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February 3, 2010 > Learn About Heart Failure and Irregular Heartbeats At Upcoming Health and Wellness Seminar

Learn About Heart Failure and Irregular Heartbeats At Upcoming Health and Wellness Seminar

While most people are aware of the symptoms of a heart attack, fewer people know about other forms of coronary heart disease that are actually more common. The American Heart Association estimates that approximately 5 million Americans have been diagnosed with congestive heart failure. Another 2.2 million Americans have atrial fibrillation - only one form of heart rhythm problems known as arrhythmias.

To help you gain a better understanding of the symptoms and treatment of congestive heart failure and heart arrhythmias, Washington Hospital is sponsoring a free Health & Wellness seminar, featuring cardiologists Dr. William Nicholson and Dr. Thirupathi Reddy. The seminar, scheduled for Tuesday, February 9 from 1 to 3 p.m., will be held in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. To register, visit and click on "Community Connection."

Congestive Heart Failure

Heart failure results from a weakening of the heart's muscle. Although the "failing" heart keeps working, it fails to pump blood throughout the body effectively. Heart failure also is often called "congestive" heart failure because fluid can build up in the lungs and body since the heart isn't pumping properly.

"A prior heart attack can be one cause of heart failure," says Dr. Nicholson. "That's because a heart attack can scar the heart muscle where the heart attack occurred. Heart failure also can result from poorly controlled blood pressure, which causes the heart muscle to become stiff."

People with congestive heart failure often experience shortness of breath when they are exercising, progressing to shortness of breath while at rest and then to problems breathing at night while lying down. Other symptoms may include fatigue, weight gain and swelling of the feet and ankles.

Dr. Nicholson notes that congestive heart failure becomes more common as people age. "Other risk factors could include high blood pressure, high cholesterol, diabetes and smoking," he adds. "Heart failure is common in both men and women - it's an equal opportunity killer."

Diagnosing congestive heart failure entails taking a complete patient history and conducting a thorough physical exam.

"A chest X-ray might be performed to see if the patient has an enlarged heart, a sign that the heart muscle had to grow in order to pump enough blood," Dr. Nicholson says. "An EKG or echocardiogram - both of which are noninvasive procedures -- could also help determine if the heart is enlarged or not pumping efficiently. An angiogram, in which we insert a catheter into the heart and inject a contrast dye, can help us view the structure of the heart and look for blockages."

Patients with congestive heart failure should follow a heart-healthy lifestyle - avoiding smoking and alcohol, eating a healthy diet, losing weight if overweight, exercising in moderation and getting plenty of rest. "It is especially important to follow a low-salt diet to avoid water retention," Dr. Nicholson emphasizes.

Various medications also can help control the condition, including:
* Diuretics to reduce water and salt retention.
* Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) to help the heart pump better.
* Vasodilators to expand blood vessels.
* Hormone-altering beta blockers to improve how well the heart pumps.

Surgery might be an option for more unusual causes of heart failure. "Surgery may be required if there are leaky heart valves or thickening of the valves that limits blood flow," Dr. Nicholson notes. "Serious artery blockages might call for angioplasty and insertion of stents or perhaps bypass surgery."

Heart failure is one of the most common reasons for hospital admission, so it's important for heart failure patients to consistently monitor their condition. "You should monitor your weight, since weight gain could indicate an accumulation of fluids creates a harder burden on the heart," Dr. Nicholson cautions. "You also should check your blood pressure at least once a day. The heart has to pump against this pressure, so high blood pressure makes the heart work harder. The ideal blood pressure range is 110/70 to 120/80, but we sometimes are more aggressive in trying to lower the patient's blood pressure to make it easier for the heart to pump."


"All of us have irregular heartbeats on occasion, and that tends to increase as we age," says Dr. Reddy. "Persistent arrhythmias, though, can cause the heart to work less effectively and may indicate a serious medical problem."

Abnormal heartbeat rhythms can cause the heart to beat too rapidly (tachycardia), too slowly (bradycardia) or erratically. "With bradycardia, the heart may not pump enough blood to the body, resulting in fatigue, dizzy spells, lightheadedness and fainting spells," Dr. Reddy explains. "Tachycardia can cause heart palpitations, shortness of breath and chest pain, as well as dizziness, lightheadedness and fainting."

Diagnosing arrhythmias begins with blood tests to evaluate electrolyte levels and thyroid function, in conjunction with an electrocardiogram (EKG) to record the timing of heartbeats.

"When an EKG indicates irregular heartbeats, we may have the patient wear a Holter monitor for 24 hours to gauge the pattern and frequency of arrhythmias," Dr. Reddy says. "Other diagnostic tools include a cardio-event monitor that can be worn for a month, an echocardiogram and a treadmill stress test. If those tests can't pinpoint the problem, we would do an electrophysiology study using a catheter."

Treatment for arrhythmias depends on the cause and severity of the problem. "Most irregular heart rhythms are benign and don't require treatment other than making lifestyle changes such as avoiding caffeine, eating a heart-healthy diet and exercising," Dr. Reddy notes.

"For more serious cases of slow heart rates, we can implant an electronic pacemaker under the skin to speed up the heart rhythm," he adds. "In cases of a rapid heartbeat, we would start with medications such as beta blockers and calcium channel blockers. If those medications don't control the problem, we might use an implantable defibrillator that delivers electrical shocks to control the heartbeat, or radiofrequency ablation, which uses a catheter to deliver radiofrequency energy that stops the extra electrical impulses."

If you suspect you have either congestive heart failure or heart arrhythmias, consult your regular physician or visit Washington Hospital's website at and click on "Find My Physician."

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