Congestive Heart Failure
Special to the Journal by
Brian Marino, DO
Congestive heart failure is
very common and affects close to 6 million people in the United States. Among
people age 65 and older, it is the leading cause of hospitalization.
What is congestive heart
Congestive heart failure
(CHF) is the inability of the heart to pump blood as well as it should. This
inadequacy leaves a person with CHF feeling fatigued and short of breath. Because
the heart is not functioning normally, fluid can build up in the body, which leads
to swelling (edema) in the ankles, legs, and abdomen. Some people with CHF also
experience nausea and loss of appetite.
There are two different
types of heart failure. Systolic heart failure is due to a weak heart muscle
that cannot squeeze with sufficient force to pump oxygen-rich blood to the
body’s organs and tissues. Diastolic heart failure is a condition in
which the walls of the heart have grown stiff and cannot relax enough to fill
with a normal amount of blood.
Who is most at risk for
The most common risk factors
for CHF are coronary artery disease or a prior heart attack, high blood pressure,
diabetes, heart valve disease, excessive alcohol use, smoking, obesity, sleep
apnea, and uncontrolled irregular heart rhythms (arrhythmia). Risk for CHF
increases as people age into their senior years.
How is CHF diagnosed?
Diagnosis is suspected based
on the patient’s symptoms, physical exam, and the results of an EKG
(electrocardiogram). Confirmation requires an echocardiogram (which produces
images of the heart using sound waves) and sometimes even a chest X-ray and
An echocardiogram determines
the ejection fraction of the heart, which is the percentage of blood ejected
from the heart each time it beats. If the ejection fraction is normal the
patient likely has diastolic CHF. In a case of systolic CHF, the ejection
fraction will be low.
How is CHF treated?
If you are diagnosed with
CHF, there are a number of steps you can take. First of all, if you are a smoker
you should quit. Patients should stay active, follow a low-sodium diet, limit
alcohol intake, and keep blood pressure controlled. Some people require
diuretics (water pills) to reduce fluid build-up. Additionally, if there is a
specific, related problem to be treated, you and your doctor can address it.
Repairing or replacing a faulty heart valve, placing a stent to restore full
blood flow to a blocked artery, treating sleep apnea, or getting a heart arrhythmia
under better control can sometimes let the heart function normally and resolve
If you have systolic heart
failure, there are a several medications that have proven to be helpful in
improving symptoms and preventing progression of CHF. Unfortunately, there are
currently no specific medications to treat diastolic heart failure, although it
is an active area of research right now.
Through the collaborative
relationship between Cayuga Medical Center’s Cayuga Heart Institute and the
Sands Constellation Heart Institute at Rochester General Hospital in Rochester,
NY, area residents with CHF have access to the entire range of treatment options.
The latest in medical management, echocardiograms, nuclear stress testing,
placement of ICDs (internal cardiac defibrillators) for systolic heart failure,
cardiac catheterization, percutaneous coronary intervention and more is
available in Ithaca through the Cayuga Heart Institute. CHF patients requiring
open-heart procedures, such as valve repair or replacement or bypass surgery,
are referred to the Sands Constellation Heart Institute, where they are seen
quickly. This is one of the valuable benefits of the close working relationship
between the two institutions and their cardiology specialists.
Dr. Marino serves on the
medical staff of the Cayuga Heart Institute and is in practice with Cayuga
Medical Associates, where he can be reached at (607) 272-0460. He is board
certified in nuclear cardiology and echocardiography. Dr. Marino completed his
cardiology fellowship at New York-Presbyterian Queens, which is an affiliate of
Weil Cornell Medical College.