This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2022. For the original video go to https://www.youtube.com/watch?v=UgZYEVzP218&t=237s
Brad: We going to talk about congestive heart failure. As a therapist, over the last 25 years, I've worked with many people, particularly elderly people with this diagnosis. As a therapist, you deal with it often, but as a patient or people out there not as familiar with it, Chris is going to go through the details. He's done a lot of research and will talk to you about what it actually is, and how it's treated. And I'll interject a little bit about what we may do with therapy in regards. Take it away, Chris.
Chris: All right, well, congestive heart failure or heart failure, that's kind of the topic of discussion today, guys. I guess the simple understanding of it is, that your heart, it's a pump. It's one of the muscles that just never stops in our bodies, the heart and our diaphragm I think are about the only two that I can think of that do that. Well, digestive, but that said, it's constantly pumping all the time. And what happens with that particular pump is, that it doesn't pump properly for our body's needs. And so then, when it doesn't work properly, and you're not getting good circulation, congestion occurs. So just like a running nose or congestion in traffic, fluid builds up, and basically, that creates a lot of damage, weakness to the heart, and a lot of other problems and complications associated with it.
Brad: So, in other words, the heart, for a number of reasons, is not efficient anymore, it's not pumping out enough blood, or it's not receiving it.
Chris: A little bit of both. There are multiple reasons, we'll kind of touch on how and why it got there. But the reality of it is, is that the body has needs, it has to get oxygenated blood that carries all the nutrients and everything else. When the pump is weakened it doesn't make it all the way through the loop to get back. As a result of that, you're going to get fluid back up. And a lot of people when they present to a hospital at that point, if it's an acute crisis, they're going to have swollen hands, feet, probably difficulty breathing, fluid in the lungs directly. They can be coughing up a kind of pink sputum.
Brad: And this is all due to the heart being weak?
Chris: Yes. As a result of it, the heart is failing. The pump itself, for a variety of different reasons within the heart, whether it's the heart muscle itself, getting too thick, the septum, which is what divides the chambers in the heart, getting a little too thick, it can crowd. And when they base it on diagnosis, and you and I were talking about ejection fraction, what happens is, that pump when your heart, if this is, let's say your left ventricle, it squeezes, it doesn't necessarily squeeze completely because the contractility of the heart muscle itself is either stiffened or it's not as flexible. So the heart itself is really supple and it kind of constantly is moving. And so when it tries to fill up with blood, it's not stretching to fill that blood up as well as we need to. And then it's not contracting properly.
Brad: So, we're talking about the blood on the left side of the heart, which is actually the oxygenated blood with nutrients, that's going out to the rest of the body. And that's the system you're talking about. Throughout the whole body, we need that oxygenated blood. And after it's old, it comes back through the veins and then goes back to the heart and then to the lungs. And that's a system.
Chris: Yep. And it makes a perfect loop. That's the other thing we can talk about, there's a left-sided failure and there's a right-sided failure. Usually, it's more common to have a left-sided failure, and then the right side can happen at the same time or it can happen in and of itself. Again, a cardiologist will be breaking all of these things down. But at the same time, what's important to recognize is that the heart itself is just not beating the way that it should and pumping the blood through the body the way that it should.
Brad: So you had mentioned some symptoms which is important. If people are wondering if their loved one or if they themselves or someone is having swelling, does that always mean you have CHF?
Chris: No, generally, it's a hallmark sign, but you're going to get probably a bunch of other things. And the problem is that we have kind of an umbrella of things that can cause conjunction heart failure. And from start to finish, it's kind of a culmination of things that happened over a lifetime. But, we see it in kids, in pediatric patients, that maybe have a genetic anomaly, where something is abnormal with their heart.
Brad: When they're born with it?
Chris: Exactly. But it's most common in people over the age of 65. And that's usually when it's going to occur. You're talking about roughly 600,000 Americans a year who are diagnosed with it.
Brad: Let's just generalize, typical symptoms, that may be from CHF.
Chris: Yeah. A lot of people, all of a sudden, "Man, my fingers are swollen," "My wedding ring doesn't fit properly," or, "Wow, look at my feet, they look huge," you see swelling all the way up the legs, you have a really plump hard abdomen, so it's very full. You can be gaining weight, significant amounts of weight. All of a sudden you can gain 2 to 4 pounds in a day. You know, 5 to 10 pounds in a week.
Brad: So that's fluid, that's not fat.
Chris: That's fluid, you didn't eat too much. You didn't have six pizzas.
Brad: You retain the fluid.
