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Question: What is congestive heart failure and how did I get it?
I had a heart attack almost 10 years ago. I have been overweight. In the last year I have lost 14 pounds, have been swimming and working two hours in my garden every day. Two weeks ago I woke up with a "gurgle" feeling in my lungs. I went to the ER three days later because I felt like I was having a hard time breathing. They gave me Lasix intravenously and my breathing became easier. They sent me home with a prescription for Lasix, 20 milligrams once a day and made an appointment for me to see my doctor six days later. I went to see my doctor and she confirmed that I have CHF. She notified the Minnesota Heart Clinic that they should schedule an echocardiagram and a followup appointment. I called them today and got things all set up. I still don't know anything more than that. I wasn't given any other information. I feel like they are treating me as if I have a cold, and not CHF. Is it NOT serious? I am feeling that it must not be anything to worry about ... all the doctors are treating this VERY casually, and that makes me believe that this is nothing to worry about. Is that what I should be feeling? Thank you for your time. Dr. Gordon Fung responds:
To begin with, CHF, which stands for congestive heart failure, is a serious problem. Please do not let the timing of events and the response time lull you into thinking that you are fine with a minor problem and the physicians are not taking this matter seriously. I am certain that this is a very important issue to them. Congestive heart failure is defined in the textbooks as a condition that occurs when the output of the heart is unable to keep up the work or demands of the body. From the information you have provided it is most likely that you developed CHF as a late complication of the heart attack you suffered 10 years ago in addition to the extra weight that you have been carrying around. Although CHF can occur early in the course of a heart attack, the late occurrence of CHF is now a recognized complication of heart disease. After a heart attack, over time, the heart undergoes a process of remodeling that can present as a significant reduction in the overall output of the heart. On echocardiogram, the heart can look enlarged and weakened. Other causes for CHF include uncontrolled high blood pressure, diabetes, kidney failure, alcoholism, and adverse reactions to medications. What does it mean when the output of the heart cannot keep up with the demands of the body? The heart output depends on the ability of the heart to pump blood at a certain volume and heart rate. When you exert yourself in the form of walking, doing household chores, gardening, or shopping, the heart must work harder by increasing the heart rate and strength of contraction for each beat. Since you suffered a heart attack, the ability of the heart to respond by increasing the strength of contraction is reduced. The heart rate can only increase so much depending on your age and the medications you may be on for your heart attack and other problems you may have. Unfortunately, once this occurs, the heart goes down a spiral and responds less well to decreasing activity. When the heart is too weak and cannot push the blood out into the body, the blood tends to back up in the lung and then you sense the congestion or what some doctors call, “fluid in the lungs.” With “fluid in the lungs” you feel that sense of choking and difficulty breathing with activity initially and sometimes it progresses to being breathless when lying down or sleeping. It is important that you work closely with your physicians and specialists to determine the exact cause and comply with the medication regimen as well as activity level and dietary guidelines that are prescribed. People with a history of CHF can lead very productive and symptom-free lives if they work with their physicians and be an active participant in their health care team. I apologize that this answer is so long; but I felt that rather than referring you to many medical Web sites, that can certainly give you the information included here, you could start here and pursue the others as time permits. Thank you and please write. Dr. Fung -- Dr. Gordon Fung, MD, MPH, is a cardiologist and associate clinical professor of medicine at the University of California at San Francisco Medical Center at Mt. Zion.
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First published September 10, 2004
Last updated June 24, 2008
Copyright © 2004 Consumer Health Interactive
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