Congestive Heart FailureDr. S.M.Safavi

Associate Professor of NutritionIsfahan School of Nutrition

and Food Sciences

Basic Definition• Heart failure is a

medical term that describes an inability of the heart to keep up its work load of pumping blood to the lungs and to the rest of the body.

Statistic

• It is estimated that as many as two million Americans suffer from congestive heart failure and that up to 29, 000 die annually from this chronic disorder.

Symptoms(involving gravity/exhaustion of heart

• Swelling of the ankles, legs, and hands

• Orthopnea, or the shortness of breath when lying flat

• Shortness of breath during exertion

Symptoms(involving circulation)

• Cyanosis, or a bluish color that is seen in the lips and fingernails from a lack of oxygen

• Fatigue or weakness• Rapid or irregular heart beat• Changes of behavior such as restlessness,

confusion, and decreased attention span

Symptoms(involving congestion)

• Unexplained or unintentional weight gain• Chronic cough• Increased urination• Distended neck veins• Loss of appetite or indigestion

Congestive heart failure is a syndrome that can be caused by multiple underlying diseases such as:

• Congenital heart disease

• Atherosclerosis

• Rheumatic fever

• Cardiomyopathy

• Valve disorders

• Ventricular failure

• Left or right-sided failure

• Hypertension

• Prolonged alcohol or drug addiction

• Previous heart attack

• Diabetes

• Chronic rapid heartbeats

Congenital Heart Disease• CHD affects one out of

every one thousand babies. In these babies the marvelously intricate combination of chambers, valves, and vessels making up the heart and circulatory systems fails to form properly before birth. Septal, atrial, and ventricular defects are the most common.

“Heart.” The World Book Encyclopedia. 1996 ed.

Rheumatic Fever

• Strep throat from the streptococcal infection begins a disease process where the heart valves are damaged. This condition is called rheumatic fever and it affects the connective tissues of the body.

Betty Mae Donnell

Rheumatic fever as a child

Died at age 48 (relatively young)

Cardiomyopathy

• Cardiomyopathy is the stretching and enlarging of the heart cavity that occurs making the heart weak so it does not pump correctly

Ventricular Failure

• Ventricular failure occurs when there are weak spots in the ventricular walls causing a bulge, or an aneurysm.

Atherosclerosis

• Atherosclerosis is the gradual clogging of the arteries by fatty, fibrous deposits. A tiny lump of fibrous tissue grows as the artery tries to repair the damage. Cholesterol accumulates and more tissue builds up. The arteries are thickened and hardened making a loss of elasticity causing congestion.

Left-sided/Right-sided Failure

• Blood backs up causing congestion and thus swelling of extremities and internal organs

Other Contributors

• Hypertension

• Prolonged Alcohol or Drug Addiction

• Previous Heart Attack

• Diabetes

• Chronic Rapid Heart Beats

Evolutionary Aspect (mainly a disease of civilization)

• Workaholic vs. Neanderthal– Stress

• Pressure of getting everything accomplished

• Less demands

– Diet• Hitting fast food instead of planned meal

• Ate what could be found/body not prepared for fatty foods

– Exercise• Lacking time to work on health

• Search for food

The body tries to overcome heart failure automatically but usually

only worsens the condition

• If the blood meant for less essential organs instead flows to the brain and other vital organs the heart has to work harder to get it to all parts of the body.

• When the activity of the heart is increased, a more forceful contraction causes an increased heart rate.

• A study by Chin and Goldman involved the hospitalization of 435 patients with congestive heart failure symptoms– Interesting percentages of symptoms

• Acute anginal chest pain 33%

• Uncontrolled hypertension 15%

• Noncompliance with medications 15%

• Diet 6%

• Other 31%

• In this study, about half of the patients with prior CHF and new onset CHF were women

• CHF is found more often in white people of this study

• CHF patients are usually over the age of 61

• Medicare

Chin, M. & Goldman, L. (1997). Factors contributing to the hospitalization of patients with congestive heart failure. American Journal of Public Health, 87. 643-8.

Treatment

• When a treatable underlying cause of congestive heart failure exists, correcting the cause may resolve, or at least greatly improve, the degree of heart failure

Valve Surgery

• If a defective heart valve is responsible for heart failure, it may be treated by heart valve surgery

Angioplasty• Angioplasty, which is catheterization using a

balloon to flatten fatty deposits, can be used to treat atherosclerosis or other conditions with blocked arteries.

• An artery of an arm or leg is used to guide the catheter through to the blocked artery.

• An uninflated balloon on the top of a smaller tube is threaded through the larger tube and centered in the plaque narrowed area.

• The balloon inflates compressing the plaque against the walls and increasing the open area.

Drugs

• Digitalis-strengthen the heart’s contractions increasing blood flow

• Diuretic-increase the output of salt and water in urine

• Vasodilators-relax blood vessels which lowers the resistance to blood flow. More blood reaches the tissues and the heart works no harder than before.

In conclusion, congestive heart failure is often assumed to be a

disease when in fact it is a syndrome caused by multiple

disorders.