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Congestive heart failure (also called heart failure) is a serious condition in which the heart doesn’t pump blood as efficiently as it should. Despite its name, heart failure doesn’t mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it can’t keep up with the body’s demand, and blood returns to the heart faster than it can be pumped out—it becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the body’s other organs. The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contracts—but over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they don’t receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse. More than 5 million people in the United States have congestive heart failure. It’s the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause. “To avoid heart failure, there’s a need to prevent other heart problems,” says Johns Hopkins cardiologist Steven Jones, M.D.
The best way to avoid congestive heart failure is to avoid the conditions that contribute to it, or to carefully manage these conditions if they develop, says Jones.
DiagnosisThere’s no one test to diagnose heart failure. Your doctor will consider your medical history, family history, a physical exam and the results of various tests. These tests can include:
TreatmentThere’s no cure for heart failure. Treatment aims to relieve symptoms and slow further damage. TheI exact plan depends on the stage and type of heart failure, underlying conditions and the individual patient. Among the components of a treatment plan: Lifestyle changes. These are the same changes as those for preventing heart failure. In addition, you may be advised to avoid salt (because of fluid retention) and caffeine (because of heartbeat irregularities). Your doctor will advise how much fluid and what kinds to drink, as sometimes fluid intake should be limited. Medications. According to Jones, the types of medications typically prescribed include these:
Surgical procedures. In more severe cases, surgery is required to open or bypass blocked arteries, or to replace heart valves. Some congestive heart failure patients are candidates for a type of pacemaker called biventricular pacing therapy, which helps both sides of the heart work in concert, or an implantable cardioverter defibrillator, which shocks the heart into converting a potentially fatal fast rhythm to a normal one. Ventricular assist devices (VAD therapy) may be used as a bridge to heart transplantation or as a treatment in lieu of transplant, says Jones. A heart transplant is considered the last resort, with success rates of about 88 percent after one year and 75 percent after five years. Other treatments. Because sleep apnea—a condition in which the muscles that allow air into the lungs briefly collapse—is linked to heart failure, you may be evaluated and treated for it. Living With...Here are some of the things you’ll want to do in addition to sticking to the lifestyle changes that can improve the health of a damaged heart:
ResearchJohns Hopkins researchers are on the forefront of the study of congestive heart failure. Among their recent findings:
Exercise intensity refers to how hard your body is working during physical activity. Your health and fitness goals, as well as your current level of fitness, will determine your ideal exercise intensity. Typically, exercise intensity is described as low, moderate, or vigorous. For maximum health benefits, the goal is to work hard, but not too hard – described as moderate intensity by Australia's Physical Activity and Sedentary Behaviour Guidelines. These guidelines recommend that for good health, you should aim for at least 30 minutes of moderate intensity physical activity on most days, in addition to a general message of moving more and sitting less. This is the same for women and men. Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you. Ensure you read through the pre-exercise self-screening before you embark on a physical activity or exercise program. Measuring exercise intensityThere are various ways to measure your exercise intensity to make sure your body is getting the most out of every workout. You may need to experiment to find out which method of measuring exercise intensity suits you best. Three different measurement methods include:
Measuring exercise intensity using your target heart rateThe human body has an in-built system to measure its exercise intensity – the heart. Your heart rate will increase in proportion to the intensity of your exercise. You can track and guide your exercise intensity by calculating your Target Heart Rate (THR) range.For moderate-intensity physical activity, a person's THR should be 50 to 70 per cent of their maximum heart rate. The maximum rate is based on a person's age. An estimate of a person's maximum heart rate can be calculated as 220 beats per minute (bpm) minus your age. Because it is an estimate, use it with caution.Keep your heart rate at the lower end of your recommended range if you are just starting regular exercise. Gradually increase the intensity of your workouts as your fitness improves. Also, your heart rate should stay in the lower ranges during warm-up and cool-down periods.Using a heart rate monitor is an easy way to keep track of your heart rate while you’re exercising, or you can take your pulse (see below).Seeking medical advice about your target heart rateIf you have a medical condition, are overweight, are aged over 40 years or haven’t exercised in a long time, see your doctor for a medical check-up before starting any new exercise program. Your heart rate target range may need to be professionally recalculated to take your health and general fitness into account.Some medications can alter your heart rate response to exercise, so make sure you discuss the medications you are taking and how they could affect your exercise plans with your doctor. It may be necessary to use another option for monitoring exercise intensity if you are taking certain medications.Target heart rate chart
Measuring your heart rate by taking your pulseTaking your pulse at regular intervals lets you know whether you are exercising within your target heart rate range. Some tips include:
Factors known to influence heart rateIt’s not just exercise that affects your heart rate. Your beats per minute could be raised by a number of internal and external factors including:
Measuring exercise intensity using the talk testThe talk test is a simple and reliable way to measure intensity. As a rule of thumb:
Measuring exercise intensity using the exertion rating scaleThis method is based on observing your body’s physical signs during physical activity, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue. To keep within a moderate intensity, aim to experience the exercise signs 3–7 in the chart below.You can keep a diary of your exertion ratings to monitor your fitness progressions. As you become fitter, the same activity will become easier and your exertion rating will decrease. Then you’ll know it’s time to increase your effort.
Your body’s response to moderate intensity exercise normally includes:
Exercise intensity warning signsIf you experience any of the following symptoms, stop exercising and seek medical help:
Where to get help
Things to remember
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