What is Congestive Cardiac Failure?
It is a condition in which the heart fails to pump blood and eventually fails to deliver oxygen and nutrients to various parts of the body.
Understanding blood circulation
In a healthy body, the blood devoid of oxygen flows from different parts of the body towards the heart and the oxygenated blood flows from heart to the different parts of the body. This is called as blood circulation.
However, as the heart fails to pump blood properly ahead, there is a stagnation of blood in the veins coming from the peripheral tissues of different parts of body. This collection of fluid leads swelling of various organs called as oedema. Oedema is a fairly common condition in elderly, due to the aging of heart.
Types of Congestive Heart Failure
The heart has four chambers, two atria and two ventricles. The atria receive blood from the body by the venous system, and ventricles pump blood into the body via arterial system.
- Left atrium:receives blood from the lungs
- Right atrium: receives blood from the rest of the body
- Right ventricle: pumps blood into the lungs
- Left ventricle: pumps blood in to the rest of the body
- Right sided failure: When the right ventricle fails to pump blood it is called Right sided failure. Blood doesn’t get pumped out from the right ventricle and hence back pressure develops in the right atrium and ultimately in venous system. All the organs swell with accumulation of fluid and a systemic failure sets in. If the condition remains untreated for a long time, the back pressure from the venous system is transmitted to the arterial system. This arterial pressure becomes too high for the left ventricle to pump against it and subsequently the left side of the heart fails too.
- Left sided failure: When the left ventricle fails to pump blood it is called Left sided failure. Blood doesn’t get pumped out from the left ventricle and back pressure develops in the left atrium and subsequently in the lungs. Fluid gets accumulated in the lungs and the patient gets breathless like he is drowning in his own fluids.
If the condition remains untreated for a long time, the pressure in the lungs becomes too high for the right ventricle to pump against it and subsequently the right side of the heart fails too.
Untreated cases soon progress to higher grades of symptoms, to finally become both sided failures as the circulation is a continuous circuit.
How common is Congestive Heart Failure?
- In age group of 50-54 years : 2% in males and 1% in females
- More than 75 years of age: 14% in males and 13% in females
What are the symptoms of Congestive Heart Failure?
In most cases symptoms appear very gradually, hence the patient doesn’t exactly know when the symptoms started. Only in a few cases the symptoms appear suddenly generally following a heart attack (patient give history of chest pain).
Right sided failure:
- Swelling (Oedema): Develops in dependent parts of the body, i.e if the patient is able to move around, swelling develops in the legs and if the patient is bed-ridden, swelling develops in the back)
- Abdominal distention
- Pain in abdomen
- Bluish discoloration of the fingertips
- Ruddy and dark complexion
- Increased frequency of urination
- In prolonged cases left sided failure and its symptoms appear
Left sided failure:
- Deep labored breathing
- Tightness of chest
- Chest pain
- Pain in abdomen
- Giddiness and fainting
- Reduced urine output
- In prolonged cases right sided failure and its symptoms appear
Who is at risk of Congestive Heart Failure?
All elderly are at higher risk of developing heart failure. Those especially at risk are:
- Those who have a history of heart attack in the past
- Patients with history of chest pain
- Patients with Arrhythmias (defects in the rhythm of the heart)
- Postmenopausal females are at a higher risk compared to women with ongoing menstrual cycles.
What are the causes of Congestive Heart Failure?
Heart failure sets mainly in due to the imbalance between the blood supply to the heart and the heart’s requirement. Some important causes and risk factors are:
- High blood pressure
- Valvular heart disease (disease of the heart valves)
- Cardiomyopathies (disease of the heart muscle)
- Vitamin deficiencies
- Alcohol and smoke dependence (high risk factors)
- Infections especially infection of the heart (endocarditis)
- Thyroid disease (thyrotoxicosis)
- Missed/changed drugs or not being regular with the prescribed drugs
What are the complications of Congestive Heart Failure?
