Cardiac Catheterization

Overview

Congestive Heart Failure

Congestive heart failure (CHF) is a condition that occurs when the heart is unable to pump blood sufficiently. Despite its name, a diagnosis of CHF does NOT mean the heart is about to stop beating. The term "failure" refers to the fact that the heart muscle is failing to pump blood in the normal manner because it has become weakened.

Some causes for CHF, or weakening of the heart muscle, may include, but are not limited to, the following:

• heart attack (Also called myocardial infarction, or MI.)
  
  
• high blood pressure (hypertension)
  
  
• valvular heart disease
  
  
• congenital (present at birth) heart conditions
  
  
• cardiac arrhythmias (irregular heartbeats)
  
  
• pulmonary hypertension (elevated blood pressure within the lung's blood vessels)
  
  
• alcoholism or drug abuse
  
  
• chronic lung diseases, such as emphysema or chronic obstructive pulmonary disease
  
  
• cardiomyopathy (an enlargement of the heart muscle)
  
  
• anemia (low red blood cell count)

CHF may appear suddenly after an acute episode (such as a heart attack) that severely damages and weakens the heart muscle, or it may progress over a much longer period of time. Symptoms of CHF may include:

• fatigue
  
  
• edema of the feet, ankles, and/or abdomen
  
  
• frequent cough
  
  
• inability to lie flat for any length of time; having to sleep on two or more pillows
  
  
• chest pain
  
  
• palpitations
  
  
• markedly decreased exercise tolerance
  
  
• dizziness
  
  
• shortness of breath
  
  
• loss of appetite

CHF is most often treated medically. That is, the patient with CHF is followed closely by the physician and treated with several different types of medications that are used to accomplish the following:

• strengthen the heart
  
  
• relax the blood vessels so that the heart does not have to work as hard
  
  
• remove extra fluid from the body
  
  
• replace certain minerals which may be removed from the body by diuretics (medication used to remove extra fluid from the body)

In addition, diet modification is used to help decrease sodium (salt) and fluids in the body. Other important components of CHF treatment include:

• elimination of caffeine and tobacco
  
  
• an exercise program tailored for the patient's activity tolerance
  
  
• daily monitoring of body weight
  
  
• ongoing patient education to assist the CHF patient and his/her family to maintain the highest possible level of functioning and quality of life

In cases of severe CHF, heart transplantation may be an option. Many factors are considered when assessing a patient for heart transplant, so it may not always be an option for any given patient. Evaluation for heart transplant is a very thorough, detailed process. This detailed process is necessary because a donor heart must be found in order for a heart transplant to be performed.

Congenital Heart Disease

Congenital heart disease refers to one or more of several conditions that are present at birth ("birth defects"). Some congenital heart conditions include the following:

• atrial septal defect
  With this condition, there is a hole between the two atria (upper chambers of the heart). Although blood from the left atrium flows into the right atrium through this defect, there may be few, if any, symptoms present in infants and children - except for a possible heart murmur (an abnormal sound heard through the stethoscope when listening to the heart).
  
  
• ventricular septal defect
  With this condition, a hole occurs between the two ventricles (lower chambers of the heart). Because of this hole, blood from the left ventricle flows back into the right ventricle, due to higher pressure in the left ventricle. This causes an extra volume of blood to be pumped into the lungs by the right ventricle, which can create congestion in the lungs.
  
  
• patent ductus arteriosus (PDA)
  In the fetus, a hole occurs naturally between the pulmonary artery and the aorta. However, shortly after birth, this hole closes on its own. Sometimes, this hole does not close, which means that oxygenated blood from the aorta returns back to the lungs through the pulmonary artery, causing congestion in the lungs, an increased workload on the heart, and eventually an enlarged heart (in some cases).
  
  
• obstruction defect
  This general term refers to several different congenital conditions that cause an obstruction in the flow of blood through the heart. Obstruction defects include:
  
  
  • aortic stenosis - a stiffening of the aortic valve (the valve between the left ventricle and the aorta).
    
    
  • pulmonary stenosis - a stiffening of the pulmonary (or pulmonic) valve (the valve between the right ventricle and the pulmonary artery).
    
    
  • bicuspid aortic valve - a defect in the aortic valve, in which there are only two leaflets (flaps) in the valve instead of the normal three leaflets.
    
    
  • subaortic stenosis - a narrowing of the left ventricle just below the aortic valve.
    
    
  • coarctation of the aorta - a narrowing or constriction of the aorta, which obstructs blood flow from the heart to the rest of the body tissues.
    
    
• tetralogy of Fallot
  In this condition, there are actually four separate defects occurring at the same time: ventricular septal defect, pulmonary stenosis, overriding aorta (the outflow tract of the aorta begins just above the ventricular septal defect instead of at the normal location in the left ventricle), and right ventricular hypertrophy (enlargement of the muscle of the right ventricle).
  
  
• transposition of the great vessels
  In this condition, the outflow tracts of the aorta and the pulmonary artery are switched during fetal development. This means that unoxygenated blood flows out to the body through the pulmonary artery and oxygenated blood flows back into the lungs through the aorta. By itself, this condition cannot sustain life after birth. However, there are usually accompanying defects that permit some oxygenated blood to get out to the body tissues.
  
  
• tricuspid atresia
  In this condition, the tricuspid valve between the right atrium and right ventricle is missing. By itself, this would mean that no blood can be pumped into the lungs to receive oxygen; however, there are usually accompanying defects that allow some blood to go to the lungs.

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