Most women rarely think about their hearts until one of two things happen: It gets broken (and we’ve all been there) or it stops working as it should. Congestive Heart Failure, also called CHF, is a term used to describe the condition when the heart can no longer effectively pump blood and oxygen. Subsequently, fluid builds up in various parts of the body.
Each time your heart beats, two separate processes are happening- it contracts to push blood forward, then it relaxes to allow itself to fill with more blood, then the process repeats itself over and over (about 115,000 times a day!) In people with CHF, the problem can be due to the heart not contracting well, also called “pump” failure, or it can be due to the heart not relaxing completely, or it can be due to a combination of the two. In either case, CHF is a serious condition that is progressive and potentially fatal. And like most life-threatening conditions, African-Americans die sooner and more often due to this illness.
What are the signs of CHF?
The signs and symptoms of CHF can range from very mild to very disabling. There can be swelling of the feet and legs (also called edema), difficulty breathing or catching your breath (called dyspnea), fatigue, weakness, or difficulty breathing while lying on your back. This is called orthopnea, and it is usually a symptom of advanced heart failure. You may notice that it is necessary to sleep on more pillows in order to breath. There may also be attacks of severe shortness of breath that awaken you from sleep and can be very frightening. The attacks are often associated with coughing and wheezing, and are sometimes called “cardiac asthma”. What are the causes of CHF?
There are many potential causes of congestive heart failure. The major causes, especially among African-American women, are hypertension and heart attacks. Long-standing, poorly controlled high blood pressure causes the heart to get stiff, therefore it doesn’t relax as it should and fluid can start to buildup. Heart attacks cause portions of heart muscle to die, and if a large enough part of heart muscle is dead, blood is not pumped to the rest of the body efficiently.
Some other causes of congestive heart failure include problems with the heart valves (such as aortic stenosis), long-standing irregularities in heart rhythm (called “arrhythmias”), and heavy alcohol use. For women, there is also a more rare but not uncommon cause of CHF called “postpartum cardiomyopathy”. This heart condition occurs after giving birth, and results in the heart loosing its pumping ability. Unfortunately, this type of heart disease is often rapidly progressive, with heart transplantation being the only long-term cure.
In a minority of cases, there is no identifiable cause of heart failure, called “idiopathic” (which means nobody knows). It is thought that certain viruses may play a role in its development. Certain drugs (such as chemotherapy medicines) and uncontrolled hyperthyroidism are less frequent causes of CHF.
How do you know if you have CHF?
If you are experiencing any of the above symptoms, you should see your doctor right away. Your physician will take a history, perform a physical exam, and evaluate your risk factors for heart disease. If you smoke, have high blood pressure, consume large amounts of alcohol on a regular basis, or have had a history of heart attacks, you are at increased risk for congestive heart failure. Diabetes is also a major risk factor in the development of CHF. Your doctor may wish to order an echocardiogram, which is the best way to look at the heart and determine if it is pumping effectively. (It is similar to the ultrasound used to look at babies in the womb). It is important to remember that other processes can cause symptoms that resemble CHF, such as lung disease, and sometimes distinguishing the two may be difficult. That is why it is so important to see your doctor regularly and at the first sign of symptoms.
How is CHF treated?
Treatment of CHF has advanced over the past decade, however, in the majority of cases, the goal is to slow progression of the disease. Few therapies offer a cure. If you have been told you have CHF, there are several medications you should ask your doctor about. These include medications called ACE Inhibitors, Angiotensin Receptor Blockers (ARBs), beta-blockers, digoxin, diuretics (which help the body get rid of excess water), and spironolactone. Aspirin and a cholesterol lowering medicine may also be needed if you are risk for heart attacks. What these medicines do is beyond the scope of this article, but it is important to initiate a discussion with your physician so that as a team, you and your doctor can determine the best and most effective course of treatment.
If the cause of the heart failure is a problem with a heart valve, a valve replacement surgery may be an option. For selected patients with a history of heart attacks, bypass surgery may help prevent further weakening of the heart. The ultimate cure for severe heart failure is heart transplantation, however this option is often limited due to the age of the patient (usually, transplants are not done on people over the age of 60) or other medical conditions that make transplantation excessively dangerous.
What can you do to prevent CHF?
Since once heart muscle is weakened or destroyed, there is usually no way to recover normal function, the key is to prevent heart failure. Here are the vital ways to keep your heart healthy, and if you are already diagnosed with CHF, how to slow or stop its progression:
1. STOP SMOKING! If you do not smoke, DON’T START! Smoking is the number one preventable cause of heart disease.
2. Control your blood pressure. If you have high blood pressure, take your medications every day. Your blood pressure goal is the top number (called “systolic pressure”) less than 130, and the bottom number (called “diastolic pressure”) less than 80. If your blood pressure does not reach these goals, additional therapy is necessary.
3. If you have diabetes, strict, aggressive control of your blood sugars will help prevent heart disease.
4. LOOSE WEIGHT. Discuss your weight goals with your doctor. Obesity increases the likelihood of developing high blood pressure, diabetes, and heart attacks.
5. EXERCISE. This not only helps in weight loss, but also naturally lowers blood pressure and cholesterol.
6. Drink alcohol only in moderation.
7. Take all medications prescribed by your doctor every day. Know your medicines and why you are taking them. Do not hesitate to ask questions if you are unsure about your health issues. ALWAYS consult with your doctor before taking over-the-counter or herbal medicines, as they can worsen heart failure or interact with your medications.
8. Limit salt intake. Discuss with your doctor the daily amount of salt that is right for you.
Remember that as women, you do not have to be victims of any illness or disease. Accepting responsibility and educating yourself are the first steps to taking control of your bodies and your health.
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