Have you ever heard the saying, time is tissue? This is a motto that healthcare workers use to explain the importance of early intervention in a heart attack. The longer a person goes without medical attention during a heart attack, the more extensive the damage done to the tissue of their heart. When a blockage is present in one of the coronary arteries, the tissue that is normally supplied by that artery is starved for oxygen. On a very specific timetable, the tissue begins to die. It starts out with fairly superficial damage, generally in the upper tissue layers, but if it continues, it begins to go deeper and deeper into the most functional layers of the heart’s tissue. So if you’ve ever wondered why its so darned important to play it safe when dealing with any kind of chest pain, this is why. Even a minor little blockage, if left untreated, can cause life-altering damage. On the other hand, a major catastrophic blockage, if caught in time and opened up, will produce little or no damage. Time is tissue. The size of the blockage pales in comparison to the amount of time taken to get it opened.
All this is very well, but what happens when the damage has been done? For many different reasons, heart attacks often do go untreated for a significant period of time. There are myriad reasons for this. Some people just don’t live all that close to a medical center with the capability of addressing serious cardiac events. Some people have atypical chest pain or none at all. Women in particular are known for having misleading symptoms that they don’t always associate with their heart, such as shortness of breath, nausea and vomiting, back and shoulder pain and even jaw pain. Only a trained medical team with lab tests and electrocardiograms at their disposal can make the definitive diagnosis of heart attack or MI (myocardial infarction). Once the acute phase of the heart attack is over and the patient is stabilized, what is left is often a patient who has some degree of tissue damage in their heart. Only your cardiologist can explain exactly where that damage is, how much damage was done and to what degree the damage will result in congestive heart failure. But lifestyle changes, medications and cardiac rehab (a rehabilitation program especially designed for your heart) offer your best hope of a near-full recovery.
One may never hear the term congestive heart failure until years after the heart attack that caused it, but the cascade of events starts with an insult to the heart tissue, often in the form of a heart attack. Other things that can result in CHF (as it’s known) are congenital heart defects, injuries, and infections that occur inside the heart.
Once tissue death, or necrosis, is present, the rest of the heart’s functioning tissue has to work harder to compensate for the areas that are no longer functional. When heart tissue is no longer in perfect working order, several things begin to occur. Tissue may hypertrophy (overgrow) thereby shrinking the effective workspace of the heart (the chambers through which blood flows). The pump mechanism of the heart begins to weaken, causing fluid/blood to back up into other areas of the heart and system. This is where the congestion in CHF comes from. Depending on where the weakness is, sufferers may experience swollen (edematous) lower extremities or wet sounding cough. Other symptoms include weakness, poor activity tolerance, loss of appetite, renal failure and water weight gain. The fluid in the body isn’t running through the heart correctly, so the other organs aren’t perfusing as well either. The kidney function often suffers, which only causes the congestion to get worse, because the kidneys aren’t able to eliminate excess water from the body as well.
CHF is a chronic illness that can become deadly in it’s acute phase. When the fluid overload reaches critical mass, hospitalization is required. Medications such as diuretics, strict fluid monitoring and oral cardiac medications may be enough to turn it around and stabilize the patient. When that is not the case, the patient often requires mechanical ventilation until the excess fluid can be removed from the system. Additionally, renal dialysis may be required to help the kidneys in filtering and removing that excess fluid. During this time, the patient will need intense cardiac monitoring and quite possibly, several different vasoactive drugs (intravenous drugs that improve cardiac function in a variety of different ways). These patients are kept under close watch in the intensive care unit of the hospital. In a small hospital that doesn’t possess the necessary treatment and monitoring modalities for a patient of this acuity, transfer to a regional center is almost guaranteed.
The unfortunate facts of the matter are as follows. People who suffer from CHF typically experience occasional hospitalizations due to their condition. In most cases, this is a chronically worsening condition, which means it grows slowly worse over time. It significantly decreases the quality of life of those who suffer from it. Advanced directive is critically important for this population, to ensure that the patient’s next of kin is prepared to make end of life decisions as needed. Patients can wither away on a ventilator for weeks and months, with little or no chance of getting off it while family members struggle to make the right decision.
Long term treatment of this condition requires vigilance on the part of the patient. The good news is that people with CHF who take their medications, monitor their fluid intake carefully, weigh themselves daily and follow up with their primary care doctor and cardiologist can maintain a good quality of life and prolong the chronic phase of their disease drastically compared to their noncompliant cohorts. Research is ongoing in this field and different cutting edge biotechnological advances offer hope that one day soon, CHF will be a curable disease.