Congestive Heart Failure (CHF) is one of the most prevalent diagnoses today.
Congestive heart failure is a combination of heart dysfunction along with symptoms of heart failure such as shortness of breath or leg swelling. The heart dysfunction can be systolic, in which the ejection fraction is low and heart muscle strength is weakened. Or it can be diastolic heart dysfunction, in which the heart filling and relaxation is impaired because of heart muscle stiffness.
The goal of treating heart failure is to improve quality of life and life expectancy, prevent unnecessary emergency room visits and hospital admissions, and promote use of heart strengthening medications.
What are the warning signs and symptoms of heart failure?
Symptoms of heart failure may get worse over time. The most common symptoms include:
Shortness of breath-this may get worse over time.
Fatigue-this happens because your muscles aren’t getting enough oxygen from your blood.
Palpitations-this is a feeling that your heart is racing or that your heartbeat is irregular.
Chronic cough-this is due to the fluid buildup in the lungs.
Fluid retention-especially in the legs and feet.
Other symptoms can include heart palpitations (feeling that your heart is racing or that your heartbeat is irregular). Some people also have nausea and lack of appetite, dizziness, fainting spells, or difficulty concentrating.
Heart failure severity is described by the New York Heart Failure Class System:
Class I- has heart failure but does not yet have heart failure symptoms
Class II-has symptoms with mid-level exercise
Class III-has symptoms with low-level exercise
Class IV-has symptoms even when at rest.
How is heart failure detected?
Heart failure can be diagnosed in a variety of different ways. Your doctor will decide which tests are appropriate for you.
What are the treatment options for heart failure?
People suffering from heart failure can almost always be helped by changes in lifestyle. For instance, it is important that people with heart failure eat low-fat foods and especially low-salt (low-sodium) foods. Your doctor may also recommend cardiac rehabilitation as part of your treatment, which will show you the best exercises to do, suggest new eating habits, order medications to reduce your symptoms, and help you regain or learn new lifestyle and coping skills.
Also, check with your doctor about pain relievers you may need for aches and pains. Heart failure patients should avoid one type of pain reliever: non-steroidal anti-inflammatory medications. This includes medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve), among others. Ask your doctor or nurse which pain relievers you can take.
Other types of treatment may depend on your test results. Your doctor may ask you to report worsening symptoms, blood pressure readings, and/or your weight on a regular (sometimes daily) basis. If you report changes in those areas, your doctor can act accordingly to change your treatment.
Pacemaker Therapy
Some types of heart failure can be improved by pacemakers which enhance the timing and vigor of the way the heart beats. Some can correct lethal arrhythmias which are more common in heart failure. These and other devices are being used more commonly in the treatment of heart failure.
Coarctation of the aorta is a constriction in the aorta causing obstruction to blood flow.
The narrowing most often is located just after the aorta gives its branches to the head and arms as it curves down to supply the lower body. The left ventricle of the heart has to work harder to force blood past the narrowed area. This may cause the left ventricle to weaken and may cause an elevation of blood pressure before the narrowed area.
What are the warning signs and symptoms of coarctation of the aorta?
Coarctation of the aorta generally presents in one of two ways. An infant, often in the second week of life, may not tolerate the obstruction and may develop signs of significant congestive heart failure including labored breathing, poor feeding, and decreased urination. Some infants, however, tolerate the obstruction very well and their hearts rapidly compensate. The diagnosis is then often made later in life, either in childhood or adulthood, and the person may be referred to a specialist because of the presence of a heart murmur or elevated blood pressure in the upper extremities.
How is coarctation of the aorta detected?
Coarctation of the aorta may be suspected because of the following: a heart murmur, elevated blood pressure in the upper extremities with lower blood pressure in the lower extremities, and/or absent pulses in the lower extremities.
The following tests can confirm the presence of the coarctation:
Echocardiography, MRI Scan, CT scan, Cardiac Catheterization
What are the treatment options for coarctation of the aorta?
