What is cardiac insufficiency?
The term cardiac insufficiency means heart failure, which happens when the heart is unable to perform its basic function to pump blood (loaded with oxygen and nutrients) to all the cells in the body so they may function normally.
People who suffer from cardiac insufficiency do not receive an adequate supply of oxygen and nutrients and thus feel weakness, fatigue or shortness of breath. Daily activities like walking, climbing stairs, carrying packages and gardening can become really difficult.
What are the causes of cardiac insufficiency?
When someone experiences heart failure, he probably has or has had one of the following causes without even being aware of it; some affect the heart directly and others alter its function without causing damage.
Among the following are:
Coronary artery disease
When cholesterol and fats are deposited in the arteries, they form plaques of fat which narrow the artery, limiting blood flow to the heart muscle. This damages the muscle and cardiac tissue which then has less force to do its job.
Prior heart attack (myocardial infarction)
A myocardial infarction occurs when one of the coronary arteries is obstructed. The loss of oxygen and nutrients damages the heart muscle which begins to die.
Decompensated arterial pressure doubles the risk for a person to have a heart attack. When the pressure in blood vessels is elevated, the heart must pump harder to maintain blood circulation, affecting its function, and in time the chamber becomes larger and weaker.
Abnormal heart valves
Heart valve problems may be the result of various causes like infections or congenital heart defects. When the valves do not open or close completely at each heartbeat, the heart muscle must pump more strongly to maintain blood circulation, and if it is not repaired in time, the heart will fail.
Heart muscle disease (cardiomyopathy) or inflammation (myocarditis)
Any damage to the heart muscle, whether from toxic drug use, alcohol, viral infections or unknown reasons, increases the risk of cardiac insufficiency.
Congenital heart problems
If the heart and its chambers are not formed correctly, the heart´s function may be affected.
Severe pulmonary disease
When the lungs do not work as they should, the heart finds an obstacle in its function.
Diabetes increases the risk of heart attack in various ways. Diabetics tend to be obese, hyper tense with high cholesterol, all of which increases the risk of damage to the heart. The role of the doctor is to establish in each patient the cause or causes responsible for his condition and at the same time to explain what is happening in his particular case and how to resolve the problem, either with medicine or special treatment.
Who is affected?
Cardiac insufficiency affects people of all ages, from children to adolescents to adults and the elderly. However, it is most commonly found in the elderly.
How many types of cardiac insufficiency are there?
SHF Systolic heart failure
There is reduced contractility of the heart.
DHF Diastolic heart failure
Abnormal ventricle relaxation.
How to diagnose heart failure?
To make a diagnosis, your doctor will want to make a complete physical exam and ask you about your medical history and symptoms. Be honest and do not be afraid of looking bad. For example, if you smoke (or a family member does), eat lots of fast food and never exercise, tell this to your doctor. He cannot make an accurate diagnosis without your collaboration. Think about working together as a team to reach success.
Moreover, you must have blood and urine tests (to verify that the liver and kidneys have not been affected by cardiac insufficiency), x-rays of the thorax (to determine whether the heart has increased in size and whether there is pulmonary congestion), a resting electrocardiogram (to register the electric activity of the heart) and to ascertain if the patient has suffered a myocardial infarction, whether the left ventricle has thickened or the cardiac rhythm is abnormal, Doppler echocardiogram (ultrasound of the heart which helps the doctor detect the thickness of the heart and how it pumps blood), echocardiogram of stress, exercise tolerance test (to monitor heart activity during exercise), a Holter monitor for 24 hours, studies of nuclear medicine and other more complex diagnostic methods like coronariography, heart catheterization, and biopsy of the heart muscle when necessary.
How is it treated?
Treatment is complex and depends on the cause and how advanced the disease at the moment of diagnosis. In general the following methods exist:
- Non-pharmacological measures
- Pharmacological measures
- Special therapeutic measures
These are related to changes in the life-style of the patient. You or your loved one must change your daily routine.
- Stop smoking
- Reduce your weight.
- Avoid alcohol
- Avoid caffeine
- Don´t consume prohibited drugs (ex. Cocaine)
- Eat fat free foods with little salt and many vegetables
- Exercise (depends on each patient), under the supervision of the cardiologist
Naturally it is easier to say this than do it. Our lives are very busy without having to cope with these restrictions and responsibilities. However, working with these changes to your routine, one at a time, can make a real difference.
