here for Multimedia Lecture on Heart Failure!
What is Congestive Heart
How common is CHF
How serious is CHF
What are the causes of
What are the symptoms
or complaints of CHF?
How does the body respond
What is Diastolic heart failure?
How is CHF diagnosed?
How is CHF treated?
What is diastolic heart
failure or CHF? The left ventricle (LV) or
major pumping chamber of the heart empties during systole
(pronounced sis-tull-e). The filling process of the
LV is known as diastole (pronounced die-as-tull-e).
Traditionally, CHF usually refers to failure or weakness
of the pumping or systolic action of the heart. However,
CHF can also occur in patients who have well preserved
systolic function but have problems with diastole or
filling of the LV.
The walls of the LV are made up
of fairly "elastic" muscle which stretches
when it is filled up with blood returned by the body.
The LV becomes stiffer and less elastic when it is severely
thickened as a result of long standing, uncontrolled
high blood pressure or certain types of heart disease
such as hypertrophic (pronounced hi-per-trow-fic) cardiomyopathy
(pronounced car-dee-o-my-op-a-thee). Stiffness of the
LV can also be caused by a disease known as restrictive
With increased stiffness of its
walls, the LV requires a higher volume of blood to stretch
it adequately. In other words, less blood will not be
able to stretch and fill the LV. To understand this
concept, let us compare the elasticity or filling of
a balloon to that of an automobile tire. A balloon can
be inflated with air with the use relatively low pressure.
On the other hand, the flat automobile
tire on the left requires a considerably greater amount
of pressure to inflate it. Now imagine if you will that
the balloon and tire are both of the same size or volume.
The air pressure within the balloon will be far less
than that of the automobile tire. In other words the
pressure within diastole or filling of the LV is far
greater when its walls are very stiff.
The high pressure is
reflected back to the lungs, the right ventricle and
to the body. As the pressure rises, the lungs, legs,
etc., become congested in a manner similar to that of
CHF caused by weakness of the heart muscle. This is
known as diastolic failure of the heart and can be seen
even when the pumping ability of the heart is well preserved.
How is CHF diagnosed?
The diagnosis of CHF is first suspected when the patient
provides a history and complains about fatigue, shortness
of breath, swelling and weight gain. Physical examination
by the physician helps to strengthen the suspicion or
even confirm the diagnosis. At this time, the physician
will usually order an EKG (to determine if there is
evidence of a prior heart attack, signs of increased
wall thickness, irregular heart beats, etc.). A chest
x-ray will show if the heart is enlarged and whether
or not the lungs are congested or filled with fluid.
An echocardiogram is an extremely important test that
helps determine the size, thickness and function of
the various heart chambers and valves. It also helps
estimate pressure within the lungs and determine whether
or not the patients volume of blood is excessive. Based
upon the above evaluation, the physician may order a
Holter monitor if irregular heart beats are suspected
or seen, a stress test (regular, echocardiographic,
nuclear or chemical) if coronary disease is suspected
or even recommend cardiac catheterization.