Congestive heart failure

Consultant cardiologist Dr Marilyn Law rence-Wright explains the causes, the treatments

Observer staff reporter

Sunday, February 04, 2018

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The function of the heart is to pump blood to all the organs of the body. When it is no longer able to do that effectively, then heart failure begins to take place.

Congestive heart failure occurs when “fluid starts backing up into the venous system. Veins bring blood to the heart, and arteries take blood away from the heart. And because the heart is not pumping effectively, meaning it's too weak or too stiff, blood is no longer able to flow in and out of it properly. The congestive part means that blood is backing up before it gets into the heart and the failure part means it not able to pump the blood effectively”, consultant cardiologist at Heart Foundation of Jamaica, Dr Marilyn Lawrence-Wright explained.

Dr Lawrence-Wright then added: “When this happens, persons begin to experience dizzyness, shortness of breath or weakness. These are signs that your heart is failing. You also will notice difficulty to lie down flat in bed, because of shortness of breath and swelling in your legs. In these situations persons have to prop themselves up with a pillow in order to sleep comfortably.”

Dr Lawrence-Wright who was speaking at a recent Jamaica Observer Monday Exchange, further pointed out that the shortness of breath occurs when individuals exert themselves, but after a while it can happen even when a person is not doing anything. This condition can affect any age group but, the cardiologist said, her patients are mostly middle-aged.

Congestive heart failure occurs because of various reasons, but for Jamaicans the main factor is hypertension.

“It all depends on the age of the person and how long they had uncontrolled hypertension. Over time, persons with controlled hypertension can develop it as well, because that's something that puts pressure on the heart and cause the heart to enlarge. In a few months or years you can begin to weaken and actually have the heart failure symptoms.”

Having a problem with your valve can also lead to congestive heart failure. The valve allows blood to flow through the heart.

“So if a valve is leaking — what we call regurgitation or if it's tight — what we call stenotic. That can upset the pressures in the heart and cause it to fail. So, some patients who have rheumatic heart disease can experience this. Fortunately, in Jamaica we don't have as many rheumatic fever [cases]like we used to have before,” Dr Lawrence-Wright explained.

Other pre-existing conditions that can lead to congestive heart failure are HIV and cancer. According to the heart specialist, “chemotherapeutic agents, they can cause weakening of the heart, and you know we increasingly place young people on chemotherapeutic agents”.

Although it is a serious condition, persons can long life with it. However, Dr Lawrence-Wright says this heavily depends on the cause and the stage. “You have different stages of heart failure. There's a staging system that stages it as A,B,C,D. When you're C or D you're more at the end stage. If you're A, your life expectancy is probably about the same as the average person.”

The consultant cardiologist continued: “Some with very low ejection fraction (measurement of the percentage of blood leaving your heart each time it contracts), who are very weak will have a low life expectancy. For others it's mild or it's because the heart is stiff — I wouldn't say it significantly changes their life expectancy. It might change their quality of life, because they may have frequent hospitalisation. It may limit what they can do, they don't have the same exercise tolerance and so on. But those who are more on the stiffness end, the symptoms are not very severe. I don't think it significantly changes their life expectancy.”

Doctors use diuretics (water pills), beta blockers, ace inhibitors and angiotensin receptor blockers to treat this illness. The cardiologist explained that “these medications are there to help keep the blood pressure under control, to help prevent the heart from getting too enlarged, and to limit the amount of extra fluid that the heart has to manage”.

For patients who have blockage in the arteries she recommends that they get a defibrillator (AICD - automatic implantable cardioverter-defibrillator). This she said can help to prevent some deaths in patients with heart failure. The treatment method is expensive, but most of the medications are covered by the National Health Fund ( or the Jamaica Drug for the Elderly Programme.

Dr Lawrence-Wright said that the medications do work well, but lifestyle modification also plays a vital role in controlling this condition. She warned that congestive heart failure patients should lower their sodium intake, and medications must be taken properly.

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