Congestive Heart Failure

As a medical condition, congestive heart failure (or CHF) affects not only the heart, but also many other organs of the body. The cause-and-effects of congestive heart failure are best explained through 3D animation - a tool widely employed in cardiology to visualize complexities in diseases and their treatments.

So what is Congestive Heart Failure?

When talking of CHF, it is important to know how heart failure occurs. Heart failure refers to the condition where the heart’s pumping power is weaker than normal. The blood circulation in our body is reduced, thus increasing the pressure inside the heart. Due to this there is a lack of supply of oxygen and nutrients required for the daily functioning of the body. As the blood coming out of the heart slows down, blood returning to the heart through the veins backs up, causing congestion in the body tissues. Hence, the name ‘Congestive Heart Failure’. The chambers of the heart (upper Atria and lower Ventricles) respond by stretching to accommodate more blood (enlarged heart), but as a result of this the muscle walls weaken and over a period of time are unable to pump blood as efficiently. The kidneys react to this change by causing the body to retain fluid and salt to maintain its nutrient supply. CHF can be an outcome of irregular heartbeat (arrhythmia) due to impairment of systolic and diastolic function not present in sinus rhythm. The condition is known as atrial fibrillation (AF), and it is both a cause as well as a consequence of CHF. Both the conditions have a genetic basis and share similar risk factors, have a common pathophysiology, including structural and electrical remodeling, and neuroendocrine mechanisms. Patients with both heart failure and atrial fibrillation offer a unique set of challenges to the physicians. In fact, when these two disorders occur concurrently, they interact to affect hemodynamic functioning in a variety of ways, with the end result being worsening heart function and a poorer prognosis for the patient. Since multiple studies show that AF contributes to the progression of HF, and the longer a patient has HF, the greater chance there is of developing AF, it is important to appropriately treat both the conditions simultaneously. However, the AF treatment options are either risky or ineffective in these patients, and physicians often must walk a fine line when choosing which treatment approach to pursue. 3D medical animation explaining causes of Congestive Heart Failure When it comes to Congestive Heart Failure, cardiologists believe that the daily lifestyle of patients is a key-contributing factor.

1. Smoking: A puff of nicotine reduces heart-rate in the body and forces the circulation of blood which is low on oxygen content, thus affecting the daily performance of these organs. Smoking also tends to increase the stickiness of the blood vessels supplying blood to the heart.
2. Sudden weight gain/loss: Drastic changes in weight can be a sign of a developing heart failure. It is essential to keep track of weight on a daily basis, preferably every day before breakfast. Weight changes due to crash dieting, over-exercising, tension and depression; sleeplessness and anxiety etc. should be closely monitored. Light exercises and a healthy diet ensure that a steady weight is maintained and cuts down the risk of becoming obese and in turn, developing heart diseases.
3. Eating Habits and Diet: Following a "heart healthy" diet goes a long way in establishing longevity of the heart muscles. A balanced diet with a variety of fruits, vegetables, whole grains, lean meats, poultry, fish, and low-fat or fat-free dairy products is key. Eating habits should be regular, rather than binge eating and drinking that could affect the general health of all internal organs. In particular, foods that are low in saturated fat, trans fat, cholesterol and sodium are highly preferable for a healthy heart.
4. Alcoholism and Caffeine addiction: Alcohol consumption needs to be kept at a bare minimum, and if possible avoided completely. Alcoholism leads to rapid degeneration of organs like liver and kidneys, which put a lot of stress on the heart. Caffeine as well should be consumed moderately, preferably within the range of 1-2 cups of coffee in a day. Alcohol and coffee are responsible for increasing blood pressure. Daily consumption of alcohol leads to a condition where platelets tend to clump together into blood clots, which may lead to heart attacks.
5. Inadequate rest/sleep: In order to do a lot of things in a little bit of time, we forget to give our body the rest it requires. Sleeplessness and anxiety are potent contributors to heart diseases. To improve sleep at night, pillows may be used to prop up the head. Naps and big meals right before bedtime are to be avoided. Instead, napping after lunch or putting your feet up for a few minutes every couple of hours may help. These frequent naps and short rests help to release the mind of unnecessary tension. Anxiety leads to faster heart beats while making breathing more difficult. Taking yoga or meditation classes are also a good way to limit stress and ensure proper breathing.

