ASK THE DOCTOR               

Jeffrey Tauth, M.D., board certified in cardiovascular disease St. Joseph's Mercy Health Center

I keep hearing conflicting information about breast cancer. Can you give me some easy guidelines for detection?

What is Congestive Heart Failure and how does it affect me?
Congestive heart failure is not a disease but a condition that occurs when the heart is unable to pump enough blood to meet the needs of the body. When the heart fails, it is unable to pump out all the blood that enters its chambers. Physicians use a calculation called ejection fraction, which is the percentage of blood pumped out during each heartbeat, to determine the rate of blood flow in the heart. An ejection fraction of 50 percent to 75 percent is normal.

In most cases of congestive heart failure, the left side of the heart fails, causing systolic dysfunction, which causes fluid to accumulate in the lungs. The ejection fraction in such cases falls below 40 percent; severe failure may drop as low as 5 percent. In cases of right-sided heart failure, which is less common, fluid entering the heart backs up, causing the veins in the body and tissues surrounding them to stretch. Physicians can often make a preliminary diagnosis of heart failure by reviewing the patient's medical history and conducting a physical examination. About 250,000 people die of heart failure each year. It is the number one cause of death for people over the age of 65. About two-thirds survive the year after initial diagnosis.

What symptoms can help me detect congestive heart failure?

Left-sided symptoms include:

• Fatigue and shortness of breath caused by fluid in the lungs
• Feel out of breath after mild exertion
• Asthma-like wheezing or a dry heaving cough that occurs a few hours after lying down but then stops after sitting up.
• Loss of muscle weight due to low cardiac output

Right-sided symptoms include:

• As with left-side heart failure, fatigue is an early symptom
• Accumulation of fluid, first in the feet, next in the ankles and legs and finally in the abdomen
• The liver may enlarge
• Patients gain weight, although their appetites are often depressed, because they retain salt and water
• Gradual loss of muscle mass as the tissues become oxygen depleted