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Heart Failure - Symptoms and Treatment

Heart failure affects approximately 4 to 5 million Americans annually. Developing slowly over time, heart failure occurs when the heart loses the muscle strength to pump enough blood throughout the body. Persons with heart failure may not even know their heart is pumping less efficiently until symptoms appear. Through recommended lifestyle modifications, medical treatments and surgical interventions, our physicians and surgeons can help heart failure patients lead a longer and fuller life.

What is Heart Failure?

Heart failure, frequently referred to as congestive heart failure, is a progressive disease building up over time; therefore symptoms and severity can range from mild to acute. However, heart failure is generally defined as a point in time “when the heart muscle doesn't pump as much blood as the body needs.” Heart failure is typically the result of heart attack or other heart diseases that damage the heart and is a serious health problem that can limit simple activities such as walking, bathing, or cooking.

Heart Failure Risk Factors and Symptoms

Risk Factors

Age – 5% of persons over 75 years of age have been diagnosed with heart failure.

Smoking – Smoking cigarettes doubles the chances of developing heart failure.

High LDL cholesterol levels – Overtime, high levels of LDL cholesterol (over 130 mg/dl) can add to plaque build-up and cause thickening and hardening of the arteries making the heart muscle work harder, increasing your risk for heart disease.

High blood pressure – Uncontrolled high blood pressure increases risk for developing heart failure by 200%.

Diabetes – Diabetics have up to an eight-times greater risk of developing heart failure.

Obesity – Obese persons are 50% more likely to develop heart failure.

Coronary artery disease – Heart muscle damage and scarring from heart attacks greatly increases the risk for heart failure.

Any risk factor will increase a person’s risk for developing heart failure. However, a combination of risk factors, along with advanced age, increases risk significantly.

Symptoms

Shortness of breath

Fatigue

Edema (fluid accumulation) in the hands, legs, ankles, or feet

Persistent dry coughing

Dizziness

Nausea and abdominal swelling

Heart palpitations

Sudden weight gain

If you have one or more of these heart risk factors or experience any of these heart failure symptoms, talk to your primary care physician.

Heart Failure Diagnostic Testing

Electrocardiogram (ECG) –an ECG records heart electrical activity, measuring heart regularity and can indicate previous heart attack.

Echocardiography – An ultrasound of the heart, commonly called an Echo, measures heart chamber size, heart wall thickening, heart valve condition, and heart chamber function.

Chest x-ray – X-rays are used to visually check heart size and lung condition.

Heart MRI – MRI produces cross-sectional or three-dimensional images of the body's soft tissues. Blood flow can be assessed and heart structures examined for damage or deformities.

Heart biopsy – Heart muscle tissue samples help to find the cause of heart failure. Determining a diagnosis of myocarditis, virus or other causes of heart failure helps identify the best treatment course.

Right heart catheterization – The pressure levels in the heart, called hemodynamics, are checked through an invasive, non-surgical procedure. To perform a cardiac catheterization, a small hollow tube is inserted into a vein and advanced into the heart to check pressure levels.

Blood sampling – laboratory tests check cholesterol levels as well as major organ function.

Heart Failure Services and Treatments

Although there is no known cure for heart failure, several treatment options are available at California Pacific to help improve heart stability.

Lifestyle Modification
With the help and guidance of health care professionals, patients can take the first step toward improving their heart health by making lifestyle modifications.

Smoking cessation – If you smoke – quit.

Weight loss – Lose weight if deemed necessary by your physician.

Alcohol reduction – If you drink alcohol, reduce or cease consumption.

Watch what you eat – Reduce dietary salt and fat.

Physical activity – With a doctor's approval, exercise daily.

Medical Therapies
Heart failure medications can control symptoms and improve survival rate. Therefore, medications are tailored to each individual’s heart disease severity, symptoms, and disease stage. Pharmaceutical interventions include Vasodilators, Beta Blockers, Diuretics, and Glycosides.

