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Heart Failure


What is heart failure?

Heart failure (also known as congestive heart failure) is a condition in which the heart does not pump blood as well as it should and cannot pump as much blood as the body needs. It does not mean that the heart is about to stop or has stopped working. It does, however, require medical attention.

Heart failure is caused by other conditions, such as diabetes, high blood pressure, coronary heart disease (narrowed arteries) that gradually leave your heart too weak or stiff to fill and pump efficiently. It is a problem that develops over time.

The condition can affect people in different ways. For some people, the heart isn’t able to fill with enough blood; for others, the heart doesn’t have enough force to pump blood to the rest of the body. It can affect either the right or left side of the heart or—most commonly—both sides:

  • right side heart failure is the result of the heart’s inability to pump enough blood to the lungs so that they can receive oxygen; this can cause fluid to build up in feet, legs, ankles, abdomen, liver, and veins in the neck
  • left side heart failure happens when the heart is unable to pump enough oxygen to the rest of the body
  • failure in both sides of the heart can cause shortness of breath and fatigue (tiredness)

Heart failure affects over 5 million people in the United States, with about half a million new cases occurring each year. The condition affects both adults and children.

What are the symptoms of heart failure?

With heart failure, the symptoms typically get worse over time as the heart weakens. These problems can be ongoing (chronic), or, in some cases, they may start suddenly (acute).

The most common signs and symptoms of heart failure are:

  • shortness of breath or trouble breathing
  • fatigue (tiredness or weakness)
  • swelling in the ankles, feet, legs, abdomen, and veins in the neck

As the heart weakens, other signs and symptoms may develop, including:

  • rapid or irregular heartbeat
  • reduced ability to exercise
  • high blood pressure
  • lack of appetite and nausea
  • grogginess or difficulty concentrating
  • more frequent urination at night
  • swelling of the abdomen
  • sudden weight gain from fluid retention
  • continual cough or wheezing with white or pink blood-tinged phlegm
  • sudden, severe shortness of breath and coughing up pink, foamy mucus

These last two symptoms tend to be worse at night and when you're lying down. The coughing could be a sign of too much fluid building up in your lungs, which is a condition called acute pulmonary edema. If you experience this, you should seek emergency treatment right away.

If you think you are experiencing any signs or symptoms of heart failure, make an appointment to see your doctor as soon as possible.

How is heart failure diagnosed?

Because the signs and symptoms of heart failure are common in other conditions, your doctor will ask about your medical and family histories, perform a physical exam, and may recommend a combination of diagnostic tests to better pinpoint the source of your condition.

The doctor will first ask you to discuss any symptoms that you have had, how long you’ve had them, and how much they have affected your day-to-day living. He or she will also want to know about any other medical conditions you have, look for risk factors such as high blood pressure, and ask if anyone else in your family has had a disease or condition that could cause heart failure.

Next, your doctor will want to perform a physical exam. During the exam, the doctor will listen to your heart with a stethoscope to evaluate heart and valve function and for the sounds of fluid buildup. The doctor will feel your pulse to check your heart’s rate and rhythm and take your blood pressure. Then the doctor will examine your feet, legs, ankles, abdomen, and veins in your neck for signs of swelling.

Diagnostic testing

Because no one test can diagnose heart failure, the doctor may want you to have one or more others tests to help with the diagnosis and to evaluate the extent of any damage done to your heart. These tests may include:

  • blood tests to check the level of a hormone called BNP, which rises during heart failure; to see how your thyroid gland and kidneys are functioning; and to look for signs of other diseases that could affect the heart
  • chest x-ray to see if the heart is enlarged or if the lungs have extra blood flow or extra fluid, a sign of heart failure
  • echocardiogram (ultrasound), which uses sound waves to create a moving image of the heart, allowing doctors to assess overall function of the heart and to see any problems with blood flow, injuries caused by poor blood flow, or heart muscle that isn’t contracting properly; it can also show valve problems or evidence of previous heart attacks, as well as some unusual causes of heart failure
  • electrocardiogram (EKG or ECG), which records the heart’s electrical activity and checks for irregular heart rhythms (arrhythmias); the test can show signs of damage due to coronary heart disease or signs of a current or previous heart attack
  • ejection fraction, which is performed during an echocardiogram and is an important measurement of how well your heart is pumping; it is used to help classify heart failure and guide treatment
  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast; the doctor will look for signs of coronary artery disease, such as  shortness of breath or chest pain, abnormal changes to your heart rate or electrical activity that may indicate coronary artery disease
  • cardiac computerized tomography (CT) scan, which is a large circular machine with a sliding table that you lay on; the machine uses an x-ray tube that revolves around your body to and captures images of your heart to diagnose problems and the causes of heart failure
  • cardiac magnetic resonance imaging (MRI), which is a long tunnel-like machine with a sliding table you lay on; the machine uses magnets, radio waves, and a computer to captures images of your heart and major blood vessels to see whether parts of the heart are damaged

Your doctor may also want you to have one or more medical procedures to confirm the diagnosis. These tests may include:

  • cardiac catheterization, during which a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, upper thigh, neck, then threaded into the heart where it can measure pressures in the heart chamber to gauge its pumping ability; the procedure is typically performed in a hospital while you’re awake and with minimal pain
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart and blood vessels; this procedure is often done with cardiac catheterization
  • myocardial biopsy, which is the removal of a tissue sample from the heart during cardiac catherization that is then studied for signs of changes in cells; this can help to diagnose certain types of heart muscle diseases that cause heart failure

While your doctor may detect signs of heart failure, a cardiologist—a doctor who specializes in the diagnosis and treatment of heart problems—will diagnose your condition.

