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Biological and psychosocial issues



Seniors and heart failure


In heart failure, the heart cannot pump enough blood through the body. The heart cannot fill with enough blood or pump with enough force, or both. Heart failure develops over time as the pumping action of the heart gets weaker. It can affect either the right, the left, or both sides of the heart. Heart failure does not mean that the heart has stopped working or is about to stop working.

In most cases, heart failure affects the left side of the heart when it cannot pump enough oxygen-rich blood to the rest of the body. When heart failure affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen.

In normal hearts, blood vessels called veins bring oxygen-poor blood from the body to the right side of the heart. It is then pumped through the pulmonary artery to the lungs, picking up oxygen. From there, the blood returns to the left side of the heart. Then it is pumped through a large artery called the aorta that distributes blood throughout the body.

When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath.
Heart failure is a serious condition. Heart failure is most common in those who are age 65 years and older and is the number one reason older people are hospitalized.

Heart failure tends to be more common in men than in women, but because women usually live longer, the condition affects more women in their 70s and 80s.
Heart failure can also be called congestive heart failure, systolic heart failure, diastolic heart failure, left-sided heart failure, or right-sided heart failure.

Risk Factors and Prevention

Heart failure can happen to almost anyone. It is most common in people over 65, and is more common in African-Americans. Also, men have a higher rate of heart failure than women. It is the number one reason for hospitalization for people over age 65.
Heart failure is caused by other diseases or conditions that damage the heart muscle. It is often caused by coronary artery disease, including heart attacks. Diabetes and high blood pressure also contribute to heart failure risk.
Coronary artery disease is the leading cause of death in men and women. It happens when the arteries that supply blood to the heart become hardened and narrowed. People who have had a heart attack are at high risk to develop heart failure.
There are a number of things that you can do to reduce risk of coronary artery disease and heart failure.
Keeping your cholesterol levels healthy can help prevent coronary artery disease. For most people, the targets are:
  • LDL, or "bad" cholesterol -- below 100
  • HDL, or "good" cholesterol -- above 40 in men and above 50 in women
  • Triglycerides, another fat in the blood -- below 150
High blood pressure causes the heart to get larger and work harder, which can then lead to heart failure. You should aim for a blood pressure level of 130/80 or below. Talk to your doctor about ways to lower your blood pressure.
Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure.
You can help prevent heart disease by losing weight if you are overweight, quitting smoking, and limiting the amount of alcohol you drink. Doctors also recommend that you eat a diet low in salt because salt can cause extra fluid to build up in your body.
Limiting foods that are high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil, can help you maintain a heart-healthy diet. Heart-healthy foods include those high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables.
Exercise also helps keep your heart strong. Aim for at least 30 minutes a day of exercise.

Symptoms and Diagnosis

The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling usually occurs in the ankles, feet, legs, and sometimes in the abdomen.
Swelling is caused by fluid buildup in the body and can lead to weight gain and frequent urination, as well as a cough. The cough can be worse at night and when lying down.
When symptoms first begin, you might feel tired or short of breath after routine physical activities, such as climbing stairs. As heart failure progresses, the symptoms get worse. You may feel tired or short of breath after performing simple activities, like getting dressed.
There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests.
The tests will identify whether you have any diseases or conditions that can cause heart failure. They will also rule out any other causes of your symptoms and determine the amount of damage to your heart.
During a physical examination, you can expect your doctor to listen to your heart for abnormal sounds and listen to your lungs for a buildup of fluid. Your doctor will also look for swelling in your ankles, feet, legs, abdomen, and in the veins in your neck.
If your doctor determines that you have signs of heart failure, he or she may order several tests.

Tests that are given to determine heart failure include:

An EKG or ECG -- electrocardiogram -- measures the rate and regularity of your heartbeat. The test can also show if you have had a heart attack and whether the walls of your heart have thickened.

A chest X-ray takes a picture of your heart and lungs. It will show whether your heart is enlarged or your lungs have fluid in them, both signs of heart disease.

A BNP blood test measures the level of a hormone called BNP -- B-type natriuretic peptide -- that increases in heart failure. Once these initial tests have been performed, your doctor may decide to send you to a cardiologist who specializes in the diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests.

There are several tests that can identify the cause of heart failure. These tests include :

An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged.

A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity.

An exercise stress test reads your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity. An echocardiogram is often part of the test to show how your heart pumps. Treatment and Research

There is no cure for heart failure, but it can be controlled by treating the underlying conditions that cause it. The goals for treatment are to improve symptoms, stop it from getting worse, and prolong life span.
Treatment includes lifestyle changes, medications, and specialized care for those who are in the advanced stages.
Treatment for heart failure will reduce the chances that you will have to go to the hospital and make it easier for you to do the things you like to do. It is very important that you follow your treatment plan by keeping doctors appointments, taking medications, and making lifestyle changes.
Your doctor will probably recommend that you follow a diet low in salt because salt can cause extra fluid to build up in your body, making heart failure worse. You should limit the fluids you drink and weigh yourself every day. Let your doctor know right away if you have sudden weight gain. This could mean extra fluid is building up.
Your doctor may also tell you to lose weight, quit smoking, and limit the amount of alcohol you drink.
Your doctor will prescribe medications to improve your heart function and symptoms. These may include:
  • Diuretics, which are water or fluid pills. These reduce fluid in your lungs and swelling in your feet and ankles.
  • ACE inhibitors to lower blood pressure and reduce strain on your heart.
Medications your doctor may prescribe include:
  • Beta blockers to slow your heart rate. They will also lower blood pressure to relieve some of the workload on your heart.
  • Digoxin will help the heart beat stronger and pump more blood.
Those with heart failure should try to avoid respiratory infections like pneumonia and the flu. Ask your doctor about getting an annual flu shot. Your doctor may also order extra oxygen if you have trouble breathing. The oxygen can be used in your home or in the hospital.
People with severe heart failure may also receive a mechanical heart pump that is placed inside the body to help pump blood. Some heart pumps can stay in your body for a long time, while others are temporary.
You may also be considered for a heart transplant. During transplantation, a healthy heart from someone who has recently died is put in to replace yours. A transplant is an option when all other treatments fail to control symptoms.
Many advances in treatment for heart failure have been made over the past few decades, but heart failure is still very common. Scientists are trying to determine the best ways to prevent and treat heart failure.


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