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Congestive Heart Failure And Fatigue

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Assessment Of Arterial Stiffness

Heart Failure Warning Signs and Symptoms

Of a number of non-invasive methods that are available to assess vascular stiffness, the two commonly used ones are pulse wave velocity and augmentation index . The elasticity of a segmental artery is assessed by PWV. A pulse wave is generated by each cardiac contraction, which travels distally and can be measured by the distance travelled by the pulse wave divided by the time taken between two regions such as carotid to femoral. More the arterial stiffness, more the PWV. Carotidfemoral PWV measures central arterial stiffness, whereas brachial-ankle PWV measures both central and peripheral arterial stiffness. As changes in blood pressure can affect these measurements, a new cardio-ankle vascular index has been used that is independent of BP. CAVI uses measured PWV adjusted by a stiffness index . Particularly in the elderly, arterial stiffness independently predicts cardiovascular morbidity and mortality.

AI is derived from the interaction between the forward pulse wave and the reflected wave and is a measure of resistance of the entire arterial tree. It increases with increasing arterial stiffness and is influenced both by BP and heart rate. Although both PWV and AI increase with age, changes in AI are more prominent in younger people below < 50 years of age and PWV changes are more marked in those older than 50 years. In women after menopause, arterial resistance rises sharply and is higher than in men.

Traditional Understanding Of Heart Failure

Historically, heart failure was thought to be a disorder of its pumping function and the ejection fraction therefore, these became an important component and determinant of the condition. The increasing prevalence of heart failure with preserved ejection fraction and the current lack of disease-modifying therapy for this group of patients raise the question again of whether we truly understand the mechanisms that drive the entire spectrum of the heart failure syndrome. How can all the different described types of heart failure be linked up to create a spectrum and a story that is easily understandable? Can we link the relationship of the core mechanism of heart failure with EF and then with the types of HF such as heart failure with reduced ejection fraction , HFPEF or even with the old classification of high-output, low-output, forward and backward failure, right and left heart failure? Unless we progress further in answering these questions, discovering treatment for the entire heart failure population will be difficult.

Causes Of Heart Failure And Congestive Heart Failure

Heart failure and CHF are typically caused by other conditions that damage the heart. Some of these conditions are:

When the heart is weakened, it has difficulty pumping blood forward, so blood and fluid back up into the lungs. Fluid in the lungs can cause shortness of breath, a common symptom of congestive heart failure.

If the heart is having serious difficulty with pumping, then you might experience edemaa buildup of blood fluid in the feet, ankles, and legs.

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How Are Fatigue And Weakness Characterized In Heart Failure

Fatigue and weakness are often accompanied by a feeling of heaviness in the limbs and are generally related to poor perfusion of the skeletal muscles in patients with a lowered cardiac output. Although they are generally a constant feature of advanced heart failure, episodic fatigue and weakness are also common in earlier stages.

Prognosis By Ejection Fraction

Heart Failure

Ejection fraction is a measure of how much blood is pumped out of your heart each time it contracts. A healthy heart has an EF of between about 55 percent to 75 percent.

Some people with CHF have a reduced EF. This means their heart is pumping less blood out to the rest of their body than a healthy heart. Studies have shown that people who have CHF and a reduced EF have a more challenging outlook than people with CHF who do not have a reduced EF.

The exact survival rates varied among studies, but have shown that EF has an impact on prognosis. Your doctor will have the best information about how your ejection fraction can affect your prognosis.

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What You Can Do

Some risk factors of heart failure, like age, cant be modified. Still, people with CHF can take steps to improve the long-term prognosis. The first thing to do is to be familiar with any family history of heart disease. You’ll also want to learn about all the possible symptoms. Don’t ignore any symptom that you think is cause for concern. Tell your healthcare provider about them right away.

Regular exercise, along with managing any other health issues you may have, can also help to keep CHF under control.

How Do Doctors Diagnose Heart Failure

  • Heart failure can be diagnosed by physical exam, reported symptoms, or chest X-ray.
  • An echocardiogram test can identify a low ejection fraction or a thickened, stiff heart muscle.
  • Echocardiograms may be used to distinguish between systolic and diastolic types of heart failure.
  • Blood tests such as BNP suggest heart failure.
  • Algorithms and guidelines exist to score and weigh signs and symptoms to help make the diagnosis.

