What is congestive heart failure?
Congestive heart failure occurs when your heart muscle doesn’t pump blood as effectively as it normally does. This can be an ongoing/chronic condition or it can occur suddenly. Left untreated, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually weaken your heart to the degree it can’t fill and pump the blood out efficiently.
Congestive heart failure is the leading cause of hospitalization in people older than 65. Roughly 670,000 people are diagnosed with heart failure every year, with the condition affecting nearly 6 million Americans.
It’s easy to assume that “failure” means the heart has stopped working, but this isn’t the case. It means that the heart no longer works efficiently. This leads to various other problems, such as a stiffening of the heart chambers, as the heart tries to keep the blood moving. But this also weakens the heart muscle walls. The kidneys respond by retaining water and salt throughout the body. This builds in the arms, legs, ankles, feet, lungs, or other organs — they become congested — hence the term congestive heart failure.
An ejection fraction is used to measure how efficiently your heart is pumping. A healthy heart has an ejection fraction of 50 percent or higher. This means that half the blood that fills the ventricle is pumped out with each beat.
What causes congestive heart failure?
Conditions that damage the heart muscle lead to failure. These include:
- Coronary artery disease — As the arteries fill with fatty deposits known as plaque they become narrower, decreasing blood flow to the heart muscle. If they become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
- Heart attack — A heart attack occurs when a coronary artery becomes blocked. The blood flow to the heart muscle is stopped and damage ensues. This creates scar tissue on the heart that impairs its function.
- Cardiomyopathy — This is damage to the heart muscle that is due to causes not related to blood flow. This damage can result from infection, or drug or alcohol abuse.
- Overwork — Certain health conditions cause the heart to work too hard, damaging the muscle. When the heart has to work too hard to circulate your blood, this extra exertion makes the heart muscle more and more stiff over time, which weakens it ability to pump blood. These health conditions include high blood pressure, kidney disease, thyroid disease, diabetes, valve disease, and congenital heart defects.
- Arrhythmias — Abnormal heart rhythms, due to malfunctioning electrical signals across the heart, can cause the heart to beat too fast, creating extra work. An overly slow heartbeat can also lead to heart failure.
Is heart disease genetic?
Heart disease definitely has a genetic factor. Most cases of are known as polygenic, meaning they result from changes in a number of different genes. At this point, researchers have identified 67 different sites in the DNA sequence that increase a person’s heart attack risk. The more copies of these variants a person has, the higher their genetic risk of heart disease.
While there are genetic risk factors, there are plenty of ways a person can lower these factors through lifestyle choices, such as regular exercise, eating a healthy diet, maintaining a healthy weight, not smoking, and the like.
What happens when you have valvular heart disease?
When you have valvular heart disease, there is damage or a defect in one of the four heart valves: the mitral, aortic, tricuspid, or pulmonary. The mitral and tricuspid valves control blood flow between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood to the lungs. The aortic valve controls blood flow between the heart and the aorta, affecting the blood vessels to the rest of the body.
When your heart valves function normally, they ensure blood flows with proper force in the proper direction at the proper time. When a person has valvular heart disease, the valves become too narrow or too hard, and they are unable to close completely. This allows blood to back up into an adjacent heart chamber, or to leak back into a chamber it just exited.
When the heart tries to compensate for this ineffective pumping, the heart muscle enlarges and thickens. This makes it stiffer and it loses efficiency — the definition of congestive heart failure.
What is a pacemaker?
A pacemaker is a small, implanted device that is placed under the skin of your chest. It has a generator and leads/wires, and its job it to help control your heartbeat. It mimics your heart’s natural pacemaker, known as the sinus node, which produces electrical impulses to stimulate your heart to beat.
The pulse generator is a small metal container that houses the pacemaker battery and the electrical circuitry that regulates the rate of electrical pulses sent to the heart. Depending on the problem with your heart, the pulse generator is connected to one to three flexible, insulated wires that run through a blood vessel into the chamber, or chambers, or your heart. These wires deliver the electrical pulses to adjust your heart rate.
