What is wrong with me? Part 2

As I said in Part 1, one of the more horrible side effects of obstructive hypertrophic cardiology is congestive heart failure. I have been in heart failure for the past 7 years now. I've spent many hospital visits trying to regulate my heart, and to bring my heart failure back into less than the heart threatening problem that brought me into the hospital in the first place.

Heart failure, also called congestive heart failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.

Causes, incidence, and risk factors

Heart failure is a chronic, long-term condition, although it can sometimes develop suddenly.The condition may affect only the right side or only the left side of the heart. These are called right-sided heart failure or left-sided heart failure. More often, both sides of the heart are involved. In my case, both sides are affected.



Heart failure is present when the following changes are present:

• Your heart muscle cannot pump, or eject, the blood out of the heart very well. This is called systolic heart failure.
• Your heart muscles are stiff and do not fill up with blood easily. This is called diastolic heart failure.

Both of these problems mean the heart is no longer able to pump enough oxygen-rich blood out to the rest of your body, especially when you exercise or are active. As the heart's pumping action is lost, blood may back up in other areas of the body, causing fluid to build up in the lungs, the liver, the gastrointestinal tract, and the arms and legs. As a result, there is a lack of oxygen and nutrition to organs, which damages them and reduces their ability to work properly. In my case, the edema (water retention) pools more in my abdomen and legs. I can see how badly the swelling is in my face, too.



Perhaps the most common cause of heart failure is coronary artery disease (CAD), a narrowing of the small blood vessels that supply blood and oxygen to the heart. Heart failure can also occur when an infection weakens the heart muscle. Such a disorder is called cardiomyopathy.
Other heart problems that may cause heart failure are:

• Congenital heart disease
• Heart attack
• Heart valve disease
• Some types of abnormal heart rhythms (arrhythmias)

Diseases such as emphysema, severe anemia, hyperthyroidism, or hypothyroidism may also cause or contribute to heart failure.

Symptoms

Symptoms of heart failure most often begin slowly. At first, they may only occur when you are very active. Over time, breathing problems and other symptoms may be noticed even when you are resting. However, heart failure symptoms may begin suddenly after a heart attack or other heart problem. Common symptoms are:

• Shortness of breath with activity, or after lying down for a while
• Cough
• Swelling of feet and ankles
• Swelling of the abdomen
• Weight gain
• Irregular or rapid pulse
• Sensation of feeling the heart beat (palpitations)
• Difficulty sleeping
• Fatigue, weakness, faintness
• Loss of appetite, indigestion

Other symptoms may include:

• Decreased alertness or concentration
• Decreased urine production
• Nausea and vomiting
• Need to urinate at night

Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:

• Abnormal heart rhythm (arrhythmias)
• Anemia
• Hyperthyroidism
• Infections with high fever
• Kidney disease

Signs and tests

A physical examination may reveal the following:

• Fluid around the lungs (pleural effusion)
• Irregular heartbeat
• Leg swelling (edema)
• Neck veins that stick out (are distended)
• Swelling of the liver

Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. In my case, my heart murmur signaled my official diagnosis of HCM but made hearing other abnormal sounds more difficult.

The following tests may be used to diagnose or monitor heart failure:

• Chest x-ray
• ECG
• Echocardiogram
• Cardiac stress tests
• Heart CT scan
• Heart catheterization
• MRI of the heart
• Nuclear heart scans
  
  The most common tests, the ECG, is used at every doctor's appointment and I get an echo several times a year to keep track if my heart's progression.

This disease may also alter the following test results:

• Blood chemistry
• BUN
• Complete blood count
• Creatinine
• Creatinine clearance
• Liver function tests
• Uric acid -blood test
• Sodium - blood test
• Urinalysis
• Sodium - urine test

Treatment

If you have heart failure, your doctor will monitor you closely. Too often, in my opinion. If I don't control it, my doctor's appointments would be all that I do. I see 3 cardiologists and my primary care doctor monthly. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weigh yourself at the same time each day and on the same scale, with little to no clothes on.Weight gain can be a sign that your body is holding onto extra fluid and your heart failure is worsening. Talk to your doctor about what you should do if your weight goes up more than 5 lbs or if you develop more symptoms.

Other important measures include:

• Take your medications as directed. Carry a list of medications with you wherever you go.
• Limit salt intake.
• Do not smoke.
• Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for your degree of heart failure. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
• Lose weight if you are overweight.

Here are some tips to lower your salt and sodium intake:

• Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
• Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
• Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
• Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
• Use oil and vinegar, rather than bottled dressings, on salads.
• Eat fresh fruit or sorbet when having dessert.

MEDICATIONS
Your doctor may prescribe the following medications:

• ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart
• Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)
• Digitalis glycosides to help the heart muscle to contract properly and help treat some heart rhythm disturbances
• Angiotensin receptor blockers (ARBs) such as losartan and candesartan for those who have side effects with ACE inhibitors
• Beta-blockers such as carvedilol and metoprolol, which may be helpful for some patients

Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms. Right now I use metoprolol, spirolactone, torsemide, warfarin, and many other medications.

SURGERIES AND DEVICES
Heart valve surgery, coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.The following devices may be recommended for certain patients with heart failure:

• A pacemaker to help treat slow heart rates or other heart signaling problems
• A biventricular pacemaker to help the both sides of your heart contract at the same time; it is also called cardiac resynchronization therapy.
• An implantable cardioverter-defibrillator that recognizes life-threatening, abnormal heart rhythms and sends an electrical pulse to stop them.  I have one of these implanted and should be replacing it this summer.

Severe heart failure may require the following treatments when other therapies no longer work. They are often used when a person is waiting for a heart transplant:

• Intra-aortic balloon pump (IABP)
• Left ventricular assist device (LVAD)

Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

Expectations (prognosis)

Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress. Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder.

Complications

• Irregular heart rhythms (can be deadly)
• Pulmonary edema
• Total heart failure (circulatory collapse)

As stated before, the next installation of this 3-part post will concentrate on my irregular heart rhythms.

Possible side effects of medications include:

• Cough
• Digitalis toxicity
• Gastrointestinal upset (such as nausea, heartburn, diarrhea)
• Headache
• Light-headedness and fainting
• Low blood pressure
• Lupus reaction
• Muscle cramps

 I tend towards light-headedness, fainting, coughing, headaches, nausea, and WICKED muscle cramps. I don't just get foot and leg cramps, my hands cramp as do my abdominal muscles. Very very painful. The cramping is caused by a potassium and magnesium deficit.  The cure is to take a lot of potassium in gigantic pill form. In the hospital they make me drink potassium, which is vile. Taking diuretics is a constant balancing act, with blood tests galore. It really sucks.

Of all the many bad things about CHF, the worst is taking diuretics. HATE IT. They destroy my ability to lead a normal life.

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