Hello, I just got out of the hospital. A few nights ago I went to the ER with a feeling of not being able to breath. Turns out I have Congestive heart failure. I have an EF of 27%. which means my heart is running at about 27% of what it should be. I am 30 years old. I don't really have a prognosis. Just take my meds and hope things will turn around. Wish me luck.
Heart failure is a syndrome of ventricular dysfunction. Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid accumulation; the ventricles can be involved together or separately. Diagnosis is initially clinical, supported by chest x-ray, echocardiography, and levels of plasma natriuretic peptides. Treatment includes diuretics, ACE inhibitors, angiotensin II receptor blockers, β-blockers, aldosterone antagonists, specialized implantable pacemakers, and correction of the underlying disorder.
Heart failure (HF) affects about 5 million people in the US; > 500,000 new cases occur each year.
Generally, patients with HF have a poor prognosis unless the cause is correctable. Mortality rate at 1 yr from first hospitalization for HF is about 30%. In chronic HF, mortality depends on severity of symptoms and ventricular dysfunction and can range from 10 to 40%/yr. Specific factors that suggest a poor prognosis include hypotension, low EF, presence of CAD, troponin release, elevation of BUN, hyponatremia, and poor functional capacity (eg, as tested by a 6-min walk test).
HF usually involves gradual deterioration, interrupted by bouts of severe decompensation, and ultimately death, although the time course is being improved with modern therapies. However, death can also be sudden and unexpected, without prior worsening of symptoms.
Immediate inpatient treatment is required for patients with acute or worsening HF due to certain disorders (eg, acute MI, atrial fibrillation with a very rapid ventricular rate, severe hypertension, acute valvular regurgitation), as well as for patients with pulmonary edema, severe symptoms, new-onset HF, or HF unresponsive to outpatient treatment. Patients with mild exacerbations of previously diagnosed HF can be treated at home.
The primary goal is to diagnose and to correct or treat the disorder that led to HF.
Short-term goals include improving symptoms and hemodynamics; avoiding hypokalemia, renal dysfunction, and symptomatic hypotension; and correcting neurohumoral activation.
Long-term goals include correcting hypertension, preventing MI and atherosclerosis, improving cardiac function, reducing hospitalizations, and improving survival and quality of life. Treatment involves dietary and lifestyle changes, drugs, devices, and sometimes percutaneous coronary interventions or surgery.
Treatment is tailored to the patient, considering causes, symptoms, and response to drugs, including adverse effects. Treatment of systolic and diastolic dysfunction has become more similar, although there are more evidence-based therapies for systolic HF.
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