The treatment of coarctation of the aorta for many years has been surgical repair. This is still the treatment of choice in many infants. In older children and adults, a newer non-surgical approach can be offered. A catheter is threaded from the artery in the groin up to the area of narrowing. The catheter has a balloon on the end of it and when the narrowed area is straddled, the balloon is inflated to expand the area. Sometimes a metallic stent is placed over the balloon. When the balloon is inflated, the stent enlarges along with the balloon to open up the narrowed area. The balloon is then deflated and removed; the metal stent retains its enlarged shape and keeps the artery open.
Angina Pectoris, more commonly known as chest pain, is a sign that the heart needs more oxygen.
Angina can be caused by an insufficient supply of blood and oxygen to the heart muscle. The body responds to this oxygen deprivation with pain (many people refer to the pain as tightness or pressure) in the chest, arms, shoulders, neck and/or jaw. Some people also experience shortness of breath, fatigue, sweating, dizziness and/or vomiting. It is most frequently caused by narrowing of the coronary arteries. The narrowing is due to buildup of fatty deposits (plaque or Atherosclerosis) within the artery walls.
Remember, you may not have chest pain as your heart disease equivalent. If you have symptoms that are not readily explained, always think about heart disease. It is the number one disease that affects Americans. Do not ignore your warning signs, as they may be an indicator of an impending cardiac event. Angina usually lasts several minutes. If your angina lasts more than 5 minutes, don’t delay in getting help. Dial 9-1-1 right away. Do not drive yourself to the hospital.
There are two types of angina:
Stable angina typically occurs when you exercise or feel stress, so it is somewhat predictable, and it feels the same way each time. Stable angina usually disappears when you rest and/or take your medication.
Unstable angina is less predictable and may occur even when you rest. It can occur more frequently, feel more severe, and/or last longer than stable angina. Your doctor may be more concerned about unstable angina, since it can mean there is a blocked artery in your heart. In some people, unstable angina can be a sign of a heart attack.
What is the cause?
Angina is most often caused by plaque buildup in the coronary arteries (heart arteries). Plaque is made up of fatty substances, like cholesterol, in your blood. The plaque builds up slowly, over a number of years. In time, plaque can harden and narrow the coronary arteries. Eventually the plaque can slow or block blood flow to the heart, cut off the oxygen supply, and cause angina.
Atherosclerosis is the general medical term for plaque buildup that clogs arteries. Coronary artery disease (CAD) is the medical term for atherosclerosis in the coronary arteries in particular. Angina, therefore, often results from atherosclerosis and from CAD.
Of course, chest pain is not always caused by reduced oxygen supply to the heart. Sometimes, chest pain is not related to heart vessel blockages at all. It could instead be related to valvular heart disease, other structural heart disease, or a lung condition.
How is chest pain evaluated?
If you have angina, your doctor may suggest one or more tests to find out the underlying cause. The test results can also help your doctor choose the best treatment(s) for you.
What are the treatment options for angina?
There are a variety of treatment options for angina which are targeted according to the cause of the pain. They include:
Procedure(s) that open narrowed arteries (for example, Angioplasty) and Coronary Artery Bypass Surgery
Medication(s) (such as Nitroglycerin, Beta Blockers, Calcium Channel Blockers) and ACE Inhibitors
Lifestyle changes to reduce your risk factors (e.g. smoking cessation, exercise, diet, etc).
Changing your lifestyle to reduce your risk factors is one of the most important steps you can take to improve your overall cardiovascular condition.
Heart disease is the #1 killer of men AND women. How can it be prevented and can it be reversed?
In this video, Dr. Prerana Manohar of the Heart and Wellness Institute and other panelists discuss the answers to these questions.
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About 85-90% of heart disease is preventable. Many things a person does in the course of a day affects the heart- what is eaten, habits formed (from exercise to smoking), quality of sleep, the environment, and stress. These heart health factors can be controlled and making changes in the necessary areas can certainly prevent and even reverse heart disease and the underlying symptoms.
Experts agree diet plays a very important role in heart, health. “Diet†in this case, simply means what is eaten, not restricting calories. Issues such as high blood pressure, high cholesterol, and diabetes all increase a person’s risk of heart disease. Blood pressure, cholesterol, diabetes, and other food related health issues will be controlled if healthy diet choices are made and the risk of heart disease as a result will be diminished.
