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more articles by Marino, Brian , DO, FACC  |  author's bio

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 failure?

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 developing CHF?

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 blood work.

 

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 the problem. 

 

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.

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