27/07/10

Congestive heart failure: Inability of the heart to
keep up with the demands on it and, specifically, failure of the
heart to pump
blood with normal
efficiency. When this occurs,
the heart is unable to provide adequate blood
flow to other organs such as the brain, liver and kidneys. Heart
failure may be due to failure of the right or left or both
ventricles. The signs and symptoms depend upon which side of the
heart is failing. They can include shortness of breath (dyspnea),
asthma due to the heart (cardiac asthma), pooling of blood (stasis) in
the general body (systemic) circulation or in the liver's (portal)
circulation, swelling (edema),
blueness or duskiness (cyanosis), and enlargement (hypertrophy) of
the heart.

There
are many causes of congestive heart failure including: (1) coronary
artery disease leading to heart attacks and heart muscle weakness,
(2)
primary heart muscle weakness from viral infections or toxins such as
prolonged alcohol exposure, (3) heart valve disease causing heart
muscle
weakness due to too much leaking of blood or heart muscle stiffness
from a blocked valve, and (4) hypertension (high blood pressure).
Rarer causes include hyperthyroidism (high thyroid hormone), vitamin
deficiency, and excess amphetamine (”speed”) use.

The aim of therapy
is to improve the pumping function of the
heart. General treatment includes salt restriction, diuretics (to
get rid of excess fluid),
digoxin (to strengthen the heart), and other medications. A drug called spironolactone has been found to be a major help in treating congestive heart failure Its beneficial effects are additive to those from ACE inhibitors, another class of drugs commonly relied on in treating heart failure. A pacemaker-like device is also now available to treat heart failure. The implantable device delivers synchronized electrical stimulation to three chambers of the heart, enabling the heart to pump blood more efficiently throughout the body.

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