What we have most to fear is failure of the heart.

Sonia Johnson  (American feminist activist and writer)

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).

Heart failure signs and symptoms may include by the MAYO CLINIC are:

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Sudden weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack
• To diagnose heart failure, your doctor will first ask you questions about your medical symptoms and history. Your doctor will want to know:

• if you have any other health conditions such as diabetes, kidney disease, angina, high blood pressure, or other heart problems.
• if you smoke
• if you drink alcohol and how much you drink
• what medications you are takingYour doctor will also perform a complete physical exam. Your doctor will look for signs of heart failure as well as any other illnesses that may have caused your heart to weaken.
• After the physical exam, your doctor may also order some of these tests:
• For the diagnosing of the CHF the MAYO clinic states the following:

• Blood tests. Your doctor may take a sample of your blood to check your kidney, liver and thyroid function and to look for indicators of other diseases that affect the heart.
• A blood test to check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help in diagnosing heart failure if the diagnosis isn’t certain when used in addition to other tests.
• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
• Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper.
• This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
• Echocardiogram. An important test for diagnosing heart failure is the echocardiogram. An echocardiogram helps distinguish systolic heart failure from diastolic heart failure in which the heart is stiff and can’t fill properly.The echocardiogram also can help doctors look for valve problems or evidence of previous heart attacks, other heart abnormalities, and some unusual causes of heart failure.
• Your ejection fraction is measured during an echocardiogram and can also be measured by nuclear medicine tests, cardiac catheterization and cardiac MRI. This is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment.
• An echocardiogram uses sound waves to produce a video image of your heart. This test can help doctors see the size and shape of your heart and how well your heart is pumping.
• Stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Sometimes the stress test can be done while wearing a mask that measures the ability of your heart and lungs to take in oxygen and breathe out carbon dioxide.If your doctor also wants to see images of your heart while you’re exercising, he or she may order a nuclear stress test or a stress echocardiogram. It’s similar to an exercise stress test, but it also uses imaging techniques to visualize your heart during the test.
• Stress tests help doctors see if you have coronary artery disease. Stress tests also determine how well your body is responding to your heart’s decreased pumping effectiveness and can help guide long-term treatment decisions.
• Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including causes of heart failure.In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.
• In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
• Coronary angiogram. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries.
• A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray. This test helps doctors identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure. The test may include a ventriculogram — a procedure to determine the strength of the heart’s main pumping chamber (left ventricle) and the health of the heart valves.

Myocardial biopsy. In this test, your doctor inserts a small, flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.

Tune in tomorrow for part 3 of CHF treatment, complications & tips.

“Heart failure is serious. But there is hope. With the right treatment, you can lead an active life.”

HEARTMATE 11

The definition of heart failure, it occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as hypertension and CAD = coronary artery disease. The term heart failure suggests a sudden and complete stop of heart activity but actually the heart does not suddenly or abruptly stop. Instead the way it works is heart failure usually develops over time, years. The heart first compensates with the disease or illness the individual has but, just like a car, after wear and tear the heart goes into decompensating to heart failure due to the heart decline. How serious is this condition? It varies from person to person depending on factors like an individual with obesity & unhealthy versus a person in healthier condition. All people diagnosed or not diagnosed with heart failure lose a pumping capacity of the heart happens as they age but diagnosed with heart failure makes the engine of the body a challenge in doing its function properly. The pump loss is more significant in the person with heart failure and often results from a heart attack (actual scaring to the tissue=death to that tissue area) or from other diseases that can damage the heart. The severity of the condition determines the impact it has on a person’s life. At the other end, extremes, treatment often helps people lead full lives if the person follows the meds ordered by the doctor including the diet and activity/exercise the doctor orders to the patient with heart failure (compliance so important). There are different levels of heart failure but even the mildest form is a serious health problem, which must be treated. If not the pump (the heart) will just get worse in doing its function properly. To improve the chance of living longer in an individual with heart failure, patients must take care of themselves, see their physician (cardiologist) on a regular basis, and closely follow treatments (as ordered) with knowing what heart failure actually to understanding how the disease works (is the failure on the right side or left side? Which in time will effect the other side in time). In knowing what side the failure is on will make you understand what signs and symptoms to expect.

