Ricardo Burgos had always been a strong man, but during the months leading up to January, 1993, his strength mysteriously ebbed away, leaving him unable to walk more than a few feet without pausing to catch his breath.

"I couldn't breathe and I was tired all the time. My legs were swollen. It was horrible," recalls Burgos, 46, a former computer technician who lives in Inglewood, Calif.

Only when he was hurried to the hospital did Burgos discover he was suffering from congestive heart failure (CHF)-a dangerous, and often fatal, weakening of the heart muscle.

"At the time, I was 41 and I had a lot of plans for my life. Then all of a sudden, those plans were gone," he says.

Burgos is one of 4.8 million Americans suffering from CHF, a chronic, incurable illness that often robs its victims of the ability to perform basic activities such as walking, climbing stairs or even sleeping through the night.

Heart failure-defined as whenever the heart pumps blood at less than 60 percent of its maximum potential-can be triggered by a variety of conditions, including chronic high blood pressure, coronary artery disease, diseases of the heart valve, diabetes, viral infections and alcohol abuse. The most common symptoms include shortness of breath, fatigue and swelling of the ankles and legs.

Uri Elkayam, M.D., director of the USC Heart Failure Program, says the illness remains the most common diagnosis in Americans age 65 and older.

"There's a strong relationship between age and congestive heart failure simply because the two leading causes-high blood pressure and heart attacks-usually occur during the fifth or sixth decade of life," Elkayam says.

However, he points out that heart failure can strike people of any age, including those in their 20s and younger. For example, young people with genetic predisposition for heart disease are at risk. Those who drink excessive amounts of alcohol or use amphetamines or cocaine-any of which can weaken the heart or cause dangerous arrhythmias-can also succumb.

Burgos attributes his heart failure to alcohol consumption: "At the time, I was a bartender and it was too easy to drink. I was having a lot of fun, but I'm paying the price now."

Burgos was originally hospitalized for two weeks and has been fortunate to have required only two return visits in five years. About 35 percent of heart failure patients require hospitalization each year-some of them multiple admissions. Further, more than 400,000 Americans are diagnosed with congestive heart failure annually-of which half are likely to die within seven years, Elkayam says.

Still, Elkayam says that treatment for the condition has progressed enormously in the recent past, with significant increases in both life expectancy and quality of life for patients like Burgos.

"We have made enormous strides in the last 10 years. Recent improvements in therapies and the overall approach to the illness give us reason to be optimistic," he says.

Now, more and more medical centers staffed with specialists are starting CHF programs that utilize powerful new drug treatments and surgical options that are rapidly changing how the illness is treated, he says.

USC's Heart Failure Program treats hundreds of patients each year. It offers a wide range of treatment options, from medications and diet modification to heart transplantation. In addition, the program offers access to experimental therapies and drugs that are otherwise unavailable.

In standard treatment, patients most commonly receive drugs, including Digitalis, which improves the heart's ability to contract, and diuretics, which flush excess water and salt from the body. Removing excess water from body tissues is crucial because fluid build-up fills the lungs and makes it hard to breathe, forces the heart to work harder and causes swelling in the extremities.

In addition, angiotensin converting enzyme (ACE) inhibitors can counteract some of the potentially harmful hormones produced in excess in patients with chronic heart failure. Rejecting more conservative approaches used elsewhere, the heart failure team at USC has pioneered the successful use of high-dose medications such as ACE inhibitors and nitrates to greatly alleviate symptoms. Equally important, careful attention is given to avoid using some otherwise useful drugs that can harm the heart in patients with heart failure.

Recently, the U. S. Food and Drug Administration also approved the use of a class of drugs called "beta blockers" that reduce the workload on the heart and improve its function. Such drugs have been shown to increase survival by as much as 50 percent, Elkayam says.

He says that one reason drug therapies are becoming more effective is that research is starting to uncover the biochemical triggers that cause the heart condition to grow worse over time. As a result, physicians are becoming better able to target therapy to counteract and minimize harmful compounds within the body before they can do more damage. A number of new and promising drugs are presently being tested by the investigators at the USC Heart Failure Program. These drugs are likely to further enhance the benefits of the medical treatment of this disease.

