The Truth About
You need serious intervention once your heart starts losing its pumping power.
The best solution is prevention.
By Lisa James
Heart failure is one of the most confusing terms in all of medicine—and one of the scariest when coming from your doctor’s lips: What do you mean, my heart is failing? “It’s quite a fearful term for many patients,” says Justine Lachmann, MD, FACC, director of the congestive heart failure program at St. Francis Hospital (www.stfrancisheartcenter.com) in Roslyn, New York. “The words may be more fearful than the condition.”
Heart failure is not cardiac arrest, in which the heart stops beating. Rather, heart failure, or HF, is a collective term for “signs and symptoms of fluid buildup,” explains Eileen Hsich, MD of the Cleveland Clinic (www.clevelandclinic.org). “It may be caused by a strong heart that does not relax or a weak heart that cannot pump properly.”
According to the American Heart Association, 5.7 million people in the US have HF, and the rate is rising because we as a nation are growing older. “Medical interventions are allowing people to live longer,” Lachmann says. “The presence of HF is increasing exponentially in people over the age of 65.”
To understand HF it helps to know some basic cardiac anatomy. The heart has four chambers, two on each side of a inner wall called the septum. The upper chambers, or atriums, take blood in; the lower ones, or ventricles, pump it out. Blood enters the right side of the heart and is sent to the lungs, where it picks up oxygen. It then enters the left side, from where it is circulated throughout the body. A system of valves controls blood flow in and out of the different chambers.
The term “heart failure” covers any situation in which the heart cannot circulate blood the way it should. If it affects the right side, blood can back up in the veins, the vessels that carry blood to the heart, causing swollen legs. If it affects the left side, fluid can gather in the lungs, causing shortness of breath and dry cough; as blood flow drops fluid can collect in the body’s tissues, a condition called edema. Reduced circulation can also cause fatigue, weakness and dizziness.
The term congestive heart failure is used to describe HF marked by fluid accumulation. However, the more accurate terminology is “decompensated and compensated heart failure, depending on if the patient is retaining fluid or not,” according to Hsich. HF can also be described as systolic, in which a weak chamber is unable to provide adequate pumping power, and diastolic, in which a thickened chamber cannot relax enough to fill completely with blood between heartbeats.
A number of underlying conditions can cause the heart to go into failure. “A heart attack results in the death of heart muscle,” says Lachmann. “Cardiac muscle does not regenerate, so eventually the heart becomes an inefficient machine.” Diabetes and high cholesterol raise the risk of heart attack and coronary artery disease (CAD), or the presence of blockages in the arteries feeding the heart. Both conditions raise the risk of HF as well.
High blood pressure is present in 70% of all people with HF. “What happens is that the heart is constantly pumping against force; it’s like opening a door against a strong wind,” explains Lachmann. “The heart becomes stiffer and more muscular.” In this case, more muscle is not good. “There was a myth that people who had HF with a strong heart would do well,” Hsich says. “But according to recent studies, once you develop fluid buildup the prognosis is the same if the heart is weak or strong.”
Heart-wall thickness can be seen on an echocardiogram, in which ultrasound waves provide an outline of the heart, while Doppler ultrasound is used to measure blood flow through the valves.
Cardiac catheterization can detect plaque buildup within the coronary arteries. These and other tests allow physicians to stage HF based on if or how badly the heart is damaged and whether symptoms are present.
Technology is increasingly used to treat as well as diagnose HF. “With defibrillators people are living longer—arrhythmias [abnormal heartbeats] used to be the biggest cause of mortality in people with heart failure,” says Lachmann. “We also have left ventricular assist devices.”
HF is a serious condition, but it’s manageable. “With the right interventions you can decrease mortality by 70%,” Lachmann says.
Living a Heart-Healthy Life
Having HF, or one of the disorders that can lead your heart to fail, requires changes in lifestyle. “Buy a blood pressure cuff and monitor your own blood pressure,” advises Lachmann. “If there’s evidence that the heart is thickening you know your pressure is not being well controlled.”
Relieving stress is also important in treating or preventing HF. Lachmann explains how stress affects the heart in terms of the fight-or-flight response. “We used to have to increase blood flow to think our way out of situations, such as hunting or escaping,” she says. “What happens in heart failure is that the system is activated in an effort to get blood flowing faster. But if you keep this system activated for a long time, its like driving a stickshift in low gear—you get more out of the car but you burn out the engine.” Lachmann notes that stress also leads to “overeating, which leads to diabetes, which leads to metabolic syndrome, which leads to unhealthy vessels.”
Cutting calories is important in dealing with HF, as is cutting salt intake to less than 2 grams a day. Emphasizing fresh produce helps on both counts. “When you buy frozen or canned food it is usually very high in salt,” says Hsich. “Salt substitutes are unsafe for HF patients; they can only use herbs to spice their food.” Salt is harmful because it causes retention of water, which the body uses “in an effort to increase blood flow,” Lachmann says. “You’re carrying dead weight—it’s like a Volkswagen Bug engine pulling an SUV.” (People with HF need to reduce fluid intake to less than 2 liters a day.)
Exercise helps control both weight and stress. What’s more, “you not only exercise the heart but you exercise the blood vessels,” says Lachmann. “Poorly controlled high blood pressure is the opposite of exercise—the vessels are stiff. Exercises trains the vessels to become more reactive.”
Just about all HF patients take various prescription medications, but a number of supplements have also been found to be helpful. CoQ10 has helped improve cardiac function in people with HF, who often have low levels of this important nutrient. In a similar manner, HF has also been linked to deficiencies in the amino acids taurine and carnitine; the first helps reduce excess fluid buildup, the second may increase exercise tolerance and help reduce left ventricle size in HF patients. The antioxidant lipoic acid has improved blood-vessel function and glucose utilization in people with type 2 diabetes, while magnesium helps reduce the chance of developing an arrhythmia. (Always consult a healthcare practitioner before starting a supplementation program.)
“If you are diagnosed with HF you can take control and improve your chances of survival,” says Lachmann. That’s good. But preventing HF is even better. Controlling blood pressure and maintaining a healthy weight are the two best ways to keep your heart from failing.
The Cleveland Clinic Guide to Heart Failure by Randall Starling, MD, MPH (Kaplan)
Success with Heart Failure by Marc Silver, MD (Da Capo Press)
Dealing with Diabetes
Having excessive amounts of glucose in your bloodstream leaves you prone to not only HF but a bevy of other ailments as well, including coronary artery disease and problems with your eyes, kidneys and nerves. Blood sugar does its dirty work through glycation, in which glucose molecules combine with protein molecules to form advanced glycation endproducts (AGEs). These AGEs can cause organ damage, in part by promoting the harmful free radicals that lead to oxidative stress.
The best way to avoid diabetes—or its many complications if you already have it—is, not surprisingly, through dietary means. Losing excess weight is crucial, given the strong link between obesity and high glucose. Avoiding excess sugar is an obvious place to start. But getting rid of other refined foods, such as white bread and pasta, is important too; these substances break down into the simple sugars that can cause glucose levels to skyrocket. Such whole foods as fresh (or frozen) produce and whole grains contain lots of fiber, which helps slow down carbohydrate digestion within the intestinal tract. These foods also contain many of the micronutrients and phytochemicals essential for good health.
A number of supplements can help keep blood sugar under control, including: