Congestive Heart Failure


If you caught my first heart health topic, heart health, acute valve disease, then you’ll know I touched on acute diseases of the heart valves. Well, the heart valves can also have chronic end stage disease. And that is, for the most part, congestive heart failure.


Certainly, leave most of this to the cardiologist. However, most primary care doctors are getting involved with the treatment of congestive heart failure for a couple of main reasons. One, it has been too under diagnosed by too many cardiologists for too many years. Two, there is a whole division of congestive heart failure that occurs without the requisite decrease in heart ejection fraction incorrectly preached by cardiologists for many decades. They were wrong. You don’t have to wait for heart ejection fraction to drop below normal before you start calling it and treating it as congestive heart failure. That delay does harm to the patient, it’s now official.

So all of us doctors are now getting involved in that care to help more Americans. I hope? Your increased awareness of the possibility of congestive heart failure will make you a valuable asset to your family‘s health. But obviously, don’t try to treat it yourself when you suspect it. Please, and as soon as possible, outsource that to your regular doctor.


What is acute disease of the heart valve vs chronic heart valve problems?


So, acute disease of the heart valves is mostly embolic. Shooting off emboli into the body will clued the vasculature and produce organ damage almost always. Now, for chronic disease of the heart valves, think congestive heart failure. The valve becomes dysfunctional, and, you guessed it, blood backs up.

So, again, acute heart valve problems, think embolic. Chronic heart valve problems, think end of the road as congestive heart failure. And one important additional note about the mitral valve, add rhythm problems. Rhythm problems occur when the mitral valve is diseased because a back up produced by the mitral valve leads to atrial dysfunction, the chamber of the heart right before the mitral valve. That’s right. Atrial chamber enlargement and dysfunction particularly from mitral valve disease (from infection mostly, right?) leads to Atrial-tachy dysrhythmias. That means heart arrhythmias of high-speeds coming from the atria. Not good.

All these things define heart disease when talking about the heart valves, a primary component of heart disease, usually from infection: acute or embolic, so firing off clogs into the tissues ahead; and chronic, or congestive heart failure from blocked blood flow from a bad valve leading to back up in the blood behind it, forcing fluid to remain in the tissues.

And infection for the most part is what troubles the heart valves in the first place. If you can’t for the most part too much about infection, what can you do to help your heart. Well… It takes hypercoagulable states and thromboembolic states to make heart disease truly come forward. So what are those? These are two general states that are produced by things you can change to minimize heart disease.


Minimize Heart Infection by treating strep throat


After all, everyone can minimize heart infection by making sure you get your sore throat covered with antibiotics if it turns out to be strep. If it’s strep, you have to be on an antibiotic so that you don’t get the sequelae of strep which includes heart disease of the valves. Many other infections also affect the heart, including gingivitis. So good dental hygiene is important to minimizing heart disease! Are you getting it? And, of course infections produced by IV drug abuse are very distructive to the heart. So: (obviously) don’t do IV drugs. Don’t do drugs at all, is the obvious message here. But IV drugs are absolutely, completely stupid.

So, other than good healthcare maintenance and preventative care, infection itself, for the most part, you CAN’T control. So what are the things that lead to these hypercoagulable states or these thromboembolic states that you CAN control?

If you’ve read this blog, you know by now that I’m going to teach you. Correct. And there’s probably going to be pneumonics so that you can remember them. Right again.

Hypercoagulable states that will make heart disease that is brewing come forward can be remembered in the pneumonic that clues doctors to atherosclerotic risk: “CHUMS”

What increases atherosclerotic heart disease risk?




Unspecified DM (1 or 2 or 3)

Morbid obesity


(I.e., things causing thrombotic plaque)

Clues to hypercoagulable states: “SHES”

She (more factor deficiencies; & OCP)

HX or FHx clotting factor disorders or

Embolic phenomenon (DVT or PE)


(all consistent with hyper coagulability)


How to prevent heart disease


So. Cholesterol? Eat less red meat. Supplement fish oil. Hypertension? The new guidelines says anything over 130/80 is hypertension. Safe medications like diuretics and beta blockers are probably advisable for most Americans. Diabetes? It must be controlled (And did you know there was a type III diabetes? That’s diabetes produced by something that surgically destroys the pancreas. Trivia.). Obesity? You must lose weight. Your heart depends upon it. Smoking? Of course. It’s gotta go. And being female increases your risk for having a hypercoagulable bloodstream (One of the uncontrollable factors, sorry ladies). This is from two reasons mainly, women are most at risk for most of the clotting disorders. And women of course could be on the birth control pill which causes hypercoagulability.


So, now you know a lot of things that you do have control over that can help minimize heart disease. weight, blood pressure, smoking, diabetes control. You also know the things that you can’t control much, but that you can optimize. Infection. Regular dental care, good dental hygiene in general, no IV drug abuse, and make sure you get any sore throat checked out for strep which causes rheumatic fever, the number one cause of mitral valve disorder which can lead to heart problems, both emboli and congestive heart failure.

Did I make much mention about statins? Nope. Stay well.