What is Congestive Heart Failure?
The Heart and its Pumping Action
The heart is composed of two independent pumping systems, one on the right side, and the other on the left. Each has two chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart.
The Right Side of the Heart. The right system receives blood from the veins of the whole body. This is "used" blood, which is poor in oxygen and rich in carbon dioxide.
- The right atrium is the first chamber that receives blood.
- The chamber expands as its muscles relax to fill with blood that has returned
from the body.
- The right ventricle is one of the heart's two major pumps. Its function
is to pump the blood into the lungs.
- The lungs restore oxygen to the blood and exchange it with carbon dioxide,
which is exhaled.
The Left Side of the Heart. The left system receives blood from the lungs. This blood is now oxygen rich.
- The oxygen-rich blood returns through veins coming from lungs (pulmonary
veins) to the heart.
- It is received from the lungs in the left atrium, the first chamber on
the left side.
- Here, it moves to the left ventricle, a powerful muscular chamber that
pumps the blood back out to the body.
- The left ventricle is the strongest of the heart's pumps. its thicker
muscles need to perform contractions powerful enough to force the blood
to all parts of the body.
- This strong contraction produces systolic blood pressure (the
first and higher number in blood pressure measurement). The lower or diastolic
blood pressure is measured when the left ventricle relaxes to refill
with blood between beats.
- Blood leaves the heart through the ascending aorta, the major artery that
feeds blood to the entire body.
The Valves. Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart:
- The tricuspid regulates blood flow between the right atrium and the right
ventricle.
- The pulmonary valve opens to allow blood to flow from the right ventricle
to the lungs.
- The mitral valve regulates blood flow between the left atrium and the
left ventricle.
- The aortic valve allows blood to flow from the left ventricle to the ascending
aorta.
The Heart's Electrical System
The heartbeats are triggered and regulated by the conduction system, a network of specialized muscle cells that form an independent electrical system in the heart muscles. These cells are connected by channels that pass chemically caused electrical impulses
Description of Heart Failure:
Congestive heart failure is not a disease but a condition that occurs when the heart is unable to pump enough blood to meet the needs of the body's tissues. When the heart fails, it is unable to pump out all the blood that enters its chambers.
Ways the Heart Can Fail. Heart failure can occur in several ways:
- The muscles of the ventricles in the heart may become thin and weakened.
They stretch (dilate) to the extent that they cannot pump the blood with
enough force to reach all the body's tissues.
- The heart muscles stiffen or thicken. In this case they lose elasticity
and cannot relax. Insufficient blood enters the chamber and so not enough
blood is pumped out into the body to serve its needs.
- Sometimes the valves of the heart are abnormal. (Valves open or close
to control the flow of blood entering or leaving the heart). They may narrow,
causing a back up of blood, or they may close improperly so that blood leaks
back into the heart. The mitral valve (which regulates blood flow between
the two chambers on the left side of the heart) often becomes leaky in severe
heart failure.
- The very mechanisms that the body uses to compensate for inefficient heart
pumping can, over time, change the architecture of the heart and finally
lead to irreversible problems.
Specific Effects of Left or Right Side Failure. The specific effects of heart failure on the body depend on whether it occurs on the left or right side.
- Failure on the Left Side. Failure on the left side of the heart is the
more common event. In such cases, the heart muscles weaken and cannot keep
up with the demands of the body. Fluid backs up and accumulates in the lungs.
Given the interconnected nature between the chambers of the heart, left-sided
failure may ultimately precipitate failure in the right side of the heart.
- Failure on the Right Side. Most often in this case, in failure on the
right side, the heart muscles thicken so that the muscles become abnormally
relaxed. In this case fluid entering the heart backs up. this causes the
veins in the body and tissues surrounding the heart to swell.
Over time, however, in any form of heart failure, the organs in the body do not receive enough oxygen and nutrients, and the body's wastes are removed slowly. Eventually, vital systems break down.
Ejection Fraction. To help determine severity, physicians use a calculation called an ejection fraction. This is the percentage of the blood pumped out during each heartbeat. An ejection fraction of 50% to 75% is considered normal, and, in general, a low percentage is considered an indication of failure. the ejection fraction in left-side heart failure typically falls below 40%. In severe failure it may drop as low as 5%. (In cases of right-side failure, however, the ejection fraction may be normal or even high.)
Common causes of heart failure include:
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Heart failure won't go away. But you can work with your doctor and help yourself to feel better. And make you heart's job easier.
Signs & Symptoms:
Some people with heart failure don't have signs and symptoms. But many do. Some common signs and symptoms are:
- Feeling tired. Muscles and organs can't get
all the blood that they need. This may make you feel very tired. You may
feel this way, even if you sleep well.
- Shortness of breath. Heart failure makes
the body hold on to water. Water can get into your lungs. This makes it
hard to breathe. When you lie down, water can pool around the lungs. You
may cough. Sleep with extra pillows. This can help drain fluid from your
lungs.
- Swollen ankles, legs, and/or belly. Water
can build up in these places. Swelling is often worse at the end of the
day.
- Weight gain. Extra water can make you gain
weight. Your doctor may tell you to track your weight. This will help you
to see how your heart failure is doing.
