Heart Failure (C.H.F) is one of the leading causes of death in
North America, accounting for more than 30% of all deaths. More
than 1 million people in Canada and the U.S. die of heart failure
each year, which amounts to about one death every 30 seconds.
Although C.H.F is so deadly, it still remains as one of the most
preventable diseases. Simon Maybaum, MD., and Ainat Beniaminovitz
from New York Presbyterian Hospital, explain in an interview how
you and your doctor can know if you have a failing heart, and
what can you do to prevent it.
fatigue, shortness of breath. These are the chronic, and frightening
symptoms of heart failure. In simplest terms, "heart failure"
refers to a heart that is not pumping as well as it should. Heart
failure is most often the result of the heart's struggle with
an underlying problem, such as clogged arteries, high blood pressure,
a congenital defect in the actual muscle of the heart, or a medical
are five million Americans suffering with heart failure, and a
half million new cases are diagnosed each year. Below, cardiologists
from the New York Presbyterian Hospital, Dr. Simon Maybaum and
Dr. Ainat Beniaminovitz, discuss how heart failure is diagnosed.
to heart failure diagnosis is the internist. Can the internist
generally spot symptoms before things get too dangerous?
MD: Well, the body does offer clues when there is a problem with
the heart, such as extra heart sounds; perhaps a murmur. Typically,
when people are actually manifesting signs and symptoms of congestive
heart failure, then diagnosis is easy. A patient comes in and
describes the symptoms. But before actual symptoms, there are
subtle signs and clues that a physician can hear with a stethoscope
on a very cursory exam. For instance, with a stethoscope, you
can detect when veins are backed up with fluid. That is an example
of a subtle sign or symptom that the patient may not even be aware
If a doctor
and patient are concerned about congestive heart failure, what
is the first test that should be performed?
MD: I think that the most useful test is an echocardiogram, which
is essentially an ultrasound of the heart. It allows us to look,
not only at the cardiac function-or the squeezing of the heart-but
also at the size of the chambers to see that they're working properly.
It is a very useful tool for giving us clues as to why the heart
failure occurred in the first place.
is the test? Is it painful at all?
MD: It's painless. That's why it's very appealing. It's much like
having an ultrasound of a baby when you're going for a prenatal
visit. It's performed at most places, including physicians' offices.
You don't have to go somewhere special. It's very informative.
You basically get the results right as they are obtained. It doesn't
pick up on arterial blockages, but it can investigate whether
or not there have been blockages in the arteries. For example,
the heart muscle may only become dysfunctional in certain regions,
rather than a global dysfunctional state, which clues you into
the fact that only one artery was blocked, and only one part of
the heart muscle died, not the whole heart muscle. It gives you
clues and signs as to what the etiology or causal factor is.
describe the causes of congestive heart failure, in their most
MD: I think the two big distinctions are whether the heart failure
is the result of a decrease or abnormal blood supply to the muscle,
or whether it's a problem within the heart structure itself-the
muscle or the valves. A problem with blood supply to the heart
muscle is what we call coronary artery disease. This is a disease
that gives us heart attacks and angina and chest pain.
The other basic category, includes everything else, doesn't involve
abnormal blood supply to the muscle. There are many of these.
There are toxic agents such as alcohol and drugs and chemotherapeutic
agents, and many others that can cause damage to the heart muscle.
The most common in this category is probably viral infection.
We think that most of the cardiomyopathies-the diseases of the
heart muscle that we see and find no cause for-have at some time
been related to a viral infection of the heart.
someone do to prevent heart failure? And does it run in families?
MD: One of the causes which is actually preventable is high blood
pressure, or hypertensive cardiomyopathy. If you know that you
have high blood pressure, getting it treated may save you a lot
of pain and suffering later on, by not allowing you to promote
more heart failure. Abstaining from alcohol if you've been diagnosed
with heart failure is also good prevention. Although it's been
touted in the press that alcohol protects the coronary artery,
excessive amounts of alcohol have a negative effect on the heart
muscle itself. It actually depresses heart function.
one glass of wine with dinner is still okay?
MD: Not okay for people who have dysfunctional heart muscles.
We ask them to refrain from alcohol completely. Even a small amount
may be deleterious.
the thyroid gets of out whack. Treating that problem can prevent
heart failure. As far as the non-preventable causes of heart failure
go, we are just beginning to understand what causes inherited
forms of heart failure, or what gene defect causes dysregulation
of the heart muscle. Until we're really good at fixing our genetic
composition, we're not going to be able to prevent those complications,
but just treat them expectantly.
are things that you can do in terms of prevention or retarding
the progression of heart failure. There is a whole compendium
of medications that we're fortunate to have currently to help
retard the disease once it's come about.
thoughts, Dr. Maybaum?
MD: I think that we need to understand that congestive heart failure
is a serious condition, which, if untreated, can lead to progressive
deterioration. But, we are much better at identifying and treating
patients with heart failure. Hopefully, we're improving their
quality of life and eventual survival.
Reference Source 104