by Noel DeBacker, M.D., Medical Director of Lieberman Center
Congestive Heart Failure (CHF) is one of the most common reasons for admission to the hospital, and it is also the most common reason for re-admission to the hospital within 30 days after the person has been discharged.
What is congestive heart failure? CHF is a condition arising when the heart is not able to circulate the blood properly, and the flow becomes sluggish. This results in backing up of fluid throughout the body, which leads to many of the characteristic symptoms. When there is an overload of fluid in the lungs, shortness of breath results. At first this occurs only with physical activity, but as time goes on, it can occur at rest. It can also occur at night and result in an attack of shortness of breath waking the person from sleep. It is generally easier to sleep with congestive heart failure when the head is elevated, so people often start using more pillows. Swelling of the ankles is another common symptom, although if this is the only symptom, it is more often the result of impairment in function of the veins in the legs. Other symptoms can include cough (especially with frothy sputum or blood), wheezing, dizziness or lightheadedness, frequent urination at night, weakness and mental confusion.
The treatment of CHF involves careful monitoring of body weight because it is the best way to know if fluid retention is occurring. Gaining or losing five pounds in a day is never due to fat loss, but instead to retention or loss of fluid, so daily weighing provides a key warning system. Salt (sodium) intake is also closely monitored because it results in further fluid retention. Medications such as furosemide (Lasix) are commonly used to help remove sodium and water from the body. Other medications may be used to reduce the load the heart has to pump against and to improve the heart’s ability to contract. Beta blocker medications have been shown to improve survival when added to ACE inhibitors.
Skilled nursing facilities providing post-acute rehabilitation are common destinations for people with CHF after discharge from the hospital. Some facilities have developed specialized units to meet the challenges that have contributed to hospital readmission rates. Lieberman Center has such a unit—the Center for Heart Health, where we provide close monitoring of salt intake and fluid balance, consultation with a Cardiologist, special nurse training to administer intravenous medications, exercise equipment to provide safe re-conditioning and a number of other enhancements.
For more information on our Center for Heart Health, please visit www.cje.net/CenterForHeartHealth.