Congestive heart failure happens when the heart is unable to pump sufficient oxygen to the body in order to meet its needs (Kulick et al. 2007, Drug Digest 2007). It can be caused by diseases, which weaken or stiffen the heart muscles or increase oxygen demand by any tissue in the body beyond what the heart can deliver. The right and left atria or upper chambers, which pump blood, can be weakened by a systolic dysfunction, such as a heart attack or myocarditis, an infection. The right and left ventricles or lower chambers are involved in relaxing the heart muscles. They can be affected by diastolic dysfunction, such as hemochromatosis, which stiffens the heart muscles. A high demand for oxygen may be due to conditions like hyperthyroidism and result in high-output heart failure (Kulick et al., Drug Digest).

Many disease processes can cause congestive heart failure by decreasing the heart's pumping efficiency (Kulick et al. 2007, Drug Digest 2007). In the U.S., the most common causes are coronary artery disease, high blood pressure or hypertension, chronic alcohol abuse, and disordered heart valves. Fatigue is an early symptom of congestive heat failure. The ability to exercise may also decrease. This may not be immediately felt because the person may unknowingly reduce his activities to adjust to the sense of limitation. An overload of fluid in the body creates swelling or edema of the ankles and legs or abdomen or in the lungs, which causes shortness of breath. This shortness of breath often occurs during exercise or when lying down flat. This can awaken the person at night and gasp for air and not fall asleep unless sitting up. The overload of fluid can increase urination. Accumulated fluid in the liver and intestines can also cause nausea and abdominal pain and reduce the appetite (Kulick et al., Drug Digest).

Coronary artery disease, valvular heart disease, diabetes and high blood pressure increase the risk of developing the condition (Drug Digest 2007). Other factors are age, gender, family history, cigarette smoking, high blood pressure, diabetes, alcohol abuse, coronary artery disease, chronic kidney disease, atrial fibrillation, high cholesterol, asthma or chronic obstructive pulmonary disease and race. Older people tend to develop the condition more than younger people. Men are likelier to develop coronary disease than women before age 60 or 70. Family history predisposes one to have it. African-Americans have been found to develop heart failure than Caucasian-Americans (Drug Digest).

Treatments

Lifestyle Modifications

Treatment for congestive heart failure consists of lifestyle modifications and medications (Kulick et al. 2007, Drug Digest 2007). Lifestyle modifications include the restriction of salt and fluid intake to offset the tendency of the body to accumulate fluid in the lungs and surrounding tissues. In most cases, intake is limited to 2 grams of sodium a day. Diuretics are prescribed to rid the body of excess fluids, at the same time, limiting the total fluid intake to 2 quarts from all sources. The patient is advised to monitor his or her body weight as an indicator of improvement or worsening of the condition. Aerobic exercise or any regular exercise can maintain overall functional capacity, enhance quality of life and even improve survival. And potentially reversible factors should be specifically addressed. Inadequate blood flow to the heart muscle, for example, can be treated by coronary artery surgery or catheter procedures. Other reversible factors, such as severe valvular disease and uncontrolled high blood pressure due to chronic or long-standing alcoholism, can also be directly resolved to reverse the condition.(Kulick et al., Drug Digest).

Medications

Medications for congestive heart failure include diuretics, beta-blockers, Digitalis or Digoxin, and ACE inhibitors (Kulick et al. 2007, Drug Digest 2007). Diuretics help keep fluid from accumulating in the lungs and other tissues. They promote the flow and elimination of fluid through the kidneys. They relieve symptoms like shortness of breath and leg swelling but have not shown to contribute to long-term survival. Beta-blockers are agents, which have shown to improve heart function and survival in congestive heart failure patients already taking Ace inhibitors, according to recent studies (Drug Digest, Kulick).

Digitalis

Digitalis is used to treat heart conditions. It works directly on the heart muscle by strengthening and regulating the heartbeat (MedicineNet 2007). Its brand name is Crystodigin. It must be taken exactly as prescribed and this is at the same time every day. It may be taken with food or milk in order to prevent or avoid stomach irritation. It should not be stopped suddenly without first consulting the doctor. Suddenly stopping the medication may make some conditions worse. Diarrhea, loss of appetite, drowsiness, headache, muscle weakness and fatigue may be experienced as the body adjusts to it. It should be used with caution if the patient has a history of liver or kidney disease, lung disease, thyroid disorders, or rheumatic fever (MedicineNet).

