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The Playbook for Congestive Heart Failure:
Medications, Diet, Mild Exercise, CRT Therapy
Eric Sweterlitsch, M.D., an interventional cardiologist, has the toughness, the wit, and the will to win against congestive heart failure (CHF). A significant part of his practice is devoted to treating CHF patients. His "playbook" for each patient is different, yet Dr. Sweterlitsch and his patients work toward a common goal: Winning against a condition for which there is no real cure.
, an interventional cardiologist, has the toughness, the wit, and the will to win against congestive heart failure (CHF). A significant part of his practice is devoted to treating CHF patients. His "playbook" for each patient is different, yet Dr. Sweterlitsch and his patients work toward a common goal: Winning against a condition for which there is no real cure.
 "The heart muscle in these patients," says Dr. Sweterlitsch, "is so weak it struggles to pump enough blood to meet the body’s demands for oxygen-rich blood. It’s an effort for many patients to move across the room. Fluid can back up behind the heart muscle, and they grasp at breath. If the body retains fluid, the heart has to work that much harder, and fluid begins to build up in the abdomen and other body tissues.
CHF usually begins over time. Heart failure can be traced to sustained heart disease or a heart infection that just sluggishly primes the systolic pump to contract and force an inadequate amount of blood to the body’s organs. It can also be traced to longstanding or untreated high blood pressure, damaged heart valves, or an enlarged heart (cardiomyopathy).
"Symptoms depend on which side of the heart is affected," said Dr. Sweterlitsch. "Left-side CHF brings fatigue and shortness of breath – even with mild exertion. There can also be fluid build-up in the lungs. On the right side, the amount of blood returning to the heart is less. So, there is swelling in the extremities, the abdomen, and other tissues because they’re retaining so much fluid."
For CHF patients, the biggest loss is quality of life. If they don’t work with their physician to attack CHF, they lose the ability for any reasonable activity, even around the house.
"I can usually diagnose CHF with a physical exam and the patient’s reported symptoms," reports Dr. Sweterlitsch. "I may want to order tests, like an electrocardiogram, to visually see the heart’s activity. CHF, though, is a rival you want to defeat quickly and as early as possible. I lay out the game plan, and tell patients if they follow this, they will likely live longer, avoid repeated hospital stays, and be part of daily activities that give life meaning."
"I’m straightforward with patients and tell them what they have to do," says Eric Sweterlitsch, MD, Cardiologist.
- "Stop smoking, if that’s still an issue. Avoid alcohol.
- Take blood pressure medications as prescribed and have your blood pressure monitored weekly.
- Eat a low-fat diet. Don’t add salt at the table, and don’t cook with salt. Avoid pre-packaged foods high in sodium.
- Limit your fluid intake to no more than the amount recommended by your physician.
- If you gain more than three pounds in one week, it’s a good bet you’re retaining fluid and should make a doctor’s appointment.
- I may put them on one or more different medications, depending on their heart function – if I want their heart to pump more efficiently, I may prescribe digitalis to slow their high rate.
- Vasodilators (ACE inhibitors) may be used to open up the blood vessels and get blood pressure under control. The heart doesn’t have to work as hard to pump blood through the body.
- Beta-blockers block adrenaline production, reduce demand on the heart, and prevent irregular heartbeats.
- If fluid retention is an issue, I may prescribe a diuretic to stimulate the kidneys to move sodium and water from the body. Frequent urination can remove potassium from the body, so I may add a potassium supplement."
Malfunctioning heart valves can be repaired. If the heart is not beating and contracting in harmony, a cardiac resynchronization device can be implanted to coordinate the action of the right and left ventricles.
"It’s true there is no cure for congestive heart failure, cautions Dr. Sweterlitsch. "However, people can live with chronic diseases successfully, but it requires discipline for the game plan to work. The late coach Paul "Bear" Bryant said: ‘Don’t give up at half time. Concentrate on winning the second half.’ It’s fitting advice for all congestive heart failure patients."
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