THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 547.5 Guest: Dr. Alan Wasserman, Cardiology, George Washington University Medical Center Topic: Congestive Heart Failure Producer/Host: Steve Girard

NEMA: Today, we're with Dr. Alan Wasserman from the cardiology department at George Washington University Medical Center in Washington, D.C. Tell us about the problem of congestive heart failure....

WASSERMAN: There are over three million people in the United States alone that have congestive heart failure, and it's estimated that we develop about 400 to 500 thousand new cases every year...congestive heart failure has become the leading cause of hospitalization for elderly Americans, Americans over the age of 65. It leads to about 40 to 50 thousand deaths in the United States per year. And complications from congestive heart failure probably account for about a quarter of a million deaths each year. The treatment costs for congestive heart failure probably run over 10 billion dollars.

NEMA: What are the physical manifestations of the disease...?

WASSERMAN: They're basically symptoms of feelings of fatigue...feeling short of breath, getting short of breath when you lay down. If you have to get up at night because you're gasping for air, or just feeling like you're not getting enough air. You start noticing that you're starting to get some swelling in your ankles, or even your hands, or even your abdomen.

NEMA: What about diagnosis? What can someone expect to happen when they see his doctor?

WASSERMAN: It can be done, usually in the doctor's office, by just getting a very good history of what's been going on, and a physical exam. Simple diagnostic tests, like a chest x-ray, like an electrocardiogram, and a little bit more specialized test, like an echo-cardiogram or an ultrasound study of the heart, can usually make the diagnosis of congestive heart failure.

NEMA: Physically, what's happening to the heart as the disease progresses?

WASSERMAN: The heart dilates, it gets bigger...the pumping function is not as effective...so maybe it pumps out one third of the blood that's in the heart. Well, the body may not be getting enough blood supply, but more importantly, the blood starts backing up. That's why it causes fluid in the lungs, making people short of breath. It's why it causes fluid in the tissues, to give people swelling, or what we call edema.

NEMA: What about treatment?

WASSERMAN: The most important message is that congestive heart failure is a disease that people can live with and lead normal lives with. The mainstay of treatment for congestive heart failure in 1996 are three medications: diuretics, to get rid of the excess fluid, digitalis, to improve the pumping function of the heart, and a new class of drugs called ace inhibitors, that work on the hormone in the body to make it easier for the heart to pump. The combination of these three medications can make people totally asymptomatic in getting back to a normal life.

NEMA: Is preventing congestive heart failure more a matter of preventing the things that lead up to it, like heart attacks and coronary artery disease...?

WASSERMAN: Obviously, the measures to decrease coronary artery disease, by making sure that your risk factors are decreased, is the way to prevent heart attacks. The other leading cause of congestive heart failure in this country is hypertension. And hypertension is definitely a treatable disease, and the other leading cause of congestive heart failure is toxins, and the biggest toxin that we see is alcohol. Too much alcohol over time weakens the heart muscle, and can cause congestive heart failure, and that's obviously an avoidable condition.

NEMA: Dr. Alan Wasserman, of the George Washington University Medical Center in Washington, D.C. I'm Steve Girard.