Vasodilators, such as ACE-I; Angiotensin II Receptor Blockers; Hydralazine; and Nitrates, as well as, Beta Blockers, such as Coreg; and Lopressor improve quality of life by controlling symptoms and increase patient survival rates.

Diuretics such as Bumex or Lasix and Glycosides such as Digoxin and Digitalis are effective in providing symptomatic relief and are many times the first line of treatment to improve patient’s life quality.

Electrophysiology Treatments
Cardiac resynchronization therapy (CRT) is a relatively new treatment option available to select patients with heart failure-induced electrical abnormalities. Used in combination with medical therapy, CRT plays an important role in heart failure management. Even though the heart walls may be weak, CRT synchronizes the heartbeats. Restoring the heart’s mechanical sequence stimulates the heart walls to work rhythmically. Using implantable cardiac devices (ICD), such as pacemakers, electrophysiologists are able to treat heart failure patients who experience atrial fibrillation or those at risk for sudden cardiac death.

Surgical Therapies for Heart Failure

Revascularization

Coronary artery bypass graft (CABG) is performed to open blocked vessels or arteries and restore blood flow when a coronary artery has narrowed or become blocked. The affected vascular area is bypassed using a harvested blood vessel from another part of the body.

Angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a procedure done in the cardiac catheterization laboratory. PTCA opens partially blocked blood vessels to improve blood flow to the heart. A thin, flexible catheter tube is carefully inserted into the narrowed artery either through the femoral artery (groin) or brachial artery (arm). Once the catheter reaches the narrowing, a small balloon is inflated pressing fat and calcium deposits (plaque) against the wall of the vessel to improve blood flow. Many times a stent is used to hold open the vessel, helping prevent reclosure as well as strengthening the vessel wall to improve blood flow.

Conventional Surgery

Mitral valve surgery repairs or replaces the damaged mitral valve. The mitral valve regulates blood flow from the upper left heart chamber (atrium) into the lower left chamber (ventricle). Mitral valve regurgitation, caused by a damaged valve, is a serious condition, as blood backs up and leaks through the mitral valve between the upper and lower left chambers of the heart. Damaged valves, without repair, can cause enlargement of the left ventricle leading to heart failure.

Biventricular pacing with an ICD helps to synchronize contractions of the left and right ventricles, reduces mitral valve regurgitation, and decreases septal wall motion. Biventricular pacing, works similar to standard pacemakers. Standard pacemakers have two right heart stimulation leads, the biventricular pacemaker has a third lead, which goes through a vein in the back of the heart wall. Biventricular pacing simultaneously stimulates the heart's upper and lower chambers, providing timed electrical impulses.

Advanced Heart Failure Care

Ventricular Assist Devices (VADs)are mechanical devices that assist the heart’s pumping function. VADs can be used for the right (RVAD) and/or left (LVAD) side of the heart, depending on the patient's needs. Implantable LVADs are one of the most innovative therapies for end stage heart failure. LVADs can be implanted as a bridge-to-transplant -- for a patient awaiting a transplant -- or as destination therapy -- long-term treatment for patients who are ineligible for a heart transplant. The LVAD is attached to a patient's own heart and is run by batteries or AC power. Natural circulation continues as the implanted pump provides additional support to circulate blood throughout the body.

California Pacific Medical Center is currently offering both the HeartMate® XVE and the HeartMate® II implantable LVADs as options for patients who may need the support of a left ventricular assist device. Both of these devices are FDA-approved for patients who are awaiting a heart transplant. The HeartMate XVE is also FDA-approved for destination therapy -- or long-term permanent therapy -- for patients who do not qualify to receive a heart transplant.

California Pacific Medical Center is the only center in Northern California who participated in the HeartMate II destination therapy clinical trial.

Heart Transplantation

California Pacific Medical Center has been actively performing heart transplants since 1984. Heart transplant surgery replaces a patient's diseased heart with a donor heart when all medical treatments or cardiovascular surgeries have failed. Approximately 2,300 heart transplants are performed each year in the United States. Transplantation is only considered when a patient’s heart failure no longer responds to other therapies and the patient’s health is otherwise good.