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The four stages of CHF.

CHF (congestive heart failure) is defined as a decrease in the heart's ability to pump enough blood to meet the body's needs. Doctors at the New York Heart Association have classified the progression of CHF into four main categories:

Class I (mild) patients function normally. Ordinary physical activities do not result in undue fatigue, palpitation, dyspnea (shortness of breath), or chest pain.

Class II (moderate) patients experience limitations of physical activity, are comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

Class III (severe) patients experience a marked limitation of physical activities, remain comfortable at rest, but less than ordinary physical activity quickly fatigues them, and they experience palpitation, dyspnea, or anginal pain.

Class IV (incapacitated) patients are unable to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or anginal syndrome may be present even at rest. Any physical activity results in discomfort.

Treatment of CHF varies among types but often relies upon a multidrug regimen that combines different therapeutic agents to achieve the best possible results. Diet also becomes a focus of control. Limiting salt intake is the rule.

Treatments for CHF have a long and colorful history. The Welsh used foxglove as early as the 13th century. The Chinese treated the disease with ch'an su, the dried skin of the common toad. These substances are cardiac glycosides, agents that reduce heart rate while increasing the force of its contraction. Until the 1960s, the primary recommended oral therapy for CHF was digitalis.

Diuretics became popular in the '60s and have been the routine treatment for most patients with mild-to-moderate heart failure. Diuretics act on the kidneys to increase urine flow (which helps the body excrete excess fluid and thus reduce pressure on the heart) and to relieve pulmonary and systemic congestion.

Magnesium is also helpful for correction of arrhythmias. Physicians can do a great deal to help CHF patients, and new drugs are coming along all the time.
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Title Annotation:congestive heart failure
Publication:Medical Update
Date:Jun 1, 1993
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