As the average age of the global population goes up, and the prevalence of heart failures increase, expenditures related to the care of these patients climb dramatically. As it stands today, CHF is a major cause of morbidity and mortality among the elderly. Quite a large number of middle-aged people are also fast falling prey to this disease, making it a serious public health problem. A big onus on the health care industry is to develop strategies to limit this staggering economic burden. These strategies may be in the shape of implementing new treatment procedures which shows efficacy as a large scale clinical practice and crucially, adopting approaches for preventing CHF. Prevention is always better than cure. So an early diagnosis of CHF (or any other heart disorder for that matter) is quintessential in effective treatment and longevity of the heart. For diagnosis of heart failure, doctors tend to take a careful medical history and perform certain physical examinations. Through the physical examination doctors check factors such as high blood pressure, and signs for congestion using a stethoscope. It is generally followed by checking the veins in the neck and the legs and abdomen for fluid build-up. The medical checks which generally follow are:

• Blood tests: To check for irregularities in the functioning of kidney and thyroid
• Chest X-ray: X-ray images help doctors see the condition of the lungs and heart
• Electrocardiogram (ECG): This test records the electrical activity of the heart through electrodes attached to your skin
• Echocardiogram: It helps to differentiate between cases of systolic heart failure and diastolic heart failure; can also look for valve problems or evidence of previous heart attacks
• Stress test: Stress tests measure how your heart and blood vessels respond to exertion
• Cardiac Computerized Tomography (CT) scan or Magnetic Resonance Imaging (MRI): These tests can be used to diagnose heart problems, including causes of heart failure
• Coronary Catheterization (Angiogram): The test helps doctors identify narrowed arteries to the heart (coronary artery disease)

An innovation in the field of heart disorder diagnosis is the 'Breath Test'. In a recent study in Cleveland (USA) during March 2013 it was found that even a breath test conducted on individuals had a telling contribution in the diagnosis of heart failure. Definitive conclusions could be drawn by analyzing the contents of a 'single' exhaled breath. These results were based on an evaluation done on a small group of participating patients, and even though preliminary reports were pretty suggestive of the condition of the patients’ heart, more extensive research will have to be done to confirm their initial success. The test is conducted by subjecting a patient's breath to a rigorous but fast analysis of the hundreds of volatile organic compounds contained therein. Based on their results, the study team concluded that there had been 100 percent accuracy in diagnosing those newly hospitalized with heart failure. Treatment of CHF follows diagnosis, although the method of treatment depends largely on the progression of the disorder.

• Lifestyle measures: The first steps in the treatment of heart failure may include limits on the amount of fluids consumed (including alcohol) and reductions in dietary sodium (less than 2,000 mg per day). In addition getting regular exercise can help prevent symptoms from worsening.
• Diuretics and Digoxin: Physicians prescribe diuretics to reduce fluid build up and Digoxin (Lanoxin) to strengthen the heartbeat.
• ACE inhibitors and ARBs: ACE inhibitors—such as enalapril (Vasotec) and lisinopril (Prinivil, Zestril)—are the cornerstone of drug treatment for people with heart failure. By promoting dilation of the blood vessels and thus improving blood flow, they subsequently slow the progression of CHF.
• Beta-blockers: These drugs—such as carvedilol (Coreg) and metoprolol (Toprol XL)—decrease the workload of the heart.
• Aldosterone blockers: Spironolactone (Aldactone) and Eplerenone (Inspra) block the activity of aldosterone, an adrenal hormone that causes sodium retention, thus reducing the chances of excessive fluid build-up in the system.

Although a complete understanding of the functioning of the human heart may yet be elusive, cardiology has taken to 3D animation to advance understanding in this area. A lot of emphasis is given on making people more aware of the working of the heart, and in parallel, talking of the factors responsible for heart failure. 3D animation makes it a more hands-on learning, as to what can go wrong in the heart and what impact a certain activity - such as excessive alcohol intake or uncontrollable obesity - can have on the regular functioning of the heart.

3D animations allows us to:

• Interact with a fully animated model and look at all the parts of the heart. We can understand the functions of each of the parts and we can inspect several heart diseases from all angles.
• We can differentiate through detailed examination how the anatomy of an affected heart differs from one that is healthy and properly functioning.
• Compare various factors such as the flow of blood, the contraction and relaxation of the chambers of the heart due to the result of a defect to the heart. And the repercussions on the body due to these shortcomings.
• Understand how a certain treatment or medication helps in rectifying the ailments to the heart. The impact of several surgical procedures taken to improve the condition of the heart can also be understood.

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