing normally, the blood returning to the heart tends to back up causing "congestion" (a build up of fluid) in the tissues. Fluid can build up in many parts of the body, such as the legs, ankles and lungs.

When you have heart failure, your heart is not circulating blood to and from the tissues in your body as it should. Depending on what side of the heart is affected (the right pump or the left pump) this might result in:

Puffiness or swelling in your legs and ankles. This is called EDEMA and is the result of the build up of fluid in the lower limbs.

Difficulty in breathing or feeling short of breath. These symptoms result from a build up of fluid in the lungs.

Dizziness, tiredness or fatigue, mental confusion and difficulty sleeping (insomnia). These symptoms are due to decreased blood supply to the brain, muscles and other parts of the body.

There are several reasons why the heart muscle may become weak and not work properly.

These include:

Blood pressure which goes up and stays above the normal range is called high blood pressure (hypertension). This increased pressure causes the heart to work harder and can lead to enlargement of the left side of the heart (hypertrophy). In turn, this may result in congestive heart failure.

Coronary artery disease is a narrowing of the blood vessels leading to the heart muscle. This narrowing interferes with the normal blood flow to the heart and can lead to congestive heart failure in two ways:

the narrowing of the blood vessels to the heart reduces the amount of oxygen-rich blood the heart muscle receives. This weakens the heart and congestive heart failure may result because the pump cannot work properly.

if a blood vessel becomes completely blocked, a heart attack (myocardial infarction or coronary) may result. A heart attack usually causes damage to the heart muscle and can weaken its pumping action. This can also lead to congestive heart failure.

Valves control the forward flow of blood inside the heart. Sometimes these valves may be damaged. This results in a backward flow of blood and the heart has to work harder. Congestive heart failure can occur.

Cardiomyopathy refers to a group of diseases (usually infections) that weaken the heart muscle and reduce the pumping action of the heart. This may result in congestive heart failure.

As you can see there are many causes of heart failure. Treatment will often depend on the underlying cause. That is why your doctor may recommend certain test if these have not already been done. These include:

A very useful test which uses ultrasound to image the heart. Enlargement or weakness of the heart chambers can be seen and measured. Valve and other structures can be assessed. The test is often combined with a doppler exam which demonstrates blood flow through the heart.

Often combined with a "thallium" study or other nuclear imaging study, is valuable for assessing the coronary circulation. This way, blockages or "silent heart attacks" can be detected.

A special X-ray test of the heart is the "gold Standard" for the detection of blockages in the coronary arteries.

Treatment of heart failure is often directed at many targets at once. Lifestyle and diet changes are as important as the use of certain medication. Medication in heart failure is intended to reduce the workload of the heart and to help it work better by increasing the muscle strength.

This drug works by strengthening the pumping action of the heart. This helps to improve the blood flow throughout the body.

These drugs work by helping the kidneys to get rid of extra salt and water from the body. This helps to relieve the "Congestion" (build up of fluid) in the body tissues and reduces the workload of the heart.

These drugs act directly on blood vessels to keep them open. When the blood vessels are open, the heart does not have to work as hard to push the blood through them.

These are a new group of vasodilator drugs which indirectly relax blood vessels throughout the body. This allows the blood to flow more easily and in turn reduces the workload of the heart.

Other Medications

Include potassium supplements to replace losses of this important mineral from diuretic use.

The beta-blocker class of medications, including Coreg, Lopressor and others reduces the high tone of the adrenergic system. There have been many studies showing favorable effects on strength of contraction and survival with this class of medication. Your doctor will need to supervise this therapy closely.

There are a number of things you can do in your daily life to help control heart failure.

These include:

Smoking reduces the amount of oxygen rich blood that is sent to the heart and other parts of the body. As a result the heart has to work harder to provide the tissues with enough oxygen.

If you smoke, and need help to stop, ask your doctor for information about Stop Smoking programs.

Instead of relying on memory, write down the points for discussion during your next visit within the space provided.

You should report to your doctor any of the following:

Heart failure can be controlled. You may need to take medicine and make some changes in your daily life. But remember, you are the most important part of your treatment plan. By working closely with your doctor, you can maintain control and achieve a full and happy life.

Because heart failure is complex, a team of health care professionals is needed for special skills and expertise.

By working with your health care team in learning how to treat your condition, you may live longer and also improve the quality of your life.

Managing heart failure requires keeping track of symptoms and monitoring how well you follow instructions of your health care team. Report changes in your health to your health care provider.

As part of your health care team, you should:

Report any sudden weight changes.

OF TEANECK