Complications appear due to failure of circulation and inadequate blood supply to various organs and organ systems.
- Heart: Disorders of rhythm, chest pain and myocardial infarction (heart attack)
- Brain: Fainting, giddiness, stroke
- Liver: Enlargement of liver, altered liver function tests, swelling of abdomen due to accumulation of fluid in the abdomen
- Kidney: Excessive urination or reduced urine output
Older patients are especially prone to develop complications since all the organs are aging and have suffered some age related wear and tear. Such patients may also have some pre-existing disease of various organs. Any circulatory failure increases the morbidity many fold.
How is Congestive Heart Failure diagnosed?
Congestive cardiac failure is generally a clinical diagnosis. The treating physician generally orders the following tests to assess the condition of the patient and decide the course of management:
- Blood pressure and blood glucose levels
- Oxygen saturation
- ECG (electrocardiogram to look for the rhythm and pumping of the heart)
- Chest x ray to look for the condition of the lungs
- Ultrasound of the abdomen to check for fluid collection
- Liver and kidney function tests
How is Congestive Heart Failure treated?
The patient is advised bed rest, especially with elevated head end of the bed. Fluid intake is regulated and urine output is monitored. Patient is generally started on medications. However, it is not advisable to take any medication without a doctor’s prescription.
Urgent symptomatic treatment goals:
- Improve oxygenation of the tissues
- Restore circulation and heart rhythm
- Relief of chest pain and breathlessness
- Reduce further tissue injury
- Reduce long term complications
The following classes of drugs are generally used:
- Diuretics: To clear fluid collection
- ACE (Angiotensin Converting Enzyme) Inhibitors
- Calcium channel blockers
- Iron supplements (in case anemia is suspected for it is a completely treatable and 100% reversible cause)
- Cholesterol Lowering agents (Statins are the commonly used drugs)
- Anti-platelet agents (most commonly aspirin)
What are the lifestyle changes required to manage Congestive Heart Failure?
- Patient is advised a low salt diet and it is advisable to not take any added salt in the diet.
- The patient should avoid pickles, papads, biscuits, wafers, and bakery products.
- The patient should quit smoking and alcohol
- Weight management should be strict.
- A diet rich in fiber, unsaturated vegetable oils (like sunflower, rice bran oil) is advised.
- The patient is advised regular aerobic exercise (about 30 mins of brisk exercise for at least 5 days a week) once the patient is healthy enough to step out and move around.
- For bed ridden patients it is essential to take care of the skin and prevent bed sores.
Depression and cognitive impairment are fairly common in cardiac failure, especially so in old age. It is important for the treating doctor to actively look for the signs of these and handle them appropriately.
Care of patients with heart failure requires a lot of support from the care givers, especially in the elderly.
How can Congestive Heart Failure be prevented?
Congestive cardiac failure is the end stage of a failing heart. The condition can be prevented by preventing the progress of underlying heart disease.
Common ailments in old age are elevated blood pressure and coronary heart disease in which the blood demand and supply ratios for the heart is already unbalanced. These conditions should be diagnosed accurately and managed aggressively.
It is essential that the treatment regimens for these ailments must be strictly adhered to and any new symptom developing should be reported at the earliest so that the disease can be caught in the early phases and early therapy can be started.
General prevention measures include a diet balanced in all nutrients and as planned by the physician/dietitian. Keeping the salt intake to the bare minimum (not more than 5 gms a day as recommended by WHO, but may be lower in patients with progressive disease, as recommended by the physician) can go long way in preventing fluid retention and congestive symptoms.
Regular aerobic exercise (30 mins for 5 days a week) helps to keep the heart function satisfactorily for long duration of time.
How to take care of someone with Congestive Heart Failure?
- Take them for their doctor’s appointment regularly
- Remind them to eat their medicines on time
- Ensure their diet is clean and healthy
- Support them in getting exercise everyday
- Be there for them as this is a hard condition to deal with
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