Types of Heart Failure

The term congestive heart failure (CHF) is often used to describe all patients with heart failure. In reality, congestion=the buildup of fluids in the heart for not pumping correctly, just like pipes in a home not working properly=back up of water in the pipes, happens with CHF also to the fluids (blood) backing up in the lungs.   This is just one feature of the condition and does not occur in all patients. There are two main categories of heart failure although within each category, symptoms and effects may differ from patient to patient. The two categories are:    1-Systolic heart failure (systolic is the top number of your blood pressure=the heart at work). This occurs when the heart’s (muscle-myocardium) ability to contract (pump=being active) decreases, particularly starting on the L side of the heart where the muscle of the heart is greatest (myocardium=heart muscle). The heart cannot pump blood with enough force to push a sufficient amount out of the heart into the circulation through the aorta. The aorta is a artery (vessel) that leaves the L lower chamber of the heart (left side of the heart=highly oxygenated rich blood). Due to the heart not using enough force pushing the blood forward in the aorta this causes the blood to back up and cause it to go back up into the L lower to the L upper chamber that goes further back up into the pulmonary vein into the lungs=congestion in the lungs due to the heart failure.

2-Diastolic heart failure (diastolic is the bottom number of your blood pressure which is the pressure when the heart is at rest). This failure occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle of the heart due to trying so hard to compensate over a long period of time with disease (ex. High B/P, Obesity, etc…) strains the heart in doing its function that failure finally starts that the muscle of the heart (myocardium) becomes stiff. This causes the heart to lose its ability to relax to allow proper filling of the heart in upper and lower chambers=back up of the blood.   This failure starts on the right side of the heart causing the blood to back up away from the heart and may lead this blood that is highly concentrated with carbon dioxide to accumulation especially in the feet, ankles and legs. Some patients may have lung congestion.

Causes of Heart Failure:

As stated, the heart loses some of its blood pumping ability as a natural consequence of aging. How- ever, a number of other factors can lead to a potentially life-threatening loss of pumping activity.

As a symptom of underlying heart disease, heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes= abnormal blood sugar levels, and obesity. A person can change or eliminate those risk factors and thus lower their risk of developing or aggravating their heart disease and heart failure through healthy habits performed routinely, proper dieting, and balancing rest with exercise.

Among prominent risk factors, hypertension-HTN (high blood pressure) and diabetes are PARTICULARLY IMPORTANT. Uncontrolled HTN increases the risk of heart failure by 200 %, compared to those who do not have hypertension.   Moreover, the degree of risk appears directly related to the severity of the high blood pressure.

Persons with diabetes have about a two to eight fold greater risk of heart failure than those without diabetes. Women with diabetes have a greater risk of heart failure than men with diabetes. Part of the risk comes from the diabetes association with other risk factors for heart disease such as high cholesterol or obesity or other risk factors. However, the disease process of diabetes also damages the heart muscle.

The presence of coronary disease is among the greatest risks for heart failure. Muscle damage and scarring caused by a heart attack greatly increase the risk of heart failure. Cardiac arrhythmias, or irregular heartbeats, also raise heart failure risk. Any disorder that causes abnormal swelling or thickening of the heart sets the stage for heart failure.

In some people, heart failure arises from problems with heart valves, the flap-like structures that help regulate blood flow through the heart. Infections in the heart are another source of increased risk for heart failure.

A single risk factor may be sufficient to cause heart failure, but a combination of factors dramatically increases the risk. Advanced age adds to the potential impact of any heart failure risk.

Finally, genetic abnormalities contribute to the risk for certain types of heart disease, which in turn may lead to heart failure. However, in most instances, a specific genetic link to heart failure has not been identified.

SO LIVE AS HEALTHY AS POSSIBLE IN YOUR ROUTINE HABITS, YOUR DIETING OF THE 4 FOOD GROUPS, MAINTAINING YOUR WEIGHT IN A THEREPEUTIC RANGE (look as calculating BMI online for free to find out what your weight range for your height is), and BALANCING REST WITH EXERCISE TO HELP DECREASE THE CHANCE OF GETTING HEART FAILURE.

CHF part 2 tomorrow and learn what the signs and symptoms with how its diagnosed, how its treated with tips on the disease (most importantly prevention).

“To keep the body in good health is a duty… otherwise we shall not be able to keep our mind strong and clear.”

