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Subject:	A colleague recommends Congestive Heart Failure: An American Epidemic
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If you've been diagnosed with congestive heart failure or know someone who has, you're not alone. Nearly five million Americans of all ages are currently living with this condition, with 400,000 new cases diagnosed each year. Although there is no known cure, new treatments are helping patients with heart failure to live full, enjoyable lives.

What is heart failure?

Despite the way it sounds, heart failure does not mean that the heart has "failed" or stopped beating. Rather, the term means that the heart can't pump enough blood to meet the needs of the body's other organs. This can result from:

• Narrowed arteries that supply blood to the heart muscle (coronary artery disease).
• Past heart attack (myocardial infarction) with scar tissue that interferes with the heart muscle's normal work.
• High blood pressure.
• Heart valve disease due to past rheumatic fever or other causes.
• Defects in the heart present at birth.
• Primary disease of the heart muscle (cardiomyopathy).
• Infection of the heart valves and/or heart muscle (endocarditis and/or myocarditis).

Although congestive heart failure may strike at any age, it is more common in people over the age of 65.

What are the symptoms?

According to Gurinder Dhillon, M.D., FACC, FRCP, an interventional cardiologist at John Muir Medical Center, Concord Campus, the most common signs of congestive heart failure are swelling (edema) in the legs and ankles, extreme fatigue and difficulty breathing. "Everyday activities such as walking, climbing stairs, carrying groceries and yard work can become quite difficult," Dr. Dhillon says. "Another symptom is weight gain because of the build-up of fluid."

Can it be cured?

"Congestive heart failure is a serious condition—and there is usually no cure," explains interventional cardiologist Christopher Wulff, M.D., FACC, director of the cardiac catheterization laboratory at John Muir Medical Center, Walnut Creek Campus. "There are several new treatments that have shown promise in improving a patient's heart function. However, even when we can render someone asymptomatic, we don't feel comfortable using the term 'cure.'"

How is heart failure diagnosed?

Your physician is the best person to diagnose congestive heart failure. He or she will order a number of tests when exploring a possible diagnosis of heart failure. Many of these tests are painless and simple. The most important test is an echocardiogram, which tells your physician how well your heart is pumping.

"Remember that early diagnosis and treatment are very important," Dr. Wulff emphasizes. "So if you think you may be at risk for heart failure, visit your physician as soon as possible."

How is congestive heart failure managed?

If you are diagnosed with congestive heart failure, there are a number of medications that work together to improve your symptoms and help keep your heart failure from getting worse. Taking these medicines, in addition to eating right and getting regular exercise, will help improve your health.

Heart failure usually requires a treatment program of:

• Rest
• Proper diet
• Modified daily activities
• Medications (such as ACE inhibitors)
• Beta blockers
• Digitalis
• Diuretics
• Vasodilators

The various drugs used to treat congestive heart failure perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance, allowing blood to flow more easily and making the heart's work easier or more efficient. Beta blockers can improve the function of the left ventricle. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water.

"Congestive heart failure is an American epidemic," Dr. Dhillon says. "However, there are many healthy choices heart patients can make to avoid this problem and increase life expectancy. Regular contact with a physician, including blood pressure checks, is paramount. Following a healthy diet, weight control and limiting salt intake are essential. Exercise can also have a positive impact.

"Exercise is like taking your medication," Dr. Dhillon adds. "It's only good for so long. You have to take it regularly!"

Advanced treatments for heart failure

Recently, there have been some major steps forward in treatment. Today, physicians can do more than ever, so many people with congestive heart failure can live normal lives and be less at risk for being hospitalized. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, in some cases heart failure can be managed by treating high blood pressure. Some cases may be treated with surgery to replace abnormal heart valves. Still, when the heart becomes so damaged that it can't be repaired, a more drastic approach, such as a heart transplant, may be considered.

"The most recent medical advancement in the treatment of congestive heart failure is the biventricular pacemaker," Dr. Wulff says. "This device, which paces the right and left ventricles simultaneously, has been shown to improve heart function in patients with severely impaired pumping capacity and the newest evidence suggests that it can even prolong life."

Cardiac Rehabilitation

Medically supervised cardiac rehabilitation programs are offered at both campuses. Physician referral required.
For more information call:
John Muir Medical Center, Concord Campus
(925) 674-2200
John Muir Medical Center, Walnut Creek Campus
(925) 947-5254

Congestive Heart Failure
Exercise Classes

This cardiac rehabilitation program is designed to meet the needs of patients with congestive heart failure.
Physician referral is required.
Held at John Muir Medical Center, Walnut Creek Campus.

Congestive Heart Failure
Education Series

A free 4-week educational program for individuals with heart failure and their caregivers. Covers general information about heart failure, medications, nutrition, exercise and support.
Held at John Muir Medical Center, Walnut Creek Campus.
For more information call:
(925) 947-4452