Chris: Yeah, as a matter of fact, when they start to retain fluid like that, they are actually losing their appetite and maybe even feel nausea. A lot of times the complications are, that they can have some chest pains, and difficulty breathing, because there's fluid actually in those lungs. And so it backs up. When you present to the emergency room, a skilled doctor's going to recognize it immediately. Actually, the nurses will recognize it immediately, and they're going to get the ball rolling. And there are a lot of things that happen when you're in an acute congestive heart failure crisis.
Brad: I do want to bring up one thing so that people don't get too concerned as far as ring becoming tight as one of the possible symptoms. My wife, she's got ring issues. We just got her a new ring, she tried to get upsized, and it's fit and tight, and I'm 99% certain she does not have CHF. So don't get excited if your ring starts fitting tight.
Chris: Yeah. It's just an example.
Brad: But it's one of the things, along with maybe other parts swelling.
Chris: And it's going to be profound. I mean, your fingers would kind of look like puffed-up sausages. You could have a salty meal and your ring might not fit properly. So I mean, and even as we age, if you've stood on your feet all day, you're going to have some swelling in your feet and ankles. I mean that's power for the course.
Brad: Any other pain symptoms that are typical?
Chris: You can be having a heart attack when you present to the office. You know when you go to the hospital.
Brad: You're talking about chest pain?
Chris: Yeah, you can have chest pains, you can have shortness of breath, you can have a cough, you can feel overwhelming fatigue in a lot of cases. And again, I think the other thing to delineate, there's chronic and there's acute. And it's a chronic progressive disease, and there are four categories.
Brad: This is over weeks, months, or years? It didn't happen overnight?
Chris: It happens over years and years and years. You know, an ounce of prevention is a pound of cure, is kind of the thing.
Brad: Is it typically lifestyle or is it genetic or a little bit of both?
Chris: Well, if you have a genetic predisposition towards CHF, so your dad, your grandpa, your mom had it, there's going to be a high likelihood that it's probably going to happen to you, but what can you do to prevent that? Well, lifestyle changes are going to be number one, stop smoking, and don't drink are things that you can just cut out. But then it's going to become, staying physically active and eating a healthy diet. Probably lots more fruits and veggies. And if you look up the DASH diet, I think that's the diet that's most profound. That diet specifically is low sodium and lean protein. Lots of fruits and veggies. That's the diet in a nutshell.
Chris: And that's been championed by most of the American Medical Association, the American Heart Association, you name it. They're going to stand behind it because they know that when you're eating that type of diet, the salt intake is at a minimum. So that's helping your heart. We're going to do a video about potassium in a little while, talking about the balance of that. So we'll explain that, but to a degree, when we have a diet that has natural potassium in it, it's going to help to balance your blood pressure out. One of the causative factors of congestive heart failure is long coronary artery disease, and high blood pressure itself. So it can be a side effect of diabetes, it could be organ problems. You could have kidney failure leading to this. So it's not just a one size fits all example, multiple things can cause congestive heart failure.
Brad: That's the information when you see your doctor and you've been diagnosed, they're going to look at you specifically.
Brad: And we really can't do that here at all.
Chris: No, that's above our pay grade. But the reality of it is, is that, if you have the symptoms, you want to get medical treatment right away. We do want to see your doctor consistently as we age because these are the things that, we want to pick up early. That's the key, if we can pick things up early, maybe it doesn't develop into a full-blown problem.
Brad: If you change your lifestyle, your diet, and exercise.
Chris: Yeah. If you listen to this and you're a young person, get your exercise, it's going to be 30 minutes, five days a week, where you're sweating and breathing hard. You know, most days of the week, usually five days is ideal if you can. But sometimes schedules are crazy. Eating well, good food choices. Those are going to be kind of the thing. It's not that hard, but you know, we are busy and the Americanized diet is not necessarily the most conducive, because we're busy, but heck, Europeans are too. It's not exclusive to just us.
Brad: So, I just want to say if you're in your 50s or 60s, and you're thinking you're not an exercise person, you don't have to go out and exercise and get sweaty and breathing and put the sweatsuit on. If you're sedentary and you go out and you walk five days a week, it's going to work great.
Chris: And gradually build. I think that's the important thing too, is Rome's not built in a day. So if you're somebody that's not accustomed to exercise, I think the other thing that's important is to find something you enjoy. Yard work, is a phenomenal workout. Taking a walk, ballroom dancing, swimming, exercise bike, treadmill, lifting weights, all these types of activities. Just find something that you can hold onto, that you know you can do. And vary it, do something different. If you take a walk, maybe take a bike ride the next day, if it's nice. You know, go walk on the beach, walking on sand is tough because it's unstable.