Exercise is also very important in having a healthy heart. Dr. Manohar recommends a half hour of exercise every day, even if it is just a brisk walk. And if that’s not feasible, at least a half hour four to five times a week is recommended. For every half hour of exercise done, the risk of heart disease is lowered by 10%.
The quality of sleep a person gets is also an important factor in preventing heart disease. Repeated low oxygen levels, as seen with sleep apnea, have a significant effect on the heart and can even lead to congestive heart failure.
Not only do smoking and second hand smoke have a detrimental effect on the heart, but recent studies have shown a correlation between smog and pollution and the occurrence of coronary artery disease. This is why it is important to NOT smoke, to try and stay away from second hand smoke, and to protect the environment.
Dr. Manohar suggests preventing heart disease and reducing risk by meeting with one’s primary care physician to assess risk and make a plan of action. This should include eating right, exercising regularly, getting good quality sleep, and getting rid of bad habits. Then, the risk factors, plan of action, and actions taken should be reassessed regularly. This action plan and regular assessment will contribute to a healthier heart.
With some lifestyle changes and continuous healthy choices, heart disease risk CAN be reduced and even reversed.
Thrombosis is the presence of a blood clot within an artery or vein.
This blood clot has the potential to break away from an artery or vein and either partially or completely block the flow of blood to a particular area of the body. Depending upon the area of blockage, this can result in a variety of debilitating or fatal conditions, including stroke and heart attack.
How does a blood clot occur?
When the flow of blood slows down, usually due to inactivity, illness, or injury, the blood may collect in a small pool. If this pool of blood hardens or coagulates, a blood clot forms. Thrombus formation can also occur from a condition known as endothelial dysfunction. This causes a disruption in the integrity of the inner walls of blood vessels, and is usually associated with high blood pressure and/or diabetes.
How is a Blood Clot detected?
Blood clots are difficult to detect, as they often do not cause any symptoms. Doctors will often look for a blood clot following a surgical procedure (especially a knee or hip replacement surgery). If your doctor suspects that you may have a blood clot, he or she will order any of the following tests to make the diagnosis:
Doppler Ultrasound
Angiography
Computed Topography (CT) Scan, especially if they suspect a clot in the lungs
Ventilation-Perfusion Scan (Nuclear lung scan) if clot is suspected
What are the treatment options for a blood clot?
To treat thrombosis, your physician may prescribe medications or perform specific procedures. Much of the treatment depends upon the severity of the blood clot.
Medications
There are three types of medications your doctor may prescribe:
Anti-Coagulants weaken blood clots and prevent them from expanding in size
Thrombolytic agents dissolve blood clots, and are generally prescribed for larger, more dangerous clots; the most common thrombolytics are TPA (Tissue Plasminogen Activator) and TNK (a newer version of TPA)
Antiplatelet Agents are preventive drugs, and work to avoid new clot formation
Various therapies and procedures can also destroy Blood Clots. These are described below.
Intravenous (IV) Therapy
Thrombolytic Therapy: Thrombolytic agents, such as streptokinase or TPA, can be given intravenously (IV) to dissolve larger clots in the blood vessels. Thrombolytic therapy requires hospitalization to 1) administer the IV drug and 2) monitor patients for complications usually related to excessive bleeding.
Procedures
Patients who cannot tolerate anti-coagulant medications due to allergies or excessive bleeding, or who develop a pulmonary embolism, may require a minimally invasive procedure such as filters or thrombectomy (embolectomy) to destroy blood clots.
An atrial septal defect (ASD) is a hole in the wall (called the septum) that separates the right and left atria.
This hole allows a portion of the blood coming back from the lungs to pass from the left atrium to the right atrium, and then back to the lungs, without passing to the body. The proportion of the blood coming back from the lungs that passes through the hole depends on the size of the hole. If the hole is large enough, then the blood passing through the hole will cause the right atrium and right ventricle to be enlarged, and the excess blood flow to the lungs could cause damage to the small arteries in the lungs.
What are the warning signs and symptoms of atrial septal defect? There usually are no obvious signs or symptoms of an atrial septal defect in a newborn or a child. Occasionally, growth will be slow or there may be more frequent pulmonary infections. A long-standing enlargement of the right heart may cause abnormal heart rhythms in adults.
