Cardiologist

The term congestive heart failure is often used to describe all patients with heart failure. In reality, congestion (the build up of fluid) is just one feature of the condition and does not occur in all patients. There are two main categories of heart failure–Systolic and Diastolic. However, within each category, symptoms and effects may differ from patient to patient.

The two categories are.

☛ Systolic heart failure: This occurs when the heart’s ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as Pulmonary congestion.

☛ Diastolic heart failure: This occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.

Heart Failures are common Between 2 to 3 million Americans have heart failure, and 400,000 new cases are diagnosed each year. The condition is slightly more common among men than women and is twice as common among African Americans as whites.

Congestive heart failure happens when the heart cannot pump well enough to distribute blood and oxygen to the tissues of the body. It can be caused by a number of factors. The most common is chronic hypertension, or high blood pressure. Other conditions that may lead to heart failure are coronary artery disease, congenital heart disease, valve disease and either very fast or very slow heart rhythms. There are many treatment options for heart failure, including:

☛ Medical management with drugs such as ACE (Angiotensin Converting Enzyme) inhibitors.

☛ Repair or replacement of damaged valves.

☛ Coronary artery bypass graft.

☛ Cardiomyoplasty, or the use of skeletal muscle to assist the heart.

☛ Heart transplantation, reserved as a last mode of therapy.

A pacemaker is a device used to keep control of heart rhythm and rate, if the heart cannot control its own rate or rhythm adequately. Many infants and children experience temporary problems with their heart rate or rhythm in the early period after surgery. Therefore a temporary pacemaker is usually attached for a few days.

The pacemaker wires (which connect the device to the heart) are sewn to the outside of the heart at the time of an operation and emerge through the skin to be attached to the pacemaker, which remains outside the body. These wires will be removed after a few days, when the heart rhythm is normal and the child is recovering. The wires can be pulled out without reopening the wound and this does not damage the heart.

In a few children there may be a need to fit a permanent pacemaker. This is connected to the heart with one or two wires (a much longer lasting equivalent of the pacemaker wires referred to above).

The wires may be introduced either through a vein (and then attached to the inside of the heart), or at an operation (if they need to be connected to the outside of the heart). The pacemaker itself varies in size from a very tiny unit (the size of a twenty cent coin), which can be used for small babies, up to something more like a small pocket watch. The device may be placed under the skin in the upper abdomen or in front of an armpit.

The batteries in these pacemakers last for many years. The pacemaker, its wires and battery all need to be checked regularly (normally every six months) at an outpatient appointment. They will need to be surgically replaced if faulty.

The normal heart is composed of four chambers. The two upper chambers (called atriums or atria) are reservoirs which collect blood as it flows back to the heart. From the atriums, blood flows into the lower two chambers (called ventricles) which pump blood, with each heart beat, into the main arteries. From the right side of the heart one of these arteries (the pulmonary artery) carries blood to the lungs for re-oxygenation. The left side of the heart pumps blood into the other main artery (the aorta), which takes blood to the rest of the body.

The two ventricles and the two atriums are separated by partitions called 'septums'. The partition between the atriums is called the 'atrial septum' and the one separating the two ventricles is the 'ventricular septum'. Dark red deoxygenated blood (shown blue in diagram) returns to the right atrium from the body through the two main veins called the 'superior vena cava' and 'inferior vena cava'. It is pumped by the right ventricle to the lungs for replenishment with oxygen. The dark blood becomes bright red (shown red in diagram) in the lungs when oxygen is taken up. This red blood returns through two veins from each lung, to the left atrium and is pumped by the left ventricle to the body again.

The heart has its own internal pacemaker which controls its rhythmical beating. It creates an electrical impulse which causes firstly the atriums, and secondly the ventricles, to contract in turn. With each contraction the blood is pumped, then the heart muscle relaxes and the chambers refill with blood, ready for the next contraction.