Brad: Right. You know, and if you're at the level where you're watching this and your balance is not so good, you use a cane or a walker just to get up and move. I know our channel has a lot of videos for the elderly, but not just ours, they're all over the place. Just to get up and walk, like, where my mother lives, walking up and down the hallways because she doesn't get outside very much is wonderful, wonderful.
Chris: Yeah. Find a friend, you can have a nice conversation while you're participating. But anyway, long story short is, you want to get out there and do, that's one of the biggest things.
Brad: Should we go into what some typical treatments as a doctor, if you're diagnosed, what they're going to talk to you about, so you can understand it?
Chris: So once you've gotten the diagnosis of congestive heart failure, and once they've gotten you stabilized. That's usually a pretty big deal when you go into the hospital with an acute crisis.
Brad: So, when you say acute crisis, you're saying the swelling is there, maybe difficulty breathing.
Chris: The breathing. They had to get your heart muscle stabilized. They had to do a lot.
Brad: A lot of people will tend to wait because they don't want to go in. They're going to say, "It's going to get better." And then they go in.
Chris: And that's the problem. There's a really good study that I read that came out many years ago, in 2008. Most people take about 13 hours before they go in. 13 hours, they're just not feeling well. You know, and whether it's a heart attack or congestive heart failure, I mean, chest pain, shortness of breath, fatigue, swelling, all those things kind of come into it. You know you have kind of that pale color, you're sweating. People will just think, "Oh I must have a little bug, or I ate something funny." Because you don't always have crushing chest pain. Sometimes you do, sometimes you don't. Sometimes you get pain that radiates into your jaw. So, these are all symptoms of heart attack too, guys. You can get the pain down your arm. It's hard to tell if you're having a heart attack or if it's leading to it. So I mean, if you have any of these things go see your doctor.
Brad: Yep. I just want to tell this little story, it's a true story. Five years ago, we were up at a cabin, a bunch of guys. My father was there. He was 79, or 80 at the time. He woke up, he went to bed early, he wasn't feeling well. He had soup with a lot of salt in it. We're out with the guys. We're not thinking about eating healthy, we're just thinking, about having a good time. He comes down the stairs, very wobbly, and it was about 10 o'clock at night. Same symptoms, kind of sweaty, not feeling well, couldn't even talk very well. It was like, "This is bad." So we put him in the car, we didn't call the ambulance. Maybe we should have, but we drove, we called the ER and said, "My dad's coming, he's got these symptoms." We had an RN in there, he went with him and he had some ER experience. So we got him to the hospital. They got him as stabilized as they could and put him in a helicopter. We were in Northern Wisconsin, a small little hospital that couldn't do it, put him in a helicopter, two-hour ride in a helicopter down. And he ended up being fine, not back to normal, but he was stabilized. And then he eventually, did get back up and around and he went back to hunting again.
Chris: It's one of those things where people tend to put things off. And I think that the sooner that you can get treatment, particularly in acute settings where it's immediate. There's nothing to be embarrassed about. "I'm going to the doctor because I had chest pains," or "I'm just not breathing well," or "I'm not comfortable." Go. I mean, let the pro sort it out. They're highly trained, they're gifted, caring people, that are going to do the best things that they can do to get you stabilized. And hopefully, minimize, maybe it would be a smaller problem to a much bigger one, that as time goes by and more swelling, more backup of blood and fluids, it can create more damage. And that's what we want to avoid. So the key is recognizing it early. We're not all trained to necessarily recognize, "Oh yeah, I think I'm having a heart attack." Just understand chest pains, shortness of breath, fatigue, weakness, you know, kind of coughing weird sputum, things like that. Where it's just not natural. These are things that are, "Hey, this is a big red flag," and these are the things that we want to pay attention to, to get the care that you need. So once you get the care that you need and you get stabilized, it's going to be medications. Medications and lifestyle changes. And the doctor's going to preach that. They're going to get you on certain blood pressure medications to try and ease the load on the heart, slow down vascular resistance or lessen it, so that the heart muscle itself can fill up properly and pump more blood efficiently through your body to help to maintain that. So, we talk about degrees of congestive heart failure. American Heart Association uses A, B, C, and D. A, being the best, which is actually a pre-stage. D, being the absolute worst, which is kind of end-stage. The New York Heart Association, which is the other one, uses 1, 2, 3, and 4. And the stages themselves have little nuances in between. Your cardiologist and your doctor will know all of these things off the top of their head. They're going to be using those as a part of their treatment plan to help you to live your best life.