How is atrial septal defect detected? An abnormal heart murmur is usually the first clue to the presence of congenital heart disease. Often an echocardiogram will be obtained which documents the presence of the atrial septal defect. It is important to precisely determine the location and size of the hole using surface and transesophageal echocardiography.
What are the treatment options for atrial septal defect? A small atrial septal defect generally does not cause complications in childhood and no treatment is required. If found in infancy, many of these small atrial septal defects will close on their own over time.
If the atrial septal defect is large enough to cause cardiac enlargement, and has not gotten any smaller after several years of age, then closure of the atrial septal defect is warranted. For many years, the mainstay of treatment was open-heart surgery, either by simply stitching the hole closed or by sewing a patch over the hole to close it. The patch is generally obtained from the wall of the sac surrounding the heart.
A newer, non-surgical approach to atrial septal defect closure has been developed and is becoming widely used. In this procedure, a catheter is threaded from a vein in the groin, up through the venous system to the right atrium, and then across the hole. An umbrella-like device is then threaded through the catheter and placed in a position that straddles the hole to seal it. The catheter itself is then removed.
Atrial fibrillation is the most common cardiac arrhythmia, or abnormal heart rhythm seen today.
Approximately 2.2 million Americans suffer from this disorder. On average, there are 160,000 new cases of diagnosed each year. Atrial fibrillation is a disorder in which the upper two chambers of the heart no longer beat in a normal, synchronized fashion. Rather, electrical impulses move about both atria in a chaotic, or circus-movement pattern, resulting in activation of the atria at somewhere between 400 and 600 times per minute. The impulses coursing through the atria traverse through a structure called the A-V node to reach the ventricles. The hallmark of atrial fibrillation is an irregular rhythm where the ventricles, or bottom pumping chambers of the heart, beat in a very chaotic fashion.
What are the warning signs and symptoms of atrial fibrillation?
Individuals with atrial fibrillation may have heart rates that are too slow, too fast, or within the normal range. Individuals with atrial fibrillation may experience no symptoms, limited symptoms in the form of palpitations, or catastrophic symptoms such as loss of consciousness due to rates which are either too fast or too slow. A major risk of atrial fibrillation is stroke, with the incidence of stroke approximately five times that of similar-aged individuals who do not have atrial fibrillation. The risk factors which appear to increase the risk of stroke in individuals with atrial fibrillation include age greater than 65 years, presence of diabetes mellitus, presence of hypertensive heart disease, congestive heart failure, mitral stenosis (tight mitral valve), or history of prior stroke or near-stroke (Transient Ischemic Attack). The risk of stroke in individuals with atrial fibrillation may be significantly reduced by use of anticoagulant therapy in the form of Warfarin.
What are the treatment options for atrial fibrillation?
Treating atrial fibrillation varies by individual. Your doctor will take a thorough history and perform a comprehensive physical examination to determine if your atrial fibrillation is due to another problem, such as hypertension, coronary artery disease, valvular heart disease, or thyroid dysfunction. Oftentimes, the atrial fibrillation is resolved with the treatment of these primary problems.
If the atrial fibrillation is not corrected by resolution of the primary problem, the patient is oftentimes anti-coagulated for three to four weeks, and subsequently cardioverted back to normal rhythm. Cardioversion may occur in the form of an anti-arrhythmic medication either orally or intravenously, or by the administration of electric shock therapy through patches placed on the chest. Electrical cardioversion occurs in a hospital setting, with the patient under brief general anesthesia for two to three minutes. Following cardioversion, patients are frequently kept on anticoagulant therapy for a minimum of three to four weeks to prevent a stroke that may occur up to that period of time following cardioversion. At times, atrial fibrillation is allowed to persist, without an attempt at cardioversion. In that case, the main concern, aside from anticoagulation, is to control the rate of the ventricles, and is typically done with either medical therapy or with use of a pacemaker in combination with A-V Nodal Ablation (see below).
Other Treatment Options
At times, medications do not adequately control the ventricular rate in atrial fibrillation. In these cases, a commonly performed procedure today is to place a pacemaker, either single or dual-chamber, followed by catheter ablation of the A-V Node. While this does not abolish the atrial fibrillation itself, or the need for anticoagulant therapy, it does abolish the slow or rapid ventricular response that may occur, and allows the patient to have a regular, normalized heartbeat.
