Last Updated on 17 July 2020 by Ray Plumlee
When dealing with the fear of heart problems, many of us think in terms of a dramatic clutching of our chests, an overwhelming pain, and a quick collapse. But this is certainly not always true. Many people must deal with a condition known as chronic heart failure, or CHF. So, what exactly is CHF?
Chronic heart failure, also known as congestive heart failure, is a disease which involves, by its very nature, many organs throughout our body. It helps to think of it this way. Our heart is a giant engine, a great pump, supplying blood to every nook and cranny of the amazing machine we walk around in every day. The two ventricles, located in the lower portion of the heart, pump blood out into our arteries, to be delivered to our farthest extremities. We can picture this quite easily, but how often do we take into consideration just why our body needs this supply of blood so desperately. The answer is that it may not need the blood, per se, but it most certainly needs the nutrients and other things which it transports. Red blood cells contain hemoglobin, which supplies oxygen, while white blood cells, known as macrophages, fight disease. Antibodies provide protection against specific diseases, and all the nutrients which our bodies need and crave.
Nutrients such as iron, sodium, calcium, potassium, magnesium, and many other vital elements and compounds which our organs need to repair and regrow cells. Not to mention the many hormones, produced in our glands, which regulate some of our physical processes, not to mention our behavior. If you have ever experienced a lack of sleep or an unexplained mood swing, you may wish that that particular hormone had neglected to make its rounds, but you must admit that some of the other ones, like the ones that prepare you for mating, or helping you lose that few extra pounds are welcome, indeed. There is also a flip side to this internal delivery system. Just like any well oiled machine, once a delivery is made, certain waste products must be removed. After the artery has delivered fresh supplies, the vein then proceeds to remove any unwanted or unneeded materials. These materials are then filtered out by the liver, kidneys, or lungs before the blood is returned by the veins to the two atria, located in the upper part of the heart. And then the journey begins all over again.
But what happens if this magnificent system breaks down? What if the heart suffers a slowdown of sorts? What happens to all those outlying organs waiting on a delivery of fresh oxygen and nutrients? Nothing good, I can tell you. In chronic heart failure, the pumping power of the lower chambers of the heart, the left and right ventricles, is reduced. The heart is no longer capable of pushing out blood at a sufficient volume to bring the needed nourishment to all parts of the body. This is why CHF is known as a multi-organ disease. The effects of CHF can be far reaching. These effects can be found in many organs throughout our body. And many people, investigators included, have yet to consider the effects which chronic heart failure can have on the gastrointestinal system.
Just as with any other organs, the lower intestinal tract can be affected by a condition known as ischemia. This happens when an organ is deprived of the oxygen it needs to survive. Just as we need oxygen to breathe, every organ, in fact every cell in our body, needs oxygen just as we do. If blood flow to an organ is compromised that organ will also suffer from a decrease in needed nutrients as well as a buildup in detrimental waste products. It will, in effect, starve to death in its own detritus. Not a pretty picture. Deprivation of oxygen to the large intestine can cause ischemic colitis. In the small intestine, it results in mesenteric ischemia. If the condition is mild to moderate, it can be treated with intravenous hydration, pain medications, and bowel rest, meaning no food or drink by mouth until the condition improves. Severe cases are often fatal, with such complications as bowel perforation and intestinal gangrene.
As noted above, chronic heart failure can be a causative factor in intestinal disease, but the reverse is also true. While many scientists have recently neglected the study of bowel health and how it applies to CHF, there is evidence pointing to a severely detrimental effect. In fact, it almost seems like a Catch-22 situation. CHF can cause bowel disease, and this disease can, in turn, adversely affect the CHF patient. Lack of oxygen to the healthy bowel can cause it to become ischemic, which can cause a severe breakdown in tissue. This can cause a condition known as a “leaky” bowel, allowing bacteria and other harmful material to find its way into the bloodstream. Inefficient bowel function brought about by CHF can lead to the malnutrition often found in patients suffering from chronic heart failure, not to mention cachexia, or “wasting syndrome”, a condition involving weight loss, muscle atrophy, fatigue, weakness, and loss of appetite. This condition is often found in end-stage cancer patients as well as sufferers of chronic heart disease.
Although to date, there have been few studies relating to the role of the gastrointestinal system in chronic heart failure, there have been some recent studies which suggest that ischemia of the bowel caused by decreased blood flow due to CHF may, in fact, cause reciprocal damage. It would seem to be a vicious cycle. Damage to the bowel may well cause a further progression in chronic heart failure. The heart weakens the bowel, which in turn weakens the heart. This understanding leaves us with some hope that, as we continue to further investigate the importance of the gut in the progression of CHF, new therapeutic strategies will be developed in the future. Finding the key to one treatment may, may in fact, lead to an effective treatment for the other.