Heart failure treatment options include making healthier decisions about lifestyle and diet, taking medications, and sometimes implanting devices. Heart transplant is sometimes considered for certain individuals.

In acute or decompensated heart failure, the person may need hospitalization or even intravenous medications to help recover.

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What Causes Heart Failure

Although the risk of heart failure doesnt change as you get older, youre more likely to have heart failure when youre older.

Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:

  • Tobacco and recreational drug use.
  • Medications. Some drugs used to fight cancer can lead to heart failure.

What Are The Complications Of Heart Failure

An Osmosis Video: Congestive Heart Failure (CHF) Explained

Some of the complications from heart failure include:

  • Irregular heartbeat.
  • History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but youve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. This category includes people who have heart failure and reduced EF due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

  • Shortness of breath.
  • Need to urinate while resting at night.
  • Rapid or irregular heartbeats .
  • A dry, hacking cough.
  • A full or hard stomach, loss of appetite or upset stomach .

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.Its important to let your doctor know if you have new symptoms or if your symptoms get worse.

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What Are The Types Of Heart Failure

There are many causes of heart failure, but the condition is generally broken down into these types:

Left-sided heart failure

Heart failure with reduced left ventricular function The lower left chamber of your heart gets bigger and cannot squeeze hard enough to pump the right amount of oxygen-rich blood to the rest of your body.

Heart failure with preserved left ventricular function Your heart contracts and pumps normally, but the bottom chambers of your heart are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.

Right-sided heart failure

Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.

How Can Congestive Heart Failure Be Treated

Your doctor will recommend different kinds of treatment depending on the causes of congestive heart failure. The treatments will also vary based on your health status and progression of the disease. They include:

1. Medications

The medications used to treat CHF include:

  • Angiotensin-converting enzyme inhibitors, which can open blood vessels to enable blood flow. Vasodilators are good alternatives when a patient cannot tolerate inhibitors.
  • Beta-blockers, which are able to reduce blood pressure and slow down the heart rhythm.
  • Diuretics, in order to reduce the fluid content in the body.

2. Surgeries

Surgery is necessary when medications fail to treat the condition. One option is angioplasty, which is a procedure that opens up blocked arteries. An alternative procedure is a surgery to repair heart valves, which enables valves to function properly.

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Reason : Are Beta Blockers Making You Tired

The anti-adrenaline effect of beta-blockers the very quality that makes them valuable for treating heart failure can make patients feel tired.

Most patients do not experience any side effects. But if you feel fatigued after starting your medicine, its important to do two things: Keep taking your medicine, and report your symptoms to your doctor. If you stop suddenly, you may risk having rebound adverse effects.

According to Dr. Taylor, understanding why beta-blockers must be taken often makes it easier to deal with this side effect. Once patients know the drug will improve their heart function, help them stay out of the hospital and live longer, most are willing to put up with a little fatigue, he says.

You and your physician can try to figure out if the symptoms are really a side effect or due to your heart problem or even possibly due to an unrelated condition such as sleep apnea. Usually, well adjust the medication dose or switch to an alternative medication and check if the side effects go away with time.

If he is able to wean the patient down or off the drug, and fatigue remains a problem, the beta-blocker is not to blame.

Damage Fatigue And Injury Concept

Congestive Heart Failure Case Study

For chronic heart failure, there may be three basic but linked mechanisms that exist to cause the heart failure: damage, fatigue and injury.

The damage mechanism is very evident in the common myocardial infarctions or some toxic/inflammatory cardiomyopathies and is naturally associated with reduced EF . Here, there is a large amount of irreversible myocardial damage leading subsequently to fibrosis the heart failure is systolic and is due to pump failure.

However, myocardial injury can often be transient, acute and limited, such as with acute viral myocarditis causing myocardial inflammation and oedema, or other reversible cardiomyopathies . It would not be unreasonable to assume that the reversible forms of left ventricular systolic dysfunction are the ones where injury has played a part but significant damage has not occurred . There could be variable amounts of injury and damage caused by alcohol, chemotherapeutic agents or other drugs, catecholamines, infections and so on with the final outcome on LV function determined by the proportion of injury versus damage. Genetic causes or myocardial infiltration would most likely also fall under the injury versus damage headings.

