Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
As we mentioned last time, there are diseases of the lungs
that come from other places. One of the most common ones is
probably the most serious illness I see. It is called by a
scary name: "Congestive Heart Failure" or CHF; but it really
isn't failure in the sense that the heart stops working.
Rather, the heart begins to pump inefficiently and instead
of blood going forward, it backs up into the lungs and they
fill up with fluid. Shortness of breath ensues and blood
pressure goes sky high in order to help the blood go forward
even more. However, the heart is weak and this makes matters
even worse. The patient is very short of breath, pale,
sweating, and may have a frothy cough or wheezing. He may
have swollen legs.
CHF occurs with a weakened heart, usually from a past heart
attack. The direct cause is usually from a small period of
lessened oxygen delivered to the heart. In the past we
thought it was from fluid overload from overeating salt;
this is not thought to be a major cause at this point. When
there is an acute attack, it is easy to diagnose this
disease, but we can get warnings beforehand by calculating
ejection fractions. This is the amount of blood pumped out
of the heart every beat (there always remains a little blood
left behind, but it shouldn't be that much).
If there is serious impairment, therapy to prevent CHF can
be done. This is best accomplished by drugs such as
diuretics ("water pills," that is they increase urination);
nitrates which increase oxygen delivery to the heart by
opening vessels, beta blockers in small doses and most
importantly drugs called Ace inhibitors. These last two
drugs make the heart's work easier and they are the only
drugs that have been shown to increase life expectancy in
this disease.
Some people are so impaired they cannot even walk a few feet
without becoming short of breath; these patients often need
supplemental oxygen all the time and some receive medicines
intravenously that increase the heart's ability to pump. If
these people are young, they are the ones that must be
considered for heart transplants. There are some places in
Europe that are doing heart-size reduction surgery in order
to remove poorly functioning heart muscle and make pumping
more efficient.
People with CHF who have reasonable ejection fractions can
live normal lives, and will help themselves with a vigorous,
doctor-supervised exercise program. There are now many heart
rehabilitation centers that specialize in this. Still, if
you want to prevent this disease from occurring, then your
best bets are the usual things we have been trumpeting all
along: lose weight, exercise, reduce stress, reduce blood
pressure; take care of yourself and screen yourself for
heart disease, and of course stop smoking. Write me in care
of the Yated.
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