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A USER’S GUIDE OF YOUR HEART: HEART FAILURE
Certainly one of the scariest sounding terms in cardiology, heart failure, sometimes called congestive heart failure, conjures up images of sudden death. While serious, this illness can be treated and patients can live productive lives for years to come.
Heart failure simply means that your heart is unable to pump blood efficiently to all parts of your body. It may accompany or be the result of coronary heart disease or other conditions such as congenital or rheumatic heart disease.
The principle symptoms are shortness of breath, fatigue, weakness, fluid accumulation in the lungs or arms and legs, and increasing inability to recover from exertion. Recovery from physical effort takes longer and longer. Patients may also find they need an extra pillow at night to sleep well. Swelling of the ankles is common, especially at the end of the day. That’s because the heart can’t work hard enough to pump efficiently enough to get fluids out of the spaces between and within body cells. Years ago this condition was called dropsy. Blood pools in the lower extremities and this causes swelling.
While incurable, heart failure can be treated with a variety of drugs. Diuretics are particularly useful in getting the fluid out of the body. And a low-salt diet is in order to prevent additional fluid retention.
In heart failure, the heart compensates for its decreased pumping capabilities in two ways. First it enlarges by stretching its muscle fibres as well as by dilating or widening its vessels. By increasing the size of its chambers and vessels the heart can keep pumping out as much blood as possible. Of course there are limits to just how much a heart can enlarge and, once it is larger, there is increased risk of irregular rhythms. A second, potentially self-defeating, method by which the heart can boost its output is by beating faster. This brings with it a heavy toll. The faster the heart beats, the less time it has to refill with returning blood, thus ultimately pumping a smaller quantity with each beat.
The sophistication with which physicians treat heart failure today allows remarkable control and the best possible quality of life. Ultimately, however, there is no cure, and for those with a life-threatening condition the only remaining treatment is heart transplantation. While that certainly is a last-ditch effort, and a sobering prospect, transplantation becomes increasingly successful with each passing year. It can no longer be viewed as experimental. More than 90 per cent of patients survive after the first year, and long-term survival is now well over 20 years.
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