- Trips to the bathroom at night. When you
lie down, the water that has built up in your body moves back into your
blood vessels. Then it goes to the kidneys and gets made into urine. *reference1on1health.
Pre-Heart Transplant Evaluation Process
When your heart can no longer be helped with medicines or by other surgery your doctor may refer you to be evaluated for a heart transplant.
The pre-heart transplant evaluation begins with the initial referral to a heart transplant center. The heart transplant coordinator's office will be responsible for the scheduling of the appropriate diagnostic tests and clinic visits with the patient and all of the transplant team members. This can be done in the hospital setting or the ambulatory care setting (outpatient) depending on how sick you may be at that time.
The Heart Transplant Team includes:
Patient & Family / Caregivers
It is essential that you participate as a responsible member of the team to facilitate your own well-being. Support from family, significant others or friends is an essential part of a successful transplant.
Heart Transplant Coordinator
This transplant specialist acts as a liaison between you, family and the other members of the transplant team.
Staff Nurse
This nurse works with members of the heart transplant team to coordinate the everyday activities of you care during your hospital stay.
Heart Transplant Surgeon
The surgeon evaluates your former surgical history to determine if heart transplantation can be performed from a surgical standpoint. the surgeon will be the one performing the heart transplant.
Heart Transplant Cardiologist
The cardiologist reviews your cardiac history and other disease processes such as diabetes. This doctor maximizes the medications for heart failure and determines what specific tests may be necessary to complete the transplant evaluation.
Social Worker
The social worker examines you and your family's psychosocial and emotional needs. These may include financial issues and concerns related to housing, medications and caregiver problems.
Nutritionist
The nutritionist meets with you and your family to determine your ideal body weight and teaches you about the dietary restrictions with heart failure as well as heart transplantation. These may include low fat, low salt and diabetic restrictions. There may also be specific fluid restrictions.
Clinical Pharmacist
The clinical pharmacist educates you and you support persons regarding the required medications you will be taking for a lifetime after your transplant.
Financial Counselor
The financial counselor reviews your insurance coverage and clears you for the initial visit with the transplant team. He/she provides information to you and your family on what expenses to expect for the future, and what supplemental fundraising options you may be required to do prior to being listed for your transplant.
Pre-Heart Transplant Evaluation Tests
Laboratory Tests
Many tubes of blood will be drawn to obtain blood and tissue typing. Tests will be run to rule out exposure to hepatitis, HIV and other disease processes as well as anemia, bleeding problems, kidney and liver studies.
Chest X-ray
An X-ray of the chest will be obtained to determine the size of the heart and any abnormalities seen on the lungs.
Electrocardiogram
This test provides information on heart wall motion, how the valves work and the size of the different chambers of the heart. It describes the pumping function of the heart and is usually called the ejection fraction and is stated as a percentage.
Left Heart Catheterization (angiogram)
This is an invasive test where dye is injected into one of the large arteries in the groin, to find out if there are any blockages in the coronary arteries of the heart. Left ventricular heart function can also be determined.
Right Heart Catheterization
This can be done at the same time as the left heart catheterization or separately. This gives the physician information on the pressures in the heart and lungs. These measurements help the physician make recommendations and suggestions on medications you may be taking and whether you are a heart transplant candidate.
Pulmonary Function Tests
This tests the ability of your lungs to carry oxygen to the rest of your body.
Carotid Doppler Studies
This is an ultrasound of the carotid arteries in the neck which carry the blood to your brain. If blockages are present, the patient could suffer a stroke during surgery.
Peripheral Doppler Studies
This is an ultrasound of the legs. The surgeon needs to know if there are blockages in the arteries to the legs. Large catheters are put into the large veins and arteries in the groin for the heart-lung machine that is used during the heart transplant operation.
Abdominal Ultrasound
This is an ultrasound of the organs in the abdomen, liver, gallbladder, pancreas, spleen and kidneys. This test looks for any abnormality that might interfere with a successful heart transplant surgery and outcome.
Vaccinations
This includes T. B. skin testing and immunizations for influenza, pneumonia, and hepatitis.
Females: Mammogram and Pap Smear, flexible sigmoidoscopy or colonoscopy.
Males: Prostate exam, flexible sigmoidoscopy or colonoscopy.
Other testing: individualized depending on patient's other diseases (i.e. Diabetes mellitus, history of cancer.
Selection of Patients for Heart Transplantation
The heart transplant team meets on a regular basis to discuss patients who have been evaluated for heart transplantation. A decision is made whether or not to offer the patient a heart transplant based upon the evaluation and the recommendations of all the heart transplant team members. If the patient is not a suitable candidate he/she will be referred back to their referring physician for continued medical management.
The criteria for potential cardiac transplant candidates are often used as a basis for judgment. Each transplant center, however, may have specific policies and procedures for transplant candidate selection.
Listing the Patient on the United Network for Organ Sharing (UNOS) List
The patient is placed on the national transplant list, which is managed by the United Network for Organ Sharing (UNOS). Information needed to list the patient appropriately for a suitable donor heart is the following:
- Last name and first initial
- Social Security Number
- Date of Birth
- Weight range for the donor
- Blood type [need for a cross match] (a blood test to determine if the
donor recipient area match).