How is heart failure treated?

There is no cure for heart failure, but rather, it is a chronic disease that requires life-long management. In some people, the condition can be corrected by treating the underlying cause. But not all conditions that cause heart failure can be reversed.

The signs and symptoms of heart failure can improve with treatment, which can help the heart become stronger, reduce the chance of sudden death, and enable those who have it to live longer. Treatment for the condition is decided based on the type and stage (or severity) of heart failure.

The goals of treating heart failure include:

  • treating the  underlying cause, such as diabetes, high blood pressure, or coronary heart disease (narrowed arteries)
  • controlling symptoms
  • keeping the heart failure from getting worse
  • helping you live longer and improving your quality of life

Treatments for heart failure typically include lifestyle changes, medications, possible medical procedures, and ongoing care.

Lifestyle changes

Changes to your lifestyle can have a positive impact on reducing symptoms of an underlying condition that may be causing your heart failure and make you feel better. Some changes that your doctor may recommend include:

  • following a heart-healthy diet (such as foods that are low in fat, sodium, sugar, refined grains)
  • quitting smoking
  • monitoring fluid intake
  • avoiding alcohol and illegal drugs
  • losing weight (if overweight)
  • reducing stress
  • getting enough rest
  • treating other conditions (such as high blood pressure or diabetes)

As for exercise, talk to your doctor first. It’s important to become more physically fit and stay as active as possible to improve your quality of life, but you need to know the kinds and level of physical activity that is safe for you before you start.

Medications

Most people with heart failure will need to take medications to help control their symptoms. Depending on the type and severity of heart failure you have, your doctor may prescribe one or more of the following medications:

  • ACE inhibitors, which widen blood vessels to lower blood pressure, improve blood flow, reduce the workload on the heart, and help lower the risk of a future heart attack
  • aldosterone antagonists, which help the body to eliminate salt and water through urine and lower the volume of blood that the heart must pump; they may also reverse scarring of the heart and help some people with severe heart failure live longer
  • angiotensin II receptor blockers to help relax blood vessels, which lowers blood pressure and makes it easier for the heart to pump blood
  • beta-blockers, which slow down the heart rate and reduce blood pressure to reduce the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death and may reduce signs and symptoms of heart failure, improve heart function, and help people live longer
  • digoxin to slow down and increase the strength of heartbeats; also reduces heart failure symptoms in some people with heart failure
  • diuretics to help reduce fluid buildup in your lungs and swelling in the feet and ankles
  • inotropes, which are medications given intravenously to people with severe heart failure to improve heart pumping function and maintain blood pressure
  • isosorbide dinitrate/hydralazine hydrochloride, which helps relax blood vessels so the heart doesn't have to work as hard to pump blood

Surgery

If medications alone are not enough to treat heart failure, different types of procedures or surgery may be considered, including:

  • surgically implanted devices that are placed under the skin in the chest or abdomen with wires leading to the heart include:
    • cardiac resynchronization therapy (CRT) device, which uses time electrical impulses to coordinate contractions between the left and right ventricles of the heart so that they pump in a more efficient manner
    • implantable cardioverter defibrillator (ICD), which sends a shock to the heart when it senses fast abnormal rhythms (arrhythmias) or if the heart stops
    • left ventricular assist device (LVAD), which works with the heart to pump blood to the rest of the body in people who are waiting for a heart transplant
  • coronary artery bypass graft (CABG), which is a type of surgery that uses arteries or veins from other areas of the body to create a pathway around a blocked artery for improving blood flow to the heart and to help avoid a heart attack; this procedure is used if severely blocked arteries are contributing to the heart failure
  • heart valve repair/replacement, which is used if a faulty heart valve causes the heart failure; repairs can be done using either minimally invasive surgery or cardiac catheterization; replacement is performed using an artificial valve when repair isn't possible
  • heart transplant, which involves replacing the patient’s diseased heart with the healthy heart from someone who has died; it is generally reserved for people who have end-stage heart failure, which means their condition has gotten so severe, there are no other treatment options available. This surgery can dramatically improve the survival and quality of life of some people with severe heart failure.

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing symptoms of heart failure, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of heart failure.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

Since 2006, Temple cardiovascular surgeons have been performing cardiac surgery procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of cardiac anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed at Jeanes for the diagnosis and treatment of heart failure include:

  • intracardiac echocardiology
  • diagnostic coronary angiogram
  • right/left catheterization for pressure/flow monitoring or cardiac biopsy
  • left ventriculogram
  • coronary intravascular ultrasound
  • wireless monitoring
  • atherectomy
  • cardioversions
  • aortic repair
  • minimally invasive heart valve repair and replacement
  • synchronized biventricular pacers for heart failure
  • implantation of pacemakers and implantable cardioverter defibrillators (ICDs)
  • surgical treatment of cardiac arrhythmia

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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