Ask an Expert: Recovering from heart failure
Q: My 52-year-old son has congestive heart failure caused by a virus that attacked his heart. He has only about 30 to 35 percent functionality of the heart muscle, and he is very concerned about the time he has with his two young children. Do many people with CHF actually get better? Is recovery possible, or should we be looking into heart transplantation? We are seeking any advice and guidance you can offer.
Answer from Jeanne Phillips, M.D., heart failure/transplant cardiologist:
Your son has a great chance to recover his lost heart function, to lead a normal, active life and to enjoy his children for many years to come.
Congestive heart failure means the heart is too weak to circulate blood as well as it should. Usually, an event – in this case, the virus – causes the initial injury. The heart tries to compensate for its weakened state by enlarging itself. But the added size just makes the heart weaker and less efficient.
The percentage of patients who recover from congestive heart failure varies, depending on the cause of the damage, the patient's age and his or her individual response to medications.
I see a number of factors that suggest optimism in your son's case. First, he is relatively young. Second, the fact that a virus started this (rather than a heart attack) is in his favor. Third, we have two medications that greatly improve the condition of most patients.
The two drugs work in different ways to allow the heart to regain its strength:
- Ace inhibitors dilate the blood vessels, making it easier for the heart to circulate blood. They also block the damaging hormonal changes that heart failure sets off.
- Beta blockers block the toxic effects of extra adrenaline that the body secretes in an ill-fated attempt to get the enlarged, weakened heart to pump faster and harder. Initially, the extra adrenaline does the job. But over time, it poisons the heart, weakening it further.
In addition, some patients need diuretics to control fluid build-up in the lungs and other tissues. This excess fluid can create extreme shortness of breath in a patient who otherwise would have enough heart function for daily activities.
Your son should start drug therapy as soon as possible. With continued use, the drugs have the potential to increase heart function to normal or near-normal levels.
Stick with it for six months, then measure the improvement.
After about six months, your son’s cardiologist may order an echocardiogram (or ultrasound of the heart) to measure how much your son’s heart function has improved on the drug therapy. It was probably an echocardiogram that was used to determine his current heart function of 30 to 35 percent. The cardiologist may refer to that number as the “ejection fraction” – that is, the percentage of blood in the heart that is pumped out, or ejected, with each beat. A normal ejection fraction is 60 to 65 percent (each time the heart muscle contracts, it pumps out 60 to 65 percent of the blood in the chamber). After six months on the drug therapy, it’s reasonable to hope that your son’s ejection fraction will have improved.
Beyond the numbers, the cardiologist will ask about changes in your son's everyday activities, his symptoms and his tolerance for exercise – all of which are important indicators of improvement.
Most patients, but not all, do respond to these medications. If your son is among the minority who do not, then you may consider exploring a heart transplant. But give the drugs a chance before taking that step.
The drug therapy is critical. Left untreated, congestive heart failure gets worse with time. With effective treatment, it improves. After patients regain heart function, they often require fewer medications to maintain their heart strength.
To contribute further toward improving his health, your son also can take some lifestyle steps:
Exercise. The goal is to maintain overall body muscle strength, not to build cardiovascular endurance. I recommend that patients walk regularly; some even can jog lightly. He should not exert himself to the point of breathing very hard or gasping for air. His physician can guide him regarding what levels of exercise are safe and appropriate.
Maintain a low-salt diet. Sodium in the diet causes the body to retain fluid, which leads to shortness of breath.
Weigh in daily. A bump in weight is often an early sign of fluid build-up. By stepping on a scale each day, your son will be able to notice any changes quickly so that he can alert his physician right away, before he starts experiencing symptoms.
A group of Providence physicians, nurses, dietitians and other health professionals has compiled a booklet called "Living with Congestive Heart Failure," which offers more guidance on how to optimize health and quality of life after a diagnosis of heart failure.
To learn more about congestive heart failure, I recommend you explore the excellent website of the Heart Failure Society of America.