An implanted pacemaker monitors the person’s heartbeat. If it is too slow, the pacemaker will send impulses to increase the heartbeat. Pacemakers have sensors to detect body motion or breathing rate, which signals the pacemaker to increase your heart rate during exercise to meet the need for increased blood and oxygen.
Can a person continue to work after receiving a pacemaker?
Yes. With your pacemaker you can return to normal activities, including work. In fact, you’ll probably only need from 3-7 days off work. Patients usually need to avoid vigorous exercise and heavy lifting for about one month after receiving a pacemaker, but that’s about it.
What is a defibrillator?
An implantable cardioverter-defibrillator (ICD) is a pager-sized device that is surgically placed under your skin, usually just below your collarbone. From the device one or more wires run from the ICD through your veins to your heart. ICDs are usually placed in patients with dangerously fast heartbeats (ventricular tachycardia) or a chaotic, uneven heartbeat (ventricular fibrillation). Once implanted, the defibrillator continuously detects your heartbeats. If it senses an arrhythmia, an abnormal heartbeat, it delivers electrical pulses to restore a normal heart rhythm when necessary.
Implantable cardioverter-defibrillators perform the same function as the defibrillators that use paddles to deliver a shock to the outer chest of a person having cardiac arrest. These simply work from inside, and they deliver the “shocks” when the person’s heart beats out of normal rhythm.
How does an implantable cardioverter-defibrillator work?
These are usually used when a person has a rapid heartbeat. When your heartbeat races, the wires attached to your heart transmit signals back to the defibrillator, which responds by sending electrical pulses back to the heart to return a normal heartbeat. The ICD can be programmed for different therapies. These are three typical therapies:
- Low-energy pacing therapy — You won’t likely feel this signal, or you may sense a painless fluttering in your chest when the ICD delivers the impulses to correct mild disruptions in your heartbeat.
- Cardioversion therapy — If there is a more serious problem, a higher energy shock is delivered. This may feel as if you’ve been thumped in the chest.
- Defibrillation therapy — This is the strongest form of electrical therapy used to restore a normal heartbeat. This strong shock may feel as if you’ve been kicked in the chest, and it can be strong enough to knock you off your feet. There is usually about one second of pain.
In most cases, a single shock is all that is needed to restore a normal heartbeat.
How much time does a new patient visit take?
A new patient visit can take up to 2 hours.
What should I bring with me to my first visit?
On your first visit you need to bring in your insurance card, driver’s license, a list of your current medications (or the actual bottles of medications), and a copy of your most recent labs.
How much time does a follow up appointment take?
A follow up appointment can take any where from 30-90 minutes.
Do I have to pay a co-payment every time I come to the office?
If your insurance plan requires a co-payment, you will be expected to pay each time you see the provider and/or mid-level. The amount of your co-pay can usually be found on the front of your insurance card. A specialist co-pay may be higher than what you normally pay to your primary care physician.
What is interventional cardiology?
Interventional cardiology refers to various non-surgical procedures for treating cardiovascular disease.
What is non-invasive cardiology?
Noninvasive cardiology focuses at improving the blood supply to the heart without any form of invasive surgeries and alternating the blood chemistry.
Is a referral required for my visit?
If a referral is required, our staff will be responsible for obtaining it. This is why it is very important that you provide our new patient coordinator with all of your insurance information and primary care physician when you make your initial appointment. It is also very important that you notify our office of any changes in your insurance.
Can I get my test results over the phone?
No results will be given over the phone. An appointment will be made for a follow up visit to receive your test results.
Is there a charge to have forms filled?
There is a $35 fee to have forms filled out by the doctor. Please allow at least a week for these forms to be completed.
What do I do if I need a refill on my medications?
We recommend that you call your pharmacy to request a refill. They will either fax over a request or send an electronic request.