Congestive Heart Failure
by Beth G. Hodges, MD

Congestive heart failure means that the heart, which is essentially just a pump, is not doing its job well and blood is getting backed up, sort of like a clogged drain.

There are two main types of congestive heart failure: systolic and diastolic. Each name differentiates for doctors whether the problem is with blood coming into the heart or blood going out of the heart.

Systolic heart failure is a problem with the pump squeezing blood out of the heart to go to all the organs of the body. If the pump strength is weak, not enough blood is squeezed out. Pretty quickly, blood will start to pool in the venous system, leading to swelling in the legs and some of the internal organs, including the lungs. In systolic heart failure, the ejection fraction, or "pump efficiency" is compromised.

A normal ejection fraction is from 55-70%. Anything under 45% is considered heart failure and the lower the number, the worse the prognosis. An ejection fraction of 35% or less increases the risk of abnormal heart rhythms, which can be fatal, and a person with an ejection fraction of less than 20% has on average about 6 months' life expectancy. That having been said, there are many good medications available, some of which can improve the ejection fraction of the heart.

Diastolic heart failure is a problem with the heart muscle not relaxing fully to allow the chambers to fill with blood before pumping. It does not effect the ejection fraction, but does cause problems on its own. Think about it like this: A person fills a glass full of water, then pours it over a plant. A second person comes in, fills a glass halfway with water, and pours it into the next plant. Both people poured 100% of their water into the plants, but one plant ended up getting a much better drink than the other, because it had more water to start.

Diastolic heart failure also can result in blood backing up and pooling in the legs and lungs and internal organs. This type of heart failure is more common in women, especially those who have had high blood pressure for many years.

High blood pressure means the heart has to pump harder against the pressure in the arteries to move blood forward. After many years, that hard work causes the muscle of the heart to become very large, or hypertrophied. Think of it like one of those body builders whose muscles are so big, he can hardly move around like a normal person. That is exactly what happens to the heart muscle. It loses the flexibility it had to relax and fill completely with blood before it has to pump out again.

Regardless of the type of heart failure, once it has been diagnosed, the important thing is to be compliant with the medication prescribed by the doctor, restrict salt in the diet (as salt causes the body to hang onto extra fluid), and hop on the scale each morning to check body weight. A sudden increase of three or more pounds could be an early indicator of worsening heart failure and the doctor should be called. Many people now live for years with a diagnosis of heart failure, but only if they take the disease seriously and are proactive about the management.

Published - September, 2009