Oral medications, patches, inhalations, injections under the skin or in veins. The list is very extensive and helps to:
- Improve general circulation by increasing the force of the heart contractions or expanding the blood vessels
- Reduce the amount of water and sodium in the organism to diminish volume overload
- Stop or slow the progress of the disease by improving the quality of life
Special therapeutic measures
Together with the above measures, it is possible to stop the progression of the disease and improve the quality of life of the patients. In general, they are costly and require specialized equipment, highly qualified doctors and a multidisciplinary team (doctors, nurses, social worker, technicians in cardiology, nutritionists, physiatrists, psychologists, epidemiologists, etc.), to implement them. Some examples include coronary angioplasties (dilations of the heart arteries when they are severely obstructed), heart surgery of different types including heart by-pass surgery, replacement or repair of heart valves, correction of congenital heart diseases, repair of damage of the main arteries or even the heart itself, pacemaker insertion and other numerous techniques and supportive devices to keep the patients alive. Success of treatment depends on the degree of commitment of the patient to follow through on the treatment, whether it requires changes in life style, medications or surgery.
What must I watch out for?
Tell your doctor if you:
- Gain weight on a daily basis
- See swelling in your feet, ankles or other parts of your body
- Have difficulty breathing when doing simple activities
- Can no longer do something you could do before
- Have a cold
- Have fever
- Have chest pain
When should I suspect that I have cardiac insufficiency?
The symptoms that a person feels and the signs that the doctor sees when he examines a patient vary according to the types and causes of cardiac insufficiency. In general, there are classical symptoms which can be found in other illnesses, but when they are present, must make us suspect that the heart might be failing.
If you experience:
- Dyspnea: difficulty breathing while exercising, doing daily activities or resting
- Edema of the lower limbs: the feet swell especially in the afternoon
- Nocturia: : you get up to urinate several times at night
- Paroxysmal nocturnal dyspnea: you get up several times at night for shortness of breath and have to sit up or get up to alleviate the problem
- Palpitations: you feel that the heart beats are rapid and irregular
- Loss of appetite, nausea: you feel full or sick to your stomach
- Confusion or difficulty thinking: yyou experience memory loss or disorientation
- Easy fatigue: you tire easily doing activities that you used to do easily
- Cyanosis: your lips, hands or mouth turn blue or purple
- Cough or feel unsettled
- Coldness or paleness of the limbs
- Chest pain or pressure: present when in repose or making an effort
“You must consult with your doctor for a diagnosis as quickly as possible.”
When will it start?
When it appears is variable and depends on the types and causes of cardiac insufficiency. For example, in the case of an extensive myocardial infarction, the cardiac insufficiency can start in hours or weeks, but if the cause is inadequately-controlled arterial hypertension, then it can take months or years to appear. It is most important not to wait until the patient feels bad to get medical help, because then it may be too late. The cardiologist can make a diagnosis in time using a Doppler electrocardiogram (special ultrasound to evaluate the heart) long before the symptoms appear.
Can it be cured?
Cardiac insufficiency is a serious condition and usually cannot be completely cured. We deliberately use the phrase “live with cardiac insufficiency” because really the patient with cardiac insufficiency learns to do that. In the majority of cases, cardiac insufficiency can be controlled with medication and changes in habits like diet and exercise. The help of family and friends is vital. These changes usually are the key to a full life.
With the continuing education of the general population and of patients in particular, with early medical consultation, especially with cardiologists that have methods of rapid and timely diagnosis, with modern and effective medicines and with the awareness of health authorities, it is possible to approach the management of cardiac insufficiency in an adequate manner.
Upon hearing that we have heart disease, the first thought is: what can we eat now? The answer we give ourselves is possibly: nothing!
But it is not like that. Despite the disease, we can enjoy the majority of foods, if we follow these basic recommendations.
What is the goal of nutritional assistance?
To feed ourselves in the best way, causing the least stress possible to the heart, reducing and preventing edema.
What should our diet be?
Follow these rules:
- 5 or 6 meals a day
- Frequent small meals to decrease the workload of the heart
- Breakfast, snack, lunch, snack, dinner and snack (optional)
- Low fat diet
- Choose foods that have been broiled, boiled, baked or barbecued. NOT FRIED.
- Low colesterol diet
- Avoid food products made from animal fats like:
- Processed meats: bologna, sausage, pepperoni, pork sausage, salami, ham, pate
- Fatty meats: pork cracklings, pork chops, beef and pork ribs
- Yellow or mature cheeses: Cheddar, Swiss, Gouda, Edam, Monterrico, American
What about salt?