One of the newer procedures for atrial fibrillation involves placing catheters into the left atrium near the pulmonary veins, which are the vascular channels that drain blood returning from the lungs to the heart. Atrial fibrillation today is thought to originate from small islands of tissue within the pulmonary veins, and catheter-ablation at the entrance of the vein into the left atrium may prevent the atrial fibrillation from occurring.
Aortic dissection is a tear or partial tear in the lining of the largest blood vessel in the body, the aorta.
This tear allows blood (and the pressure of the blood flow) to penetrate the arterial wall. Over time, this continuous flow can cause the aorta to rupture–a condition that most people do not survive. There are two types of aortic dissections, although sometimes both conditions occur:
Type A: A dissection to the ascending aorta is classified as a Type A dissection. These dissections can be treated with interventional catheterization or open surgical techniques.
Type B: A dissection of the descending aorta is classified as a Type B dissection. These dissections are most often treated medically with routine monitoring and prescribed medications. There is a surgical option, but it carries substantially increased risk of paralysis.
What are the warning signs and symptoms of aortic dissection?
Aortic dissections are commonly found in people with atherosclerosis, high blood pressure, in individuals with a family history of aortic (or thoracic) dissection and are more rarely associated with congenital cardiovascular disorders (Marfan’s syndrome, Ehlers-Danlos syndrome, and congenital valvular disorders).
“Stabbing” pain in the back is a common symptom of an aortic dissection. In some cases, people present with pain in the chest. This pain may be confused with angina (commonly referred to as “chest pain” and a warning sign of a possible heart attack). The main difference between pain resulting from dissection of the aorta, and angina due to lack of blood supply to the heart muscle, is its sudden and intense onset. The pain is characterized as a “ripping” or “tearing” sensation. This sudden pain can be felt in the back, chest, neck, or jaw.
These are important differences to understand. Why? Because a common recommendation to those with angina or “chest pain” (that may result in a heart attack) is to chew an aspirin to thin the blood. This is NOT the case if you are experiencing an aortic dissection. Thinning the blood for a person with aortic dissection may cause more blood to leak out of the aorta. This internal bleeding can lead to death.
In some cases, people do not experience any pain. Instead, you may experience distorted mental capacity (due to lack of blood supply to the brain) or numbness or tingling sensation in the arms or legs (due to lack of blood supply to the spinal cord). If you or someone you know is experiencing any of the above symptoms, call 9-1-1 immediately to get to a hospital. The survival rate increases dramatically the sooner a person is treated for an aortic dissection.
How is an aortic dissection detected?
The key to diagnosing an aortic dissection is to confirm that it is in fact a dissection and not a heart attack, and which type it is (as the treatment options vary significantly).
The gold standard for diagnosing aortic dissection is a computed topography (CT) scan. Other imaging studies may be required to identify the type and location of the dissection. These include:
Echocardiogram
Magnetic Resonance Imaging (MRI)
Peripheral Angiography
What are the treatment options for an aortic dissection?
Three treatment options are offered for an aortic dissection: 1) medical management, 2) interventional catheterization, and 3) cardiovascular surgery. Depending upon the location and severity of the dissection, your physician will decide which option is best for you.
A small percent of cases (5 – 10%) are Type B dissections (dissections of the descending aorta). This condition can be treated with surgical repair, but it carries significant risk. Typically, your doctor will monitor the condition periodically and prescribe medications to control the dissection.
The techniques used to treat dissections are as follows: Medical Therapy: Blood pressure and cholesterol lowering drugs, and treatment to reverse arteriosclerosis
Endovascular Intervention: This minimally invasive procedure requires small incisions in the groin. Small wire-like, catheter devices called endoluminal stent grafts are threaded to the location of the dissection. These devices have a woven synthetic graft tip, which is deployed at the site of dissection and left in place. This provides a channel for blood to flow freely, repairing arterial leakage, and preventing pressure from rupturing the aorta. This procedure is much less invasive than the traditional open surgery. Please note: This procedure can only be performed on specific patients based on clinical criteria, and no long-term data exists regarding its effectiveness compared to open surgery.
