Association of Cameroonian Physicians in the Americas

    CONGESTIVE HEART FAILURE

    heart

     

    My senior back in medical school once quoted "the heart like the cell is the basic functional unit of the human body, no heart action = no life". I didn't quite agree with him (what did I know? Lol) but as I advanced in my education and career, I began to see what he meant. The heart is like a water tank with the pipes (blood vessels) coming in and going out, when it stops pumping for whatever reason, there is no water supply. This is what happens with heart failure.

    What is it?

    Congestive heart failure (CHF) or simply heart failure is the inability of the heart to pump blood normally. It is a chronic progressive problem that affects the heart muscles. There are two types of heart failure; Heart failure with reduced ejection fraction (Systolic heart failure) and heart failure with preserved ejection fraction (Diastolic heart failure)

    Heart failure is an epidemic in the United States with over 5.8 million individuals affected and about 550,000 new cases each year. It can occur in all age groups. Once diagnosed with heart failure the survival rate estimates are 50% and 10% at 5 and 10 years respectively so it has a very poor prognosis.

    What are the signs and Symptoms?

    Individuals with heart failure most commonly present with the following symptoms: -

    • v Difficulty in breathing (when lying flight or with exertion)
    • v Fatigue and weakness
    • v Swollen feet which could extend past the ankles and up the legs
    • v Decreased exercise tolerance

    Additionally, they can also present with: -

    v Persistent cough associated with red stained sputum

    v Reduced appetite

    v Frequent urination at night

    v Palpitation (feeling of pounding in the chest and irregular heartbeats)

    v Dizziness

    v Weight loss or rapid weight gain due to excess fluid retention

    v Fluid with swelling in the abdomen(ascites)

    v Nausea

    v Chest pain (if your heart failure is caused by a heart attack)

    v Depression and anxiety

    What are the risk factors?

    There are some conditions and lifestyles that will increase our risk of heart failure, some of them can be changed/controlled (modifiable risk factors) and others cannot be controlled or modified (non-modifiable risk factors)

    1.Modifiable risk factors

    • i)Life style (alcohol, tobacco use, sedentary lifestyle, obesity)
    • ii)Medical conditions like Hypertension, Diabetes
    • iii)Medications (some medications used to treat diabetes like Rosiglitazone (Avandia) and Pioglitazone, NSAIDS, certain medications used to treat high blood pressure)
    • iv)Stress
    • v)Diet and Nutrition
    • 2.Non- Modifiable risk factors
    • i)Age
    • ii)Gender (generally men are more predisposed than women, but the risk increases in women as they approach the geriatric age groups)
    • iii)Hereditary
    • iv)Race (more common in blacks)

    How is a diagnosis of heart failure made?

    Diagnosing heart failure begins with a thorough medical history and physical examination. The doctor will ask about your symptoms and look for other signs of heart failure. The signs and symptoms are however not specific to confirm the diagnosis. The following may be done in addition.

    • v Blood tests are done to rule out other conditions that could lead to heart failure. These could include fasting lipid profile (to check cholesterol levels), blood cultures (to check for infections), Thyroid function tests (to see if your thyroid is functioning properly), liver function tests, blood glucose level (to see if you are diabetic) and kidney function tests.
    • v Other studies like chest X ray, electrocardiogram (ECG/EKG), echocardiogram or coronary angiogram may also be carried out.

     Treatment

    The goals of treatment in patients with heart failure is to improve clinical status, functional capacity and quality of life as well as prevent or reduce hospital admissions and reduce mortality.

    Medications will be prescribed based on the stage of disease and comorbidities. Examples of medications that can be used for heart failure include Lasix (water pill), Metoprolol succinate (Toprol XL), Digoxin, Spironolactone, ACE inhibitors like Lisinopril, ARBs like Losartan or the combination pill Sacubitril/Valsartan (Entresto). Devices like a Left ventricular assist device (LVAD) can be used in cases which are resistant to optimal medication therapy.


    Prevention of heart failure

    The key to preventing heart failure is to reduce your modifiable risk factors. You can control or eliminate many of the risk factors for heart disease like high blood pressure, high cholesterol and Coronary artery disease by making lifestyle changes along with the help of any prescribed/needed medications.

    Lifestyle changes you can make to help prevent heart failure include:

    vStopping smoking

    vTreating and controlling certain conditions, such as high blood pressure and Diabetes

    vStaying physically active

    vEating healthy foods which are low in fat and salt content

    vAvoiding excessive alcohol intake

    vMaintaining a healthy weight

    vReducing and managing stress

    Author: Lucy Ndip Epse Ndep-Obi, MD

    Reviewer/Editor: Shirley Ayuk-Takem, DO

    References:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806290/

    https://www.emoryhealthcare.org/heart-vascular/wellness/heart-failure-statistics.html

    DYSLIPIDEMIA
    LIFESAVING TIPS FOR A SAFER BIRTH
     

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    Tuesday, 10 December 2019
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