We have to be careful about two types of salt:
- The salt we add to food (table salt)
- The salt contained in the food itself
How much table salt can we use?
Do not add salt during food preparation
Put ¼ teaspoon of salt in a little bag and add this amount to the food prepared during a whole day
What about the salt contained in the food itself?
We must choose the products we consume with greater care and buy those with the least amount of salt, avoiding the salty ones.
What foods should we consume?
- Fruit and fruit juices
- Fresh vegetables
- Meat and fresh fish
- White cheese (Turrialba, Montino, Tico)
- Dry cereals, saltless crackers and low sodium breads
- Natural sauces (prepared at home using fresh ingredients without adding salt)
- Natural condiments (sweet pepper, onion, basil, oregano, garlic, thyme, etc.)
- Homemade soup (without salt)
Which foods should we avoid?
- Processed meats
- Smoked, processed or cured meats and fish
- Processed cheese
- Canned goods
- Pre-packaged foods
- Extract of meat, soup cubes, packaged mixtures for sauces, herbal salts like garlic salt
- Instant soups
- Prepared salad dressings and commercial sauces
Should we exercise?
- Only if the doctor tells us to
- Doing any physical activity depends on the seriousness and state of the disease
Which foods must we avoid if we are taking anti-coagulants?
When you are being treated with anti-coagulants like warfarin (a type of medicine that prevents the formation of clots in the blood), you must restrict and sometimes avoid all foods rich in vitamin K, as these reduce the effectiveness of that medicine. For example:
- Leafy green foods like: spinach, cabbage, broccoli, dark green lettuce, turnip greens alfalfa, parsley
- Some drinks like black and green teas
- Some legumes like chick peas and lentils
- Some cooking oils like soy and canola oils
- Meats: beef and liver have an average content of vitamin K. It is preferable to choose white meats like chicken and fish
What should I do if I experience kidney damage?
Kidney disease is very complex and during its treatment it is important to control the amount and the quality of protein (chicken, fish, meat, eggs) that we consume. It all depends on whether or not we are on dialysis.
For this reason, you must follow the directions and specific recommendations that the doctor and the nutritionist make in consultation.
- No smoking
- Avoid alcoholic beverages
- Take your medicine regularly according to medical indication.
Can I do physical activity if I have cardiac insufficiency?
For most people with cardiac insufficiency, physical activity does not entail greater risk. However, before initiating an exercise program or increasing your level of activity, you should consult with your doctor about how, when and which exercises you can do.
What are the benefits of doing physical activity?
Keeping active has great benefits: you will feel better, your symptoms of cardiac insufficiency will be reduced, your heart function will be improved, you will be able to return to your daily activities more quickly and you will feel less stress and anxiety.
What precautions must I take in doing physical activity?
Avoid doing increased physical activity if you feel shortness of breath when resting or feel exhausted, if you have chest pain, fever or infection, if you observe swelling in your feet or are going through a period of important changes in your medication.
Which physical activities are recommended for patients with cardiac insufficiency?
After your medical evaluation, it is recommended to:
Recommendations for the patient of cardiac insufficiency when he does physical activities
- Use appropriate clothing
- Wear comfortable shoes
- Avoid extreme climatic conditions (intense cold or heat)
- Avoid eating one hour before exercising
- Avoid strenuous physical exercise
- If you feel any symptom of discomfort whatsoever, you must stop the activity and consult your doctor.
Important considerations before taking your blood pressure
- You should rest for 5 minutes before checking your blood pressure
- Preferably you feel relaxed and are comfortably seated.
- Your feet should be flat on the floor, legs uncrossed.
- You must sit with your back straight
- Relax your forearm and lean it on a table or pillow.
- The cuff must be at heart level.
- Be still without talking as this might alter the results.
Clean the monitor with a soft dry cloth. Don´t try to clean the cuff.
Connect the end of the tube to the main unit.
Roll up the sleeve of your shirt, blouse, or sweater, being careful not to exert pressure on the arm.
Unroll the cuff, leaving a circular space in which to insert your arm.
Place the cuff on the upper arm in such a way that the arrow and the air tube are on the inside of the arm.
Wrap the cuff snugly around your arm without pulling it too tight.
Press the START/STOP button. All the symbols appear on the screen. The cuff inflates automatically. You must remain still until you observe the result on the screen.
When you finish measuring, the cuff deflates completely. The blood pressure and pulse appear.
Press the START/STOP button to turn off the monitor. It will turn off automatically after five minutes.
Record the results, including date and time, in the blood pressure record sheet which you have been given or in a notebook.
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