Congestive Heart Failure Prognosis

Heart failure is a major health problem that comes with the graying of America. Today, many more people are surviving heart attacks and other heart diseases. This allows them many more years of quality life but can eventually lead to the development of heart failure. In recent years, more effective medications have been developed that improve the outlook of heart failure. Medications are the mainstay of therapy with congestive heart failure. y New and sophisticated treatments are allowing people to live longer. These results are proven by clinical trials where patients volunteer to take new therapies under strict ethical and scientific monitoring. Pacemakers and implantable defibrillators have improved and now offer the ability to control rare but life-threatening disturbances of heart rhythm in some people. Some people may even benefit from sophisticated treatments such as heart transplants and newer forms of temporary mechanical hearts.

Follow-up
If you have congestive heart failure, you will need frequent, regular medical attention to adjust your medications and watch for side effects. Schedule regular visits with your health care provider as he or she recommends because congestive heart failure is a serious medical condition that requires constant monitoring. Educate yourself as much as possible about this life-threatening condition. y y Establish a daily routine for taking medication properly and on schedule. Weigh in daily. Every morning, record the weight in a diary, and take it to the health care provider every visit. An accurate bathroom scale is helpful in monitoring weight gain or loss from day to day. This will help to see fluid retention. Keep a list of all medications, with the exact name and dose, and know why each one is taken. Bring them to each follow-up visit so the doctor can double check to make sure you are on the correct medication and dose. Reminder boxes for medications are helpful. y y

Congestive Heart Failure Treatment The treatment of heart failure depends on the exact cause, but it can usually be treated effectively. The overall goals of treatment are to correct underlying causes, to relieve symptoms, and to prevent worsening of the condition. Symptoms are relieved by removing excess fluid from the body, improving blood flow, improving heart muscle function, and increasing delivery of oxygen to the body tissues.

Congestive heart failure is a serious medical condition that requires professional medical help.

Once diagnosed and under the care of a qualified medical professional, you can and should do several things at home to increase your comfort and reduce the chance of your condition getting worse. In fact, the more active role you take in managing your heart failure, the more likely you are to do well. Making the lifestyle changes described here will make a real difference. Not only will you feel better, but you will be increasing your chances of a longer, healthier life. Treat swelling with the following measures:

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Elevate the feet and legs if they are swollen. Eat a reduced-salt diet. Weigh in every morning before breakfast and record it in a diary that can be shown to a health care provider. Avoid the following:

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Not taking prescribed medications Smoking (in all forms) Alcohol (up to 1 drink per day is usually fine, unless prone to excessive intake/alcoholism) Keep walking or join a cardiac rehabilitationprogram (this program can monitor increasing or decreasing exercise capacity) Excessive emotional stress and/ordepression (Moderate-to-severe mental depression has been shown to double mortality risk.) High altitude (Breathing is more difficult because of the lower level of oxygen in the atmosphere; pressurized cabin air travel is usually fine.) Herbal or other complementary medicine without first consulting a doctor to see if they are safe Know the following:

People with diabetes must control their blood sugar level every day. Know the HbA1C level. It should be less than 7.0, preferably less than 6.5. People with high blood pressure should measure it regularly, and make sure they know the value, (systolic pressure should be below 140 mm Hg in everyone and even below 130 if the person has diabetes). People with elevated lipid levels (cholesterol and triglycerides) can take medications to get the bad cholesterol, or LDL, below 100, and the triglycerides below 150.
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What is the treatment of congestive heart failure? Lifestyle modifications After congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day. In individuals with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total sodium intake is very important. Severe restriction of alcohol consumption also is advised. Likewise, the total amount of fluid consumed must be regulated. Although many people with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given individual and should be discussed with their physician. An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight. An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe. Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each person's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable. Addressing potentially reversible factors Depending on the underlying cause of congestive heart failure, potentially reversible factors should be explored. For example: y

In certain persons whose congestive heart failure is caused by inadequate blood flow to the heart muscle, restoration of the blood flow through coronary artery surgery or catheter procedures (angioplasty, intracoronary stenting) may be considered.

Congestive heart failure that is due to severe disease of the valves may be alleviated by valve surgery in appropriate patients. When congestive heart failure is caused by chronic, uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve the condition. Heart muscle weakness that is due to longstanding, severe alcohol abuse can improve significantly with abstinence from drinking. Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible by appropriate measures.

Outlook (Prognosis)
Heart failure is a serious condition that can result in early death. How well a person does depends on the cause of the heart failure, as well as the person's age and ability to tolerate exercise. In many cases, there is little chance that the heart will fully recover. However, many forms of heart failure are well controlled with medication and the condition can remain stable for many years with only occasional flare ups of symptom

Support Groups and Counseling

Having the support of health care providers, family, and friends is essential to effectively coordinate all of the needs of a person with heart failure. People with severe heart failure have special needs beyond standard medical care. y Advance directives are legal documents that tell doctors and hospitals what treatments you might not want, should you become unable to speak for yourself. A living will provides instructions while you are still alive, for example, if you have specific wishes if your heart or breathing stops. A medical durable power of attorney allows someone you designate to make medical decisions on your behalf, if you become unable to make these decisions. Hospice care may be required when you and your physicians agree that yourprognosis for survival is poor. Professionalhospice caregivers emphasize pain control and emotional support. Treatment MONITORING AND SELF CARE If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weigh yourself at the same time each day and on the same scale, with little to no clothes on. Weight gain can be a sign that your body is holding onto extra fluid and your heart failure is worsening. Talk to your doctor about what you should do if your weight goes up or if you develop more symptoms. Other important measures include: y y y y Take your medications as directed. Carry a list of medications with you wherever you go. Limit salt intake. Do not smoke. Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for your degree of heart failure. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well. Lose weight if you are overweight. Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

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Here are some tips to lower your salt and sodium intake: y Look for foods that are labeled low-sodium, sodium-free, no salt added, or unsalted. Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels. Dont cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG). Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese. Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese. Use oil and vinegar, rather than bottled dressings, on salads. Eat fresh fruit or sorbet when having dessert.

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MEDICATIONS Your doctor may prescribe the following medications: y y y ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium) Digitalis glycosides to help the heart muscle to contract properly and help treat some heart rhythm disturbances

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Angiotensin receptor blockers (ARBs) such as losartan and candesartan for those who have side effects with ACE inhibitors Beta-blockers such as carvedilol and metoprolol, which may be helpful for some patients

Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms. SURGERIES AND DEVICES Heart valve surgery, coronary bypass surgery (CABG), and angioplasty may help some people with heart failure. The following devices may be recommended for certain patients with heart failure: y y y A pacemaker to help treat slow heart rates or other heart signaling problems A biventricular pacemaker to help the both sides of your heart contract at the same time; it is also called cardiac resynchronization therapy. An implantable cardioverter-defibrillator that recognizes life-threatening, abnormal heart rhythms and sends an electrical pulse to stop them.

Severe heart failure may require the following treatments when other therapies no longer work. They are often used when a person is waiting for a heart transplant: y y Intra-aortic balloon pump (IABP) Left ventricular assist device (LVAD)

Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant. Outlook (Prognosis) Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress. Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder. Possible Complications