Heart Failure

Ask The Doctors: June 2009

Cardiac rehabilitation is recommended for all patients after open heart surgery, coronary artery stenting/angioplasty, or heart attack. Time and again, it has been shown to improve patient survival, as well as other indices of well-being. As you say, every patient is different, so each individual will have a different definition of what constitute "normal activities." For the marathon runner, competing in strenuous races will have to wait until cardiac rehabilitation has been completed. For the person who was sedentary pre-op, "normal activities" such as walking short distances or climbing a flight of stairs may be achievable within a week or two after surgery.
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Controlling Hypertension Is Crucial for Heart Patients

The relationship between hypertension and other conditions known as "cardiovascular comorbidities" (CVCs)-conditions that affect the heart and/or blood vessels, such as coronary artery disease, heart failure, stroke, chronic kidney disease, peripheral arterial disease, and diabetes-is raising red flags in the medical community. According to a study in the Dec. 10/24, 2007 issue of Archives of Internal Medicine, nearly 75 percent of 1,671 study participants with one or more CVCs also had hypertension, and less than half achieved their blood pressure goals. "Its well established that high blood pressure is strongly associated with stroke, cardiovascular disease, and chronic renal disease, as well as a reduced overall survival rate," says Richard Krasuski, MD, a cardiologist at Cleveland Clinic.
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Heart Failure Patients Should Be Aware of Anemia Risk

Anemia associated with heart failure (HF) is "under-recognized and under-evaluated," according to a Cleveland Clinic study published in the Feb. 5 issue of the Journal of the American College of Cardiology (JACC). Low hemoglobin (molecules inside red blood cells that carry oxygen to the organs) or hematocrit (the percentage of red blood cells in the blood) levels can indicate anemia. There are several different types of anemia, caused by a variety of different factors, including iron deficiency and chronic disease. Anemia (defined in the JACC study as a hemoglobin level of <12 g/dL for men and <11 g/dL for women) was prevalent in 17.2 percent of the 6,159 HF patients studied. (Normal levels are 13.8 to 17.2 g/dL in men, 12.1 to 15.1 g/dL in women.) Persistent anemia was associated with poor survival in patients with HF; however, after six months, 43 percent of the patients with anemia at the start of the study had normal hemoglobin levels and did not have an increased mortality risk.
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Heart Failure in Women: Prevention is Best Approach

Heart failure (HF) occurs when the heart no longer pumps effectively, causing fluid to back up in the lungs, legs, liver or other organs. Although half of all patients with HF are female, not enough is known about the disease in women, which raises questions on the best way to treat it. …
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Aerobic Exercise Helps Heart Failure Patients

The words "heart failure" may sound ominous, but its a common condition that is often managed successfully with medications and healthy lifestyle choices. About five million Americans live with heart failure (HF), according to the American Heart Association. One of the activities most beneficial to patients with stable HF is aerobic exercise, according to a review of 14 studies published in the June 19 Journal of the American College of Cardiology. Reviewers found that several indicators of heart function improved [IMGCAP(1)]with aerobic exercise. However, even if your HF is stable, its essential to adhere to specific exercise recommendations to prevent further damage to your heart.
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Four New Therapies Offer Hope to Patients with Congestive Heart Failure

Many heart failure patients retain excess water that can pool in their lungs, making it hard to breathe despite the best drugs available today. This is the congestion in "congestive heart failure." Fluid-reducing diuretics are the primary treatment for congestion. But diuretics prevent the kidneys from retaining salt, and indirectly eliminate their ability to retain water, so the drugs often do an imperfect job. When this happens, powerful intravenous diuretics are needed. But the kidneys cant tolerate a lot of diuretics, and kidney function worsens.
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Alleviating the Discomfort of Edema

Swelling in the legs and ankles is fairly common among older adults, but it also may be a sign of a more serious condition. "Swelling, in general, is abnormal," says Dr. Wilson Tang, a heart failure specialist in the Department of Cardiovascular Medicine at Cleveland Clinic. In fact, swelling, also referred to as "edema," could be a symptom of heart failure.
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ACE Inhibitors: Who needs Them?

If you have heart failure, your body may mistake poor blood circulation for dehydration and signal your kidneys to retain salt and water. If this happens, an angiotensin-converting enzyme (ACE) inhibitor may be used to prevent the hormone angiotensin from constricting blood vessels and raising your blood pressure.
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Cardiologists Weigh In on the Trans Fats Controversy

While some restaurant owners in New York City threatened to fight any ban on trans fats, Cleveland Clinic cardiologists took stands on the pros and cons of laws to protect your heart.
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Ask the Doctors: 04/05

Cardiac resynchronization therapy, skipped heart beats, and a daily dose of warfarin
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