What is an “exacerbation” of CHF?

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An exacerbation of CHF is a sudden and prolongedworsening of a patient’s CHF symptoms, such as an in-creased shortness of breath, mental confusion, legswelling, fatigue, and weight gain. In severe cases, anexacerbation of CHF can be complicated by extremeshortness of breath. The patient even may report a feel-ing of drowning. The patient may cough up pink frothysputum or may even become confused or unconscious.A CHF exacerbation is a medical emergency and re-quires the immediate attention of a doctor.

Exacerbations of CHF occur when there is an in-creased demand placed on the heart that the weakenedheart cannot compensate for by beating harder orfaster. These increased demands may be the result ofcardiac or noncardiac changes. These exacerbationsoften are life threatening and can lead to hospitaliza-tion. The number of CHF exacerbations per year andthe severity of exacerbations can increase as the diseaseprogresses and the heart becomes less able to handleincreased loads.

Heart failure exacerbations are very common reasonsfor hospitalization in the United States and Canada.In severe cases, the patient needs the mechanical support of a  ventilator until the acute symptoms have resolved.

In a study examining factors that lead to worsening CHF, nearly one third of incidents occurred because ofpatients’ failure to comply with a medical regimen. Forexample, about 22 percent of patients did not restricttheir intake of salt. Salt promotes the retention of waterin the bloodstream, which can place an added strain on an already weakened heart. Eventually, excess water canback up into the lungs. Another 7 percent did not com-ply with instructions for taking their medication. Infact, many in this group stopped taking their medica-tions altogether.

Some other causes of CHF exacerbation are:

● Excessive alcohol intake

● Lung infections

● Increased exercise

● Irregular heartbeats (both beats that are too fast andtoo slow)

● Coronary artery disease

● Side effects of medications (especially the use of negative inotropic drugs such as beta-blockers,disopyramide, verapamil, nifedipine, diltiazem)

● Increased high blood pressure

● Heart valve infections (endocarditis)

● Anemia

Although this information may be frightening or evendepressing, there is good news here.The most commoncauses of CHF exacerbation are within the control ofthe average patient. By attending to these factors,physicians and patients can help to prevent the com-monest causes of CHF exacerbation. Managing thesecauses not only deals with the immediate decompensa-tion, but also improves the prognosis for the future.

 

 

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