Buddha

Let’s just start with looking at our health problems recently & the statistics. According to the “Mayo Clinic” in 2011 the top male and female problems vary a little. The health problems that are similar to them are the ones we need to be more concerned about since the ones I will be presenting to you are brought on to many Americans cause of poor health habits (which includes diet with activity). They state that cardiac disease is #1 killer for both men and women. The American Heart Association in 2011 state cardiac disease, which does cause many heart attacks and strokes, with killing more people than all forms of cancer combined. Two major factors that would decrease the amount in cardiac disease if people stop smoking and eat HEALTHIER=low fat, low sodium and occasional fast foods, if ever in their diet. Fast foods frequently eaten just doesn’t cut healthy. Another helpful key is routine exercise.                                                                                                                                                     *2011 Lung cancer was the cancer that caused most deaths in both men and women. Women are also greatly affected with breast cancer and colorectal cancer, according to the Mayo clinic 2011. To help in decreasing the chance of cancer eat HEALTHY, wear sunscreen, don’t smoke, and get regular cancer screenings.                                                                                                                                              *COPD=Respiratory Diseases classified as Chronic Obstructive Pulmonary Disease which includes Emphysema or Bronchitis. The National Heart, Lung, & Blood Institute in 2011 recommended quit smoking to prevent COPD (esp. Emphysema which is the largest RISK factor in getting it). When you smoke you expand the lung tissue and keep expanding it as you continue smoking. It doesn’t reverse and after years you have difficulty exchanging oxygen (when inhaled) with carbon dioxide (when exhale-ed) at the lung base & this is because of stretching the lung tissue so bad. The answer is either QUIT or NEVER smoke and band smoking. The U.S. lung cancer census would go down markedly in a 5-10 years *Diabetes 2 is a diabetes that you are not born with but can get later in life. It is also a leading killer for both men and women in the U.S. A lot of cases seem to be due to unhealthy eating that goes into obesity that causes the individual to end up with diabetes. This disease causes damage to many organs of the body in time. Due to the high glucose levels (hyperglycemia) it damages the kidney causing for many to be put on hemodialysis 3x/wk usually, giving heart disease, neuropathy (down the legs usually), and retinopathy=blindness, in time. To prevent this disease losing weight (with staying in a normal body mass index), doing routine exercise, and eating healthy will help a great deal, especially started young. *In 2011 Alzheimer’s disease was the fifth leading cause of death in women and the tenth in men. We really don’t know what the etiology is but there may be a link between this disease and heart disease, including head injuries. What could help this prevent this? One eating healthy, two routine exercise-as simple as walking regularly daily or 2 to 3 times a week and eating healthy to prevent cardiac disease. Also, drive safely with the seat belt on, no texting, no cell phone to prevent a MVA & hitting your head. *Kidney disease in 2011 the ninth leading cause of death for both males and females in the U.S. It can be caused by high blood pressure or diabetes, according to the Mayo Clinic. The American Diabetes Association stressed the importance of keeping your blood sugar under control if you are a diabetic in order to prevent kidney disease if done soon enough. To prevent this disease it is the same as cardiac and diabetes prevention (listed above) but the sooner started the better.

 After seeing the disease census 2011 in our country; now the next question would be is there anyway we can decrease diseases in our country overtime, like in a decade or less. Well, all the diseases I covered yesterday are impacted on what healthy habits you practice over a long period of time in your life; than these diseases can be controlled better. Wouldn’t you want to see less disease and more people young and old healthier. I know I sure would after being a RN over a quarter of a century seeing so many diseases and ones that could have been prevented by a society more health oriented than based on their food cravings. We have all heard we need to make sacrifices for certain things in life. Would you think sacrificing fast foods being eaten daily or low glycemic meals in large sizes for all your meals over numerous years that prones you to putting weight on putting you at risk for disease is worth sacrificing?   I finally do in my 40’s and it’s not that hard of a sacrifice.  You may just like what you see so give it a try.  For guidance I found Dr. Wayne Scott Anderson’s book “Dr. A.’s Habits of Health” on a regular basis very helpful. If the majority of America lived healthier like this there would be less disease in our country which would put a positive impact on our health care system for all but it would take a decade but we need to start somewhere and today is the best day to start for both us as well as future generations to come. Eating healthier, losing weight down to the ideal body mass index ratio based on your height, exercise routinely (not necessarily meaning an aerobic work out), and practicing healthy habits would increase your chance of living longer healthy and put your life on a journey .

