Newswise — For decades, the diagnosis of congestive heart failure meant a chronic, incurable long-term ailment. In old movies, heart failure patients were immobile, afraid to move far beyond their rocking chairs. If a movie were to be made today about a congestive heart failure patient, Dr. Daniel Fishbein, the medical director of the Heart Failure and Cardiac Transplantation Service at University of Washington Medical Center, says that the character might be recovering and very busy with his or her hobbies, family and job.
It's important to understand that heart failure isn't just one disease with a single possible treatment.
"Congestive heart failure is actually a syndrome of a constellation of symptoms that frequently includes shortness of breath, either at rest or with physical activity, fatigue and salt and water retention," Fishbein says. "Heart failure is the final common pathway for a number of cardiovascular disorders, such as coronary artery disease. Other patients may have what's called dilated cardiomyopathy, a weakening of the heart muscle that makes it difficult for the heart to pump blood. Still others may have diastolic dysfunction, where increased stiffness of the heart muscle won't allow the heart to fill with blood. The underlying problem that causes heart failure plays a big role in determining how we treat the heart failure."
The risk factors for congestive heart failure make a familiar list: cigarette smoking, high blood pressure, diabetes, high blood cholesterol and family history.
"High blood pressure in particular increases the risk of developing heart failure significantly and it is a very common problem in this country," Fishbein, a professor of medicine in the Division of Cardiology, says. "In fact, it is frequently not adequately treated. Fewer than half of the people in the United States who have high blood pressure actually achieve target blood-pressure levels. For patients who have a history of high blood pressure, it is very important that they see their health care practitioner and make sure that they have adequate blood-pressure control."
The same can be said for diabetes, particularly since it has become a more common disease in younger adults. Diabetes is a risk factor for coronary artery disease, which in turn can lead to heart failure.
Once the root cause of heart failure is diagnosed, you and your health care practitioner can discuss your options. The treatment for coronary artery disease may be the dilation of some arteries on the heart with the placement of stents, small tubes that will keep the arteries open, or bypass surgery. Heart valve disease may require surgery, to replace the ailing valves. Many patients can take medications that both improve symptoms and improve the function of the failing heart.
"With newer therapies, we frequently see reversal of the disease process, with improvement of the heart's ability to squeeze and move blood through the body, a reduction in heart size and a trend toward normalizing the shape of the heart," Fishbein notes. "This is very important to our patients, because when you see these changes take place in response to medical therapy, there is significant improvement in the patient's long-term health and outlook."
No matter what treatment you and your health care professional settle on, you will likely also be asked to make some changes in your diet, to cut down on salt intake. You may also be asked to exercise appropriately, avoid cigarette smoking, manage your diabetes if you have that problem and avoid excessive alcohol.
"One of the things we certainly want to avoid is additional damage to an already-damaged heart," Fishbein adds. "All these secondary prevention measures are terribly important. Most important, though, is making sure that you're taking your medications as prescribed. Don't hesitate to ask your physician, nurse practitioner or pharmacy if you have any questions at all about what you're taking."
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