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Heart Health

Question: What is congestive heart failure?

Answer: A disorder in which the heart loses its ability to pump blood efficiently, thereby failing to meet the demands of the body.

Question: What are the symptoms of congestive heart failure?

Answer: Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from inadequate delivery of oxygen-rich blood to the body's tissues. Since heart failure can progress rapidly, it is essential to consult a physician immediately if any of the following symptoms are detected.

• Weight gain (unintentional)
• Swelling of feet and ankles
• Swelling of the abdomen
• Pronounced neck veins
• Loss of appetite, indigestion
• Nausea and vomiting
• Shortness of breath, especially with activity
• Difficulty sleeping
• Shortness of breath which occurs after lying down for a while
• Fatigue, weakness, faintness
• Sensation of  feeling the heart beat (palpitations)
• Pulse may feel irregular or rapid
• Decreased alertness or concentration
• Cough
• Decreased urine production (oliguria)
• Need to urinate at night (nocturia)
• Infants may sweat during feeds (or other exertion)

Question: What are the lifestyle recommendations for congestive heart failure?

Answer: Between 30% to 47% of patients who require hospitalization for heart failure are back in the hospital again within six months. Many people return because of lifestyle factors, such as poor diet, failure to comply with medications, and social isolation.

Home Support and Rehabilitation Programs

In one study, elderly people who had no emotional support at home had triple the risk of a heart attack after hospitalization for heart failure than those who did have such support. (In women, this risk was eightfold.) In another study, the greatest risk factor for death and readmission to the hospital after a first hospitalization for heart failure was being single, regardless of the health of the patient at discharge. In a number of studies, programs that offer intensive follow-up to ensure that the patient complies with lifestyle changes and medication regimens at home are reducing rehospitalization and costs and improving survival. Patients without available rehabilitation programs should seek support from local and national heart associations and groups.

Monitoring Weight Changes

Heart failure patients should weigh themselves each morning and keep a record. Any changes are important:

• A sudden increase in weight of more than two or three pounds may indicate fluid accumulation and should prompt an immediate call to the physician.
• Rapid wasting weight loss over a few months is a very serious sign and may indicate the need for surgical intervention.

Dietary Factors

Mediterranean Diet. There is some evidence suggesting that the Mediterranean diet helps protect the heart and may even reduce the risk for heart failure after a first heart attack. Its emphasis on whole grains, fish, olive oil, garlic, and moderate, daily intake of wine, may have many benefits for the heart.

• The diet is high in fiber.
• It calls for a relatively high fat intake (about 35% to 45% of daily calories), but primarily composed of monounsaturated and polyunsaturated fats. Included in these fats are omega-3 fatty acids (docosahexaenoic and eicosapentaenoic acids). They are found in oily fish. Studies are indicating that they may have specific benefits for many medical conditions, including hypertension.
• It recommends the same protein intake as the American Heart Association diet, although fish is the primary source.
• Carbohydrate intake is reduced, and the emphasis is on fresh fruits and vegetables.
• Higher amounts of nuts, legumes, and beans are recommended than in standard American guidelines. Nuts are proving to be important for health.
• One study indicated that foods high in nutrients called flavonoids may have some benefit; such foods include tea, apples, onions, and red wine.

Salt Restriction. All heart failure patients should limit their salt intake, and in severe cases, very stringent salt restriction may be necessary. Patients should not add salt to their cooking and their meals. They should also avoid foods high in sodium; these include ham, bacon, hot dogs, lunch meats, prepared snack foods, dry cereal, cheese, canned soups, soy sauce, and condiments. Some patients may need to reduce their water intake as well. People with high cholesterol levels or diabetes require additional dietary precautions.

Exercise

Traditionally, heart failure patients were discouraged from exercising. Now, exercise is proving to be extremely important for many patients with stable conditions, when performed under medical supervision.

General Guidelines.

• Physicians should always be consulted before starting an exercise program.
• People not used to exercising should start with five to 15 minutes of easy exercise with frequent breaks.
• Although the goal would be to build to 30 to 45 minutes of walking, swimming, or low-impact aerobic exercises three to five times every week, any amount of time spent exercising is useful.

Exercising the legs, in fact, may help correct problems in heart muscles in these patients. Some studies report the following:

• Patients who exercise regularly, particularly using supervised treadmill and stationary-bicycle exercises, increase exercise capacity by 14% to 20%.
• Other studies have reported that patients with stable conditions who engage in moderate exercise (twice a week) for a year experience a better quality of life and lower mortality rates.
• One study found that performing daily hand-grip exercises improved blood flow through the arteries of patients with heart failure. This was backed up by another study that suggested that the loss of strength in small muscles, such as those in the hand, may produce as much exercise intolerance as heart failure itself.

Bed Rest

Bed rest may be required in cases of severe congestive heart failure. To reduce congestion in the lungs, the patient's upper body should be elevated; for most patients, resting in an armchair is better than lying in bed. Relaxing and contracting leg muscles is important to prevent clots. As the patient improves, progressively more activity will be recommended.

Warm Baths and Saunas

Experts have traditionally recommended that people with heart failure avoid warm baths, which can increase the heart rate. Now, one study has reported that carefully controlled bathing for short periods may not be harmful and, in fact, may be beneficial, increasing cardiac output and ejection fraction. Warm water may behave like a vasodilating drug, opening up the vessels gently and improving circulation. The people in the study sat in water up to their chests at 106โˆž F or in a dry sauna at 140โˆž F. In both situations they sat for 10 minutes with their torsos tilted at 45 degrees. None of them experienced pain in the heart, shortness of breath, or irregular heart beats.

Warning Note: Prolonged periods in hot or even warm conditions can be dangerous, however. Any patient with heart failure should consult the physician first, not bathe unaccompanied, and be sure that the temperature does not go above those described in this report for either water bathing or dry saunas.

Stress Reduction

Stress reduction techniques may have direct physical benefits lowering stress hormones, including cortisol (which suppresses the immune system) and norepinephrine (also known as adrenaline), the chemical messenger associated with heart dysfunction. Many effective stress reduction techniques, including meditation and relaxation methods, are available.

Alternative Remedies

A small study reported that taking capsules L-arginine, found in health food stores, may have some benefit. This amino acid appears to reduce endothelin, a protein that causes blood vessel constriction and is found in high amounts in heart failure patients.

Some small studies suggest that coenzyme Q (CoQ10) may have some value for patients with heart failure, particularly in combination with vitamin E. CoQ10 is a vitamin-like substance found in organ meats and soybean oil. More recent studies, however, have found no effect on the heart or the quality of life with CoQ10 or vitamin E.

It is important to stress that no supplement or diet can cure heart failure.