Because of the high prevalence of diabetes in the United States, the medical community has become increasingly reliant on nationwide education campaigns to help combat the issue. The American Diabetes Association has recommended screening guidelines for susceptible individuals with established risk factors. The risk factors for diabetes screening include:

• Family history of diabetes
• People older than 45 years of age
• Sedentary lifestyle
• Body Mass Index (BMI) greater than 25
• Elevated fasting glucose
• Hypertension
• Polycystic ovarian syndrome
• History of gestational diabetes
• Abnormal lipid levels (HDL levels < 35 mg/dL and/or triglyceride level > 250 mg/dL)

The American Diabetes Association has published two online risk questionnaires to help screen for an individual’s risk for diabetes. The first tool (“Diabetes Risk Test“) requires the user to input information regarding weight, height, age, exercise history and family history. The other online tool (“My Health Advisor“) is more detailed and requires other biomedical information, such as cholesterol readings and blood pressure, which make it more applicable in a healthcare setting.

The U.S. Preventive Services Task Force recommends screening for diabetes every three years for adults older than 45 years of age and every two years if any of the above risk factors are present. Educating the patient can mitigate several of the above risk factors, such as sedentary lifestyle, hypertension and a high BMI. Proper screening goes hand-in-hand with an instructional program that can help to reduce risk factors reported in the diabetes screening guidelines.

Once laboratory tests indicate the presence of diabetes, it is necessary to diagnose the patient with either T1DM of T2DM to determine the relevant treatment options. T1DM and T2DM can usually be differentiated through the findings associated with lab tests, medical history assessment and physical examination.

Another corroborative study was conducted which ended in conclusion, advising that test subjects with less than five hours of nightly sleep had a 47% increase in the incidence of T2DM over a 10-year period.

National Health and Nutrition Examination Survey

OTHER RISK FACTORS in getting Type 2 Diabetes:

*Although obesity and genetics are the primary risk factors for the development of T2DM, other health and environmental issues, such as hypertension, smoking, alcohol and sleep deprivation also play a role. The association between hypertension and T2DM has been the subject of several studies in the medical community. This link is based on the role that angiotensin plays in the body.

Angiotensin, produced by the blood, can affect blood pressure and interfere with normal metabolic signaling of insulin. Angiotensin is a peptide hormone that causes vasoconstriction and a subsequent increase in blood pressure. It is part of the renin-angiotensin system, which is a major target for drugs that lower blood pressure. Angiotensin also stimulates the release of aldosterone, another hormone, from the adrenal cortex. Aldosterone promotes sodium retention in the distal nephron, in the kidney, which also drives blood pressure up.

*Smoking has also been linked to the development of T2DM through several recent prospective studies.

*Alcohol as a risk for T2DM, there are two separate classifications to consider – moderate use of alcohol vs. excessive use. Like many things in life, moderate use does not appear to be a risk factor, in fact, it actually may have protective benefits. Excessive use of alcohol does appear to be a potential risk factor for T2DM. Recent systematic review and meta-analysis confirmed previous studies regarding the role of moderate alcohol consumption. This research revealed that when users consumed 22 grams of alcohol daily, protective benefits were seen. On the contrary, when users consumed more than 50 grams of alcohol per day, the protective benefits were negated and harmful affects occurred.

*Poor daily sleep-Scientists are investigating lack of sleep as another recent emerging risk factor for T2DM. Data from the Nurse’s Health Study (2012) assessed more than 70,000 women over a 10-year period concerning potential negative health issues caused by decreased sleep. The results of this prospective study suggested that these women had a 57% increased risk of developing T2DM. Another corroborative study conducted by the National Health and Nutrition Examination Survey advised that test subjects with less than five hours of nightly sleep had a 47% increase in the incidence of T2DM over a 10-year period.

*Studies have shown that individuals with metabolic syndrome have five times the risk of developing T2DM than people without the disorder. Furthermore, according to the National Heart, Lung and Blood Institute, metabolic syndrome is on the way to overtaking smoking as the leading risk factor for heart disease.

Metabolic syndrome is a disorder of energy utilization and storage, diagnosed by a co-occurrence of three out of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density lipoprotein (HDL) levels. Metabolic syndrome increases the risk of developing cardiovascular disease and diabetes.