High-output cardiac failure would also be an example of fatigue-related heart failure as a result of the myocardiums inability to cope with an enhanced volume of blood.

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What Causes Congestive Heart Failure

Heart failure, also called congestive heart failure, often develops as the result of coronary artery disease or hypertension, which exact a toll on the hearts ability to function properly. Other causes of CGF include coronary artery disease, atrial fibrillation or previous heart attack. People who have diabetes are more at risk of heart disease overall, including heart failure. But there are several other health conditions that may cause heart failure, including:

  • Diseased heart valves
  • Treatments for cancer, thyroid disorders, alcohol abuse, HIV/AIDs, and using cocaine and other street drugs can also cause problems leading to heart failure.

Another leading diagnosis from discharge from the hospital for heart failure patients is due to stiff heart syndrome.

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What Is The Prognosis And Life Expectancy For Congestive Heart Failure

  • The degree to which other organ systems are involved and the severity of other accompanying conditions
  • The person’s symptoms and degree of impairment
  • Other factors that remain poorly understood

With the availability of newer drugs to potentially favorably affect the progression of the disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.

Heart failure is often graded on a scale of I to IV based on the patient’s ability to function.

  • Class I includes patients with a weakened heart but without limitation or symptoms.
  • Class II describes patients whose only limitation is heavier workloads.
  • Class III includes patients who experience limitations with everyday activity.
  • Class IV describes patients with severe symptoms at rest or with any degree of effort.
  • The prognosis of heart failure patients is very closely associated with the functional class.

    An important issue in congestive heart failure is the risk of heart rhythm disturbances . Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias.

    Heart Failuresigns And Symptoms

    Pathophysiology of Congestive Heart Failure (CHF)

    Heart failure is a condition in which the heart fails to function properly. The terms “heart failure” and “congestive heart failure ” don’t mean that the heart has actually “failed” or stopped but mean one or more chambers of the heart “fail” to keep up with the volume of blood flowing through them.

    Heart failure is brought on by a variety of underlying diseases and health problems.

    Your condition may involve the left side, the right side or both sides of the heart. Each side has two chambers:

    • An atrium or upper chamber
    • A ventricle or lower chamber

    Any one of these four chambers may not be able to keep up with the volume of blood flowing through it.

    Two types of heart dysfunction can lead to heart failure, including:

    • Systolic Heart Failure This is the most common cause of heart failure and occurs when the heart is weak and enlarged. The muscle of the left ventricle loses some of its ability to contract or shorten. In turn, it may not have the muscle power to pump the amount of oxygenated and nutrient-filled blood the body needs.
    • Diastolic Failure The muscle becomes stiff and loses some of its ability to relax. As a result, the affected chamber has trouble filling with blood during the rest period that occurs between each heartbeat. Often the walls of the heart thicken, and the size of the left chamber may be normal or reduced.

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    Congestive Heart Failure Drugs

    There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.

    ACE inhibitors

    Angiotensin-converting enzyme inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cant tolerate ACE inhibitors.

    You may be prescribed one of the following:

    voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall.

    ACE inhibitors shouldnt be taken with the following medications without consulting a doctor, because they may cause an adverse reaction:

    • Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene , eplerenone , and spironolactone .
    • Nonsteroidal anti-inflammatory drugs .NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitors effect on your blood pressure.


    This may be achieved with:


    Your doctor may recommend:

    When To See A Healthcare Provider

    If you are experiencing chest pain, shortness of breath, sudden swelling of the arms or legs, or fatigue on exertion, you may want to get checked by a healthcare professional.

    Heart failure and CHF are chronic, progressive conditions that can often be managed with timely treatment, so do not wait to be seen by a healthcare professional if you experience any of the aforementioned symptoms.

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    What You Should Do During A Heart Attack

    If you think you are having a heart attack, you or someone nearby should call emergency services immediately. Its unsafe to drive yourself to the hospital during a heart attack, so call an ambulance. While you may feel awake and alert enough to drive, the chest pain could get so severe that you may have trouble breathing or difficulty thinking clearly.

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