Congestive Heart Failure
Congestive Heart Failure or CHF is a condition where there is weakening in the pumping action of the heart due to fluid buildup in the body. The term 'congestive' is indicative of the blood backing up into the liver, abdomen, lungs or lower extremities. This medical condition develops over a period of time and leads to enlargement of the heart. Due to the inability to pump enough blood, the heart compensates by becoming larger. This leads to enlarged heart chambers and thicker heart wall muscles. Persons suffering from coronary disease or arrhythmia are more at risk for CHF.
Persons suffering from hypertension and heart valve disease are more susceptible to congestive heart failure. If you have suffered a heart attack or congenital heart defect, you are more likely to be prone to CHF. Congestive heart failure is characterized by backing up of the blood from both one or both the lower chambers of the heart.
Symptoms of Congestive heart failure include shortness of breath and weakness. A person suffering from CHF may notice weight gain on account of body fluid accumulation. This shows up as water retention and edema in the ankles, feet and legs. The fluid buildup leads to frequent urination, especially at night. Chest pain, irregular pulse and restlessness are other symptoms of CHF. Decreased alertness and inability to pursue exercise are signs of congestive heart failure. There is weakness and extreme fatigue due to reduced blood flow to the major organs. Dizziness and confusion is noticed due to inadequate oxygen supply to the brain. Persistent cough and wheezing can also be noticed.
Diagnostic tests such as chest x-rays and ECG can aid in detecting any stress on the heart. During a physical examination, a doctor can detect fluid buildup in the chest. Imaging tests such as angiography and nuclear ventriculorgraphy help in clear diagnosis of the heart's pumping condition. EKG and echocardiogram aids in detecting any possible heart enlargement and fluid buildup. Blood tests can indicate any kidney or thyroid malfunction that may affect heart's functioning. BNP test or B-type natriuetic peptide Test is conducted to assess heart failure.
Medications for congestive heart failure include ACE inhibitors that keep the blood vessels open and inotropics to strengthen the heart's pumping capacity. Diuretics may be prescribed to get rid of excess body fluids. Vasodilators and Calcium channel blockers open up narrowed blood vessels. Angioplasty is done to open up narrowed arteries. This is resorted to in cases where there is fatty plaque buildup. Surgery to repair existing defects such as heart valve repair and coronary artery surgery are sometimes resorted to. Lifestyle changes can go a long way in keeping CHF at bay. CHF is a progressive condition; it cannot be cured but lifestyle changes can go a long way in slowing the progress of the disease. These include quitting smoking and controlling diabetes, cholesterol and high blood pressure. Control alcohol consumption and embark on a fitness regimen that includes aerobic exercise.
When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.
Nocturia types and causes
Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.
There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.
All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.
In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.
Inadequate bladder storage
The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.
A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.
Diagnosis of Nocturia
Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.
ACE inhibitors or angiotensin-converting enzyme inhibitors are a group of drugs that are prescribed for congestive heart failure and hypertension. Their effect is much like that of Angiotensin Receptor Blockers whereby they widen the blood vessels. Persons suffering heart failure, heart attack and chronic hypertension are most often prescrbied the ACE inhibitors. It is contraindicated to take NSAID or salt substitutes when taking ACE inhibitors as they might decrease their effect. Pregnant women must refrain from taking ACE inhibitors.
Bibliography / Reference
Collection of Pages - Last revised Date: February 16, 2019