Open Surgical Repair: The traditional treatment technique involves opening the chest and surgically removing the dissected aorta. A synthetic graft is sewn in its place for blood to flow freely to the rest of the arterial system.
Aneurysms can occur in any blood vessel in the body, but the most common type arises in the largest artery in the body—the aorta. This condition affects over 200,000 Americans and is referred to as an Abdominal Aortic Aneurysm (AAA).
An aneurysm is a bulging of an artery caused by uncontrolled hypertension or injury or weakness to the artery itself. The pressure from blood flow against the arterial wall causes the aneurysm to slowly grow in size, giving it its bulging characteristic. Typically, atherosclerosis (plaque buildup within the arterial wall) is present.
An AAA is a very serious condition that claims the lives of 15,000 Americans every year. As the aneurysm continues to grow, it has the potential to rupture or leak. If this occurs, more than half of these individuals go into shock and die as a result of massive internal bleeding. The key is to detect an AAA at its earliest stage so it can be properly treated.
What are the warning signs and symptoms of an Aneurysm?
Abdominal Aortic Aneurysms (AAAs) are referred to as “the silent killerâ€, as the majority of people do not have symptoms. However, AAA can sometimes present with the following:
AAA’s are most common in people over the age of 60
70% to 80% of AAA’s are in males; however, as more women are diagnosed with cardiovascular disease, this statistic is changing
High blood pressure, smoking, and high cholesterol levels have all been shown to increase the risk of developing an Abdominal Artic Aneurysm.
20% of people with AAA’s have a family history of either cardiovascular disease or aneurysms
If you have one or more of the above risk factors, we recommend that you discuss with your doctor certain tests that can detect an AAA early so it may be properly treated.
Sometimes, people will experience these symptoms that suggest the presence of AAA:
Pain in the abdomen, back, or flank (side)
An overwhelming feeling of “fullness†after eating even a small amount of food
Frequent nausea and vomiting
Pulsating in the abdomen—for example, when reading a book that is resting on the abdomen, the book moves up and down
If you experience any of the above symptoms, you should be evaluated by a doctor immediately. Prompt action may prevent a life-threatening situation.
How is an Aneurysm detected?
Abdominal Aortic Aneurysms are sometimes detected during a routine physical examination. Your physician may hear pulsations in your abdomen (also called bruits) with a stethoscope. However, they are usually difficult to detect (especially in persons who are overweight). If your physician suspects that you may have an aneurysm, either due to pulsations in the abdomen or other risk factors such as family history, high blood pressure, high cholesterol, old age, etc., he or she will likely perform any of the following imaging studies to make the diagnosis:
Doppler Ultrasound
Chest or abdominal X-Ray
CT Scan
Magnetic Resonance Imaging (MRI)
What are the treatment options for an Aneurysm?
Once an Aneurysm (including AAA) is diagnosed, your physician will determine the appropriate treatment depending upon its size and location. If the Aneurysm is small, your physician will likely monitor its growth with repeated ultrasound imaging. If it is large (greater than 5 centimeters), or is growing rapidly and showing signs that it might rupture, an interventional catheterization or surgery may be required.
Tilt Table Testing can be a very useful test for determining the cause of your symptoms.
The test starts with you lying on a special bed with a footboard and a motor that allows your doctor to tilt the bed at different angles. You will have an intravenous line (IV) in your arm to give you medications and/or fluids during the procedure if you need them. The goal will be to reproduce your symptoms and see how your heart rate, rhythm, and blood pressure respond. You may feel no symptoms at all; you may feel lightheaded, dizzy, nauseous, palpitations, blurred vision, or you may faint. You will, however, be continuously monitored and under constant medical care and supervision.
Why do I need a Tilt Table Test?
A Tilt Table Test is used to evaluate the cause of unexplained fainting spells or severe lightheadedness. The procedure is also used to evaluate heart rhythm, blood pressure, and symptoms with change of position.
How long does a Tilt Table Test usually take?
A Tilt Table Test usually takes approximately 1 hour, but plan to spend 3 hours from the time you arrive through the time that you leave.
