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Preventing diabetes best way to halt heart failure

BY DR. DAVID LIPSCHITZ Modified: October 28, 2012 at 11:17 am •  Published: October 28, 2012

A research paper in the American Journal of Cardiology reports that during the course of our lifetimes, one in four black people and one in three white people will develop heart failure that can lead to sudden death or, more frequently, a progressive deterioration of heart function with worsening symptoms including shortness of breath, abdominal pain and swelling of the legs.

Often patients are unable to sleep flat and frequently wake up at night gasping for breath. Heart failure accounts for 40 percent of the half million deaths related to heart disease each year.

The common conditions that lead to heart failure are high blood pressure and coronary artery disease. Diabetes, cigarette smoking and being significantly overweight also increase the risk of heart problems.

Chronic lung disease, including emphysema and bronchitis, can damage the pulmonary arteries, which eventually cause the heart to fail.

More rarely, heart failure can occur because of damage to the heart valves or damage to the heart muscle from viruses, hormonal disorders (such as thyroid disease) or rare abnormalities of the heart muscle called cardiomyopathies.

Heart failure often occurs when the heart muscle becomes so weak that insufficient blood is pumped out with each heartbeat. This condition is referred to as systolic heart failure.

Alternately, the heart can fail because it becomes too rigid. After each beat, the heart relaxes and fills with blood. In this form of heart failure, referred to as diastolic dysfunction, less blood can enter the heart and be pumped out with each beat.

Over time, the abnormality becomes so severe that symptoms of heart failure develop.

Heart failure causes blood to back up in the lungs. Increased pressure in the lung veins results in the seepage of fluid into the tiny lung air pockets. This leads to a condition called pulmonary edema that frequently results in a sudden shortness of breath.

Blood also can back up in the abdomen and legs, causing liver enlargement, abdominal pain and marked swelling of the legs.

As the heart fails, hormonal changes occur that reduce the production of urine and result in retention of excessive fluid.

A sign of impending heart failure is a sudden increase in weight that may average as much as two or three pounds a day.

Treatment usually involves the use of diuretics (water pills) that get rid of excess fluid and, together with other medications, reverse most or all of the symptoms. With treatment, the patient may remain symptom-free for extended periods of time.

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