Heart failure

Congestive heart failure (CHF) occurs when excess fluid starts to leak into the lungs and/or other surrounding parts of the body. Normally, the pumping actions of the left and right sides of the heart complement each other, producing a continuous flow of blood. Heart failure may occur with both ventricles failing, although one ventricle may begin to fail before the other.

Heart failure has many causes, including:

• Cardiomyopathy — Cardiomyopathy describes a weakness in the heart muscle's ability to contract. This may result from the effects of long-standing hypertension, diabetes, alcohol abuse or multiple heart attacks, all of which can damage the muscle to the point that its pumping function becomes compromised.
• Myocardial infarction — This can cause sudden acute CHF in cases where a substantial portion of the heart muscle has become severely damaged. The lack of oxygen to the cardiac muscle results in poor contraction.
• Severe anemia — This condition can cause heart failure in a patient with a very low red blood cell count. The heart will go into congestive failure as it attempts to compensate for the inadequate number of circulating red blood cells. Red blood cells are necessary for adequate oxygenation of the tissues.
• Valvular heart disease — A leaking or blocking of the heart valves leads to an ineffective flow of blood through the heart. Over time, the heart will attempt to compensate for the problem by enlarging, eventually leading to CHF, heart attack, cardiac arrhythmias or cardiac arrest (heart stops beating). Valve replacements have improved the survival rate in patients with valvular heart disease.
• Viral myocarditis — In addition to irregularities of the heart beat (arrhythmias), this viral infection of the heart can result in poor cardiac muscle function. Viral myocarditis is one of the few causes of heart failure seen in young people.

Heart failure symptoms show up in a variety of ways. It's important to speak with your doctor if you are experiencing:

• Fatigue and weakness
• Feeling of suffocation while sleeping, or awakening in the middle of the night short of breath
• Increased heart rate
• Leg swelling and/or abdominal swelling
• Persistent coughing or wheezing
• Shortness of breath during normal activities
• Sudden weight gain from fluid retention

Your evaluation will include a complete medical history and physical examination. Blood tests or a chest X-ray will be performed. Additional tests are used to determine the nature and extent of heart failure.

An electrocardiogram (EKG or ECG) can reveal evidence of a potential heart attack or other suspected heart abnormalities. Catheterization or angiography, which shows the inside of the coronary arteries, is sometimes recommended.

With the information received from your tests, your doctor will determine the appropriate treatment plan for you. Currently, medications are being used for outpatient treatment of heart failure. These medications include:

• Angiotensin-converting-enzyme (ACE) inhibitors: Helps relax blood vessels
• Anticoagulants: Prevents blood clots
• Beta-blockers: Reduces blood pressure
• Digitalis: Increases blood flow throughout your body, helping to reduce swelling
• Diuretics (also called water pills): Increases the amount of water and salt removed from the body through urine
• Vasodilators: Helps open blood vessels

In the case of advanced heart failure, inpatient treatment includes intravenous medications. Mostly, heart failure is a chronic condition that can be treated, but usually not cured. Heart failure can be successfully managed by taking medications and making healthy changes in habits, such as diet and exercise.

ECMO involves the process of removing and oxygenating your blood and returning the blood to your body. It is an advanced life support available to a patient experiencing acute failure of cardio-respiratory system.

Veno arterial (VA) ECMO which supports both heart and lung function, can be considered when you have severe cardiac failure and a potentially reversible cause who meet the following criteria:

• Severe refractory cardiogenic shock on a moderate dose of two or more inotropes/pressors and/or use of other mechanical devices (balloon pump, etc.)
• One of the following: Urine output less than 30 milliliters/hour, central venous pressure over 16, or lactate over 4 millimoles per liter/hour