Chris: And at the end of the day, when we hear congestive heart failure or heart failure, you know, it becomes a quality-of-life equation. As patients, we want to make sure that we're maximizing the medications and doing our part. So it's eating well, it's trying to get exercise, what our bodies will allow. Sometimes as we get further down into those levels of congestive heart, and you get into C and D or 3 and 4, it's much more difficult to do certain things. Just walking upstairs can be a challenge. So find little things that you can do to move, and your doctor and physical therapy team can provide you with exercises that you can do that aren't so taxing, but will still help to keep fluid moving, and keep that heart muscle doing what it should.
Chris: But the mainstay is, we want to be good patients in this. When we get this diagnosis, we want to be good patients. We want to listen to the advice that's given, because really at this point unless you can get a heart transplant, which is generally not on the table, it's difficult to manage, and it's a progressive disease state. So you end up at A, it's going to go to D at some point in life.
Chris: It's what can we do to slow down the steps? A to B, B to C, and C to D. And so if we use the medications appropriately. Talking back with your doctor, if the drugs don't agree with you. As a pharmacist, that's where I have an impact. I see people, "Hey, how are you doing with drug A, B or C? How's the combination?" That's usually what I'm listening for when I'm talking to people at the counter. Is, "How are you doing?" "Well, I'm doing all right." "Well, how's the activity level?" "Mmh, you know, it's been a little bit harder for me to get up and downstairs lately." "Oh, yeah? Have you talked to your doc?" "No, I haven't." "I think it's time to probably have a quick conversation." And you know, nowadays there are so many cool tools that patients have to communicate with their doctor. They can use it on their smartphones, they can use it on their computer and the old fashion phone call and make an appointment. You want to communicate changes right away. The sooner that they can make adjustments for you, whether it's a simple med adjustment or what have you, the sooner that you can hopefully get these things to calm down. Because the disease state itself fluctuates. You can have lots of good days in a row and suddenly you have a flare, and there's no real rhyme or reason. We haven't at least figured out what may cause it, I mean, "Yeah, maybe I ate more salty food than I should have. " Those can be the obvious things, but sometimes it's not obvious. And so, for whatever reason, your body just said, "Eh, we're going to swell, and we're going to make it hard to breathe." So you want to make sure we're addressing that. A lot of times doctors will give patients action plans, where they want them to weigh themselves every day.
Chris: When we get to the later stages, there are probably some fluid restrictions and there are some dietary restrictions as well because there could be other co-factors in there that are creating some of these issues. So you really want to listen to what your doctor has to say, and be an active participant as a patient to make sure that you communicate, when there are changes, they need to know ASAP. I think that's kind of the key to managing it, and to having a quality life. The diagnosis can be scary and intimidating, but at the same time, you can still go out and enjoy your granddaughter's birthday, wedding, or retirement party. I mean, life is still there to be enjoyed and lived, and it's not going to stop you, as long as you are an active participant and make some of those changes, and listen to your physician, your pharmacist, take the medications the way they want you to.
Brad: That's what I always find interesting. Just knowing Chris, the active, positive role pharmacists can have to recognize things or see things. And sometimes you'll call a doctor and say, "You know, I think things are going well, but maybe these drugs need to be changed or modified." You communicate and have a conversation.
Chris: Every day. And actually, where I work now, I actually do a lot of compliance backing. And so, I see a lot of congestive heart failure now. I see more now, in my 27 years, than I've ever seen in my entire life. And so it's interesting to watch the interplay with the balance of the medications, additions, and subtractions. You know, and the key is compliance, guys. I mean, I can't stress this enough. I just had a conversation with a little old lady yesterday, and we sat down for 45 minutes. I'm not sure about my pharmacy partner if that was good for her workflow, but I took the time to spend with her and I think we've gotten them on the right track. I'm going to follow up tomorrow when I go back to work. But, it takes time, you have to be an active participant in your medicine therapy. That's going to be one of the hallmark things that's going to help us to help you to keep going forward and enjoying a quality of life.
Brad: Well, I tell you, where you work now, that service you offer, that aspect to the patients is just unbelievable. And people may not have that at every pharmacy. So if you do, you're fortunate because it's going to be helpful. I mean, I always say Chris should be a doctor because he has the heart for one, he has the brains for one and, you know, those two things, that's what it takes.
Chris: Oh, I don't have nearly the education for that.
Brad: Yeah. Well, you know, get your kids out of college, and maybe you can go back.
Chris: Yeah, yeah, a second career.
Brad: All right, very good. I think we got enough information for everyone to be educated and understand it a little more.
Chris: Yeah, hopefully. I think that's the key.
Brad: Very good.
Chris: Thanks a lot guys.
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