Fiber-rich foods can reduce the absorption of digoxin, so doctors advise patients to take it a few hours before or after eating such foods (MedicineNet 2007). Difficulty in breathing and swelling in the lower legs and ankles indicate too low a dose. But a doctor should be consulted before changing a dose. Patients who will undergo surgery or dental surgery should inform the surgeon or dentist that they are taking the drug. Pregnant women are prescribed this medication only when needed. Digoxin is excreted in breast milk. Digoxin also interacts with a number of other drugs. Doctors advise that these drugs be taken at least 2 hours after taking digoxin to prevent interactions or interference of their actions. Overdose of digoxin can also occur. Symptoms include visual changes, loss of appetite, nausea, vomiting, diarrhea, dizziness, weakness and irregular heartbeat (MedicineNet).

Digitalis is a steroid, which can have a specific and powerful action on cardiac muscles in animals (May 1996). It has been in use as treatment of heart conditions since it was discovered in 1775 by William Withering, an affluent Scottish doctor. In 1775, he could cure a patient with a very bad heart condition. This patient went instead to see a gypsy who gave him a secret herbal remedy, which improved his condition a lot. Dr. Withering fervently looked for that gypsy. When he finally found her and bargained with her, she presented him with a whole range of concoctions. The main ingredient was purple foxglobe or digitalis purpurea. This extract enjoys vast popularity since the dark ages as a poison for criminal offenders undergoing "trial by ordeal" in the Middle Ages. It was also used to treat wounds the dropsy. Withering synthesized the digitalis plant extracts, got successful results and introduced it officially in 1785. That original purple foxglove or digitalis purpurea is now used as a treatment to control heartbeat. The mechanism intensifies heart muscle contracts but reduces the rate. It works at a low dosage of only 0.3 mg. Digitalis purpurea contains many cardiac glucosides and saponins, which differ from locality to locality and with the season, its potency and quality also differ. Withering recommended that it be diluted and given repeatedly in small doses until the desired outcome occurred. Today, digitalis preparations from digitalis leaves are synthesized with the use of re-crystallization methods. They are then carefully standardized by bio-assay. The dilution or hydrolysis of digitalis creates three major aglycones or genins. All of these contain an alpha, beta-unsaturated lactone ring. The hyrdroxyl group and the unsaturated lactone are important elements to its action as a drug (May).

Withering may not have realized how useful his original digitalis drug has been to stimulate the heart muscle. Today, Digitalis drugs are used to treat congestive heart failure and irregular heartbeat (Flanigan 2001). They make the heart stronger and function more efficiently. As a result, blood circulation improves and swelling of the hands and ankles is relieved. These symptoms are common in those with heart disorders. Digitalis drugs or digitalis glycosides are prescribed medicines under the generic name digitoxin and digoxin. The recommended dosage differs for every patient. Only the exact amount prescribed should be taken. During treatment, the patient's blood levels are monitored. Then the doctor changes the doses as he sees fit. Patients should, therefore, not change the dose on their own (Flanigan).

Patients taking digitalis drugs should learn to take their own pulse and do so regularly while under treatment (Flanigan 2001). Changes in pulse rate, rhythm or force could indicate side effects. But patients should not discontinue the drug without the permission of their doctors. They should avoid overdose. Taking overdoses is a serious and frequent concern in taking digitalis drugs. Signs of overdose include loss of appetite, nausea, vomiting, pain in the lower stomach, diarrhea, extreme fatigue and weakness, extremely slow or irregular heartbeat, blurring or other changes in vision, drowsiness, confusion or depression, headache, and fainting. Anyone who is taking digitalis drugs should inform health care professional in charge before undergoing any surgical or dental procedures or receiving emergency treatment. Any reactions to the drugs or other allergens should be reported before patients start taking digitalis…