Health Talk
Congestive heart failure
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By J. CHRISTIAN HIGGINS, M.D. - Published: January 30, 2008
February is American Heart Month. Congestive heart failure is a leading cause of death and disability among adults older than 65.
The risk factors that are associated with congestive heart failure are similar to those associated with coronary heart disease and heart attacks.
These are high blood pressure, diabetes, high cholesterol and tobacco use. There are other risk factors, but those mentioned are among the most obvious, the most preventable and the most treatable.
Medical therapy and newer device therapies have come a long way in treating the symptoms of CHF and preventing its progression.
The cause of congestive heart failure is identified in only two out of three cases.
Coronary artery disease is responsible for the vast majority, while presumed viral infections account for the majority of the remaining cases. Other causes include valvular diseases, infiltrative processes and high blood pressure. While medications have come a long way, the best treatment strategy is still one of prevention.
The main classes of medicines that are used to treat CHF are ACE inhibitors, beta blockers, digoxin, and diuretics such as furosemide and spironolactone. Diuretics cause a patient to get rid of excess fluid and help relieve symptoms of shortness of breath and fatigue while the ACE inhibitors and beta blockers are aimed at halting disease progression.
The Auto Implantable Cardio Defibrillator (AICD), better known as the "shock box," provides rescue defibrillation and pacemaker backup in the event of life-threatening heart arrhythmias.
These devices are about the size of a pack of cigarettes and can decrease the risk of death from rhythm disturbances by approximately 25 percent in the right group of patients. The latest generation of devices are quite sophisticated in their diagnostic accuracy and relatively small in size. They will generally last 5-6 years before needing to be replaced.
The more sophisticated brother to the standard AICD is the BiVentricular AICD, which not only provides standard AICD protection, but also helps to restore intrinsic cardiac synchronicity.
In other words, the heart's natural rhythm and sequential order of electrical activation is mimicked by this device, restoring order to what has become a less orderly sequence of electrical events. Your cardiologist is the best person with whom to discuss whether these devices may be appropriate for you.
The treatment of congestive heart failure has become quite sophisticated and now includes an advanced medical regimen sometimes accompanied by device therapy. Together they can decrease symptoms, increase longevity and provide a better overall quality of life. Check with your cardiologist if you have questions about any of the treatments discussed here.
This week's Health Talk article was written by J. Christian Higgins, M.D., director of cardiovascular services at Rutland Regional Medical Center.
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