Last month, I discussed the definition of Heart Failure (HF) and the different etiologies of this disease. To briefly recap, Heart Failure usually presents itself with fatigue and shortness of breath from the heart’s inability to pump adequate blood supply to the body due to weak heart muscle, valvular dysfunctions, and/or the inability to sufficiently relax in order to fill up with adequate blood for circulation.
The Diagnosis of HF is made clinically with the presence of signs and symptoms that may include:
1) shortness of breath with activity, which may progress at resting state in severe cases;
2) weakness and fatigue;
3) swelling of lower extremities;
4) increase in abdominal girth due to fluid accumulation in the abdomen;
5) inability to lay flat due to shortness of breath from fluid accumulation ( this may represent as increasing number of pillows or sleeping while sitting on chair) and
6) and in more severe cases, mental status changes because of inadequate perfusion of the brain.
In addition, there are physical examination signs that help a physician support the diagnosis.
Imaging studies are the next step in the work-up, which include chest x-rays and echocardiogram, which is a sonogram of the heart that distinguishes a weak heart from stiff heart; and also inspects for any valvular diseases. Basic blood work and electrocardiogram is also helpful to complete the initial work-up for HF.
In many cases the etiology of HF is due to blockage of coronary arteries that feed the heart muscle with blood, which consequently makes the heart muscle weak. Usually a cardiac angiogram or cardiac catheterization is needed to define the anatomy of coronary circulation and to discover the location and degree of the blockage. If appropriate, the operating doctor will open the blockage with inflation of a balloon and insertion of a stent, which is a metal hollow mesh to keep the artery open. In more severe cases however, Coronary Artery Bypass Graft (CABG) surgery may be more appropriate and required.
Medical therapy is a very powerful treatment these days used to stabilize and slow the progression of heart failure; and in some cases reverse and improve the pump function of the heart. The other main goal of medical therapy is to improve symptoms, increase exercise tolerance and enhance quality of life.
Usually this is achieved by using diuretics at the discretion of the treating doctor. It is very crucial that other ongoing medical issues be addressed and be treated; especially renal disease, diabetes, hypertension, high cholesterol, arrhythmias, thyroid disorders, anemia, obesity, lung disease (such as emphysema), autoimmune diseases (such as lupus), and sleep apnea.
Lifestyle modification is another critical player in the treatment, and perhaps the cure of HF in many instances. Diet and exercise that is suited and recommended by the treating doctor for individualized patients, well balanced nutrition that is low in salt, smoking cessation, and avoidance of heavy alcohol consumption are very important.
In many patients that have a very weak heart, Implantable Cardioverter Defibrillators (ICD) are placed to prevent sudden cardiac death by restoring electricity and heart beat if the heart stops its rhythm or goes into lethal arrhythmias.
In selected patients, based on their nature of their heart disease, a specialized ICD is placed to synchronize the pump function throughout the heart to alleviate symptoms as well as prevent sudden death.
In a few unfortunate cases, HF may progress to a severe form at which the above modalities are not sufficient to sustain life. In these cases, the last resort is a heart transplant that requires strict criteria to be a recipient and involves a patient dedicated to daily compliance with medications and frequent doctor visits to avoid detrimental consequences of graft rejection. Recently, new innovations are available to pump blood to the body via an electronically driven pump that is inserted in the heart to prolong life as either “destination therapy” or “bridge to transplant.” Ongoing modifications of these devices are currently under way to finesse and improve their efficacy.
New ideas are on the horizon, and are currently undergoing intense research. This mainly involves stem cell research, which entails injecting undifferentiated cells that can grow to become specialized heart cells and rebuild the damaged heart tissue and to help regain normal heart function.
It is important to note that HF is a progressive disease. The symptoms can be vague and very general but if it’s caught in time, the heart can be salvaged, life can be prolonged, and the quality of life can be improved. Many advances have come into play with regard to diagnosis and treatment of HF and I believe that the future holds an even better outcome with new innovation.