New and innovative surgical techniques now augment older options that include coronary bypass, heart valve repair and heart transplantation. For example, cardiologists can now implant a small defibrillator that jolts the heart with electricity whenever it detects an abnormal rhythm developing, thus preventing sudden death in patients with heart failure. They can also improve blood flow, paradoxically, by cutting away part of the heart muscle. Such heart reduction surgery makes the organ smaller and more efficient and affords a new treatment option for patients with very large hearts as a result of myocarditis, inflammation of the heart, alcohol use and other causes.

Another new technique, called cardiomyoplasty, involves untethering muscle from the back and wrapping it around the heart. Once in place, two electrodes attached to a pacemaker-like device stimulate the muscle and slowly train it to behave like heart muscle. The procedure helps strengthen the heart's contractions and significantly increases blood flow, Elkayam says. Cardiomyoplasty is a crucial advance because it can aid people with heart failure who are unable to receive a heart transplant. Each year, about 2,000 heart transplants are performed, leaving as many as 7,000 patients who are good candidates for whom no heart is available.

"A heart transplant is an effective treatment for patients with end-stage heart failure, whose illness cannot be controlled with other measures," he says.

Other advances in the treatment of heart failure, Elkayam says, are better surgical techniques and methods for preservation of the heart during surgery: "It is now possible to treat patients who would not have survived surgical procedures in years past."

Even so, the best treatment in the world remains a poor substitute for adequate prevention methods and heart failure is a largely preventable illness.

"All the advice that physicians give to prevent heart attacks also applies to staving off congestive heart failure: eat a diet low in fat, watch your cholesterol levels and blood pressure, avoid excessive alcohol intake, stop smoking and exercise regularly. Following that advice can prevent a lot of the heart failures," Elkayam says.

Still, many people do not understand how important those things are. As many as 50 percent of people with high blood pressure do not know they have it or do not get treatment for it, he says.

Over the last decade, programs for treating CHF have become much more specialized and effective. Teams that include cardiologists, nurse specialists, dietitians and social workers work to ensure that the patient receives not only proper medical and nutritional supervision, but also emotional support and education to ensure the best results.

"There is a great deal of emphasis on patient education because when the patient is educated about their condition, management of the disease can be much more effective," Elkayam says.

Communication is also crucial: "You need to understand their background, dietary habits and so on in order to be able to provide the guidance to this patient. For example, a lot of people have no idea that they should avoid salt and what foods contain salt. They don't know that eating fast food is the worst thing you can do with this condition. So the more knowledgeable the patient is, the easier it is for them to remain free of complications," he says.

Most often, the person who handles the job of educating patients is a nurse, says Janet V. Johnson, R.N., B.S.N., senior research coordinator.

"I give patients my home phone number because sometimes they need to talk. I let them know I am available to address their health concerns and provide individualized care even after they have left the hospital. So much of the treatment is not just medicine-it is also teaching and support."

Follow-up care after a hospitalization usually includes careful monitoring of the patient's treatment with medications, diet and exercise programs and rehabilitation.

"We have them watch their salt, cholesterol and diet. And they also have to weigh themselves every day because one of the first symptoms of heart failure is weight gain that comes with retaining fluid. So patients have to be proactive and watch their diet and take their medications religiously. That's because this is a lifelong disease-and often that's the hardest thing for a patient to understand," Johnson says.

Regular exercise-which used to be forbidden or discouraged-is now highly recommended as long as it is done with clear guidance from a physician. Johnson says exercise such as walking can improve a patient's overall health.

"The goal is to keep our patients out of the hospital. With good follow-up and close supervision, the disease can be managed. Unfortunately, there is no cure, but the patient can have good quality of life," she says.

Burgos says he knows from personal experience how true that is.

"I've been a lucky person. I've been out of the hospital for five years and ever since I've been in the care of Janet and Dr. Elkayam, my life has changed for the better. I feel more optimistic about my illness-and I'm taking it one day at a time."