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by Randy Zimmerman, M.D., PAHCS
People can feel chronically tired. Many, but not all, notice swelling in the ankles and feet. Some complain of a chronic cough, even when there is no infection. If these sound like common symptoms, you're right. CHF is responsible for more than 11 million visits to physician's offices every year in this country, and contributes to over 3.5 million hospitalizations every year. In fact, CHF is the leading cause of hospitalization in the United States for people older than age 65.
It is estimated that 4.8 million Americans have CHF, with about half a million new cases diagnosed each year. The two most common causes of CHF coronary artery disease and high blood pressure. Other causes include diseased heart valves, abnormal heart rates, and chemicals poisonous to the heart. These toxic substances aren't just cocaine and IV drugs, but include many chemotherapy drugs and even alcohol. Some people can get CHF simply after being exposed to a certain virus. This is quite rare, but since we all get colds at one time or another, it makes us quite interested when we learn that a simple cold virus may have the power to poison the heart.
If you or someone close to you has the symptoms of fatigue, shortness of breath, cough, or fluid build-up in the lungs, it may be very difficult to tell if it isn't just a bad cold. In fact, the symptoms and the doctors' exam may misdiagnose the problem more often than we care to admit. In a recent study, the diagnosis of CHF was missed in over 15 percent of patients with these symptoms. In another 15 percent of patients with shortness of breath, they were told they had CHF when they, in fact, did not. A good physician needs a sense of what to look for and which tests to run. In addition to the physical exam, we have stress tests, echocardiograms, chest x-rays, and some very useful laboratory tests.
If a patient comes to the doctor with these symptoms, our first job is to figure out what caused the CHF. We think of CHF as a symptom of the underlying medical problem. In a similar way, a fever is a symptom of strep throat. The fever is just a signal that the infection is there. Likewise, CHF is a signal that a cardiac problem is present. The doctor's job is to determine the cause of CHF and decide how to prevent the underlying problem from doing more damage than it already has.
After a patient is diagnosed and the cause of CHF is addressed, it's time for the CHF team to organize a detailed plan involving lifestyle issues, medications, and an exercise prescription. Although medications are not the only treatment for CHF, they are often the first because they act quickly to relieve the symptoms. Usually a diuretic, or water pill, is the first choice because this can rapidly improve some of the shortness of breath by flushing out extra fluids. As the symptoms improve, however, the diuretic quickly has less and less importance as the other medicines step in.
The second medicine for CHF is called an ACE inhibitor. For most patients, we soon add on a third set of medicines, called beta-blockers. These medications are proven interventions, and recent studies are so convincing that all CHF patients should be considered for them. They improve symptoms, decrease hospitalization, and actually help people live longer. For someone with heart failure, this process could easily become very complicated. Fortunately, there are clinical pharmacists and nurses who are specially trained in helping people get used to these medicines and they help adjust the doses of them.
The PAHCS is pleased to announce a new service for our patients with Congestive Heart Failure.
Our new CHF clinic is available to patients on Wednesday mornings. A physician and clinical pharmacist will conduct a thorough medical and medication review and a complete cardiac exam. A nurse trained in CHF will be available for phone follow-ups and questions.
Contact your primary care provider for more information or call Dr. Zimmerman's office at 320-243-3779 ext. 2232.
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