Heart Failure: Get to the Heart of the Matter
Hussam H. Farhoud, MD, FACC, FSCAI
Cardiologist — Cypress Heart
316-858-9000
877-449-1560
Heart failure, also known as congestive heart failure, means your heart can’t pump enough blood to meet your body’s needs. Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
Heart Failure Statistics:
Heart failure affects nearly 5 million persons in the US, with an estimated 500,000 new cases diagnosed annually. It affects men and women equally. The prognosis of heart failure, in the absence of optimal treatment, remains extremely poor. Only 50% of heart failure patients survive for 5 years after the diagnosis. The number of heart failure patients is expected to rise to 10 million by 2037. The risk of sudden death is 6-9 times higher in the heart failure population. The prevalence of heart failure increases with age, affecting 10% of persons aged 70 years or older. It is estimated that 1 million patients are hospitalized each year with heart failure diagnosis. The American Heart Association estimates the direct cost of heart failure to be over $20 billion a year. The indirect cost is even higher.
Common Symptoms:
Shortness of breath with activity, or after lying down for a while
Cough with clear sputum production
Swelling of feet and ankles
Swelling of the abdomen
Weight gain / Fluid retention
Irregular or rapid pulse
Sensation of feeling the heart beat (palpitations)
Difficulty sleeping due to breathing problem
Fatigue, weakness, faintness, confusion and sometime
impaired memory.
Loss of appetite, indigestion
Increased urination at night.
Diagnosis:
The diagnosis of heart failure can sometimes be difficult. Approximately 20-40% of the patients with heart failure have normal systolic function of the heart. If you have heart failure it is extremely important that you know your heart function or ejection fraction(EF). Echocardiography is extremely useful in establishing the diagnosis of heart failure. It helps also in establishing the etiology of heart failure.
Treatments:
Often, multiple therapies are needed to control heart failure symptoms and slow the progression of the disease. These agents include ACE inhibitors and beta blockers. Lipid disorders should be addressed aggressively to further reduce vascular and cardiovascular risks. Lifestyle modification is also very important in effectively managing heart failure. This includes cessation of smoking and alcohol and drug use, and developing an exercise program. The ultimate goal with heart failure is to prolong life. Diuretics are typically used to reduce fluid retention in symptomatic patients .The need of diuretics can change based on the patient’s diet and activities. Many patients can control their heart failure symptoms with minimal dose or even no diuretics at all. Heart failure patients are encouraged to monitor their fluid intake and weight daily. Some are able to self-adjust the dose of diuretics accordingly. Many patients taking diuretics require potassium and magnesium supplements.
ACE inhibitors have been evaluated in over 7000 patients with heart failure. They are approved for the management of heart failure. They are also approved for the prevention and treatment of heart failure. Most of them are cheap, generic and affordable. Very few patients can have a dry cough as a side effect of the ACEI. In this situation, another group of medications named ARBS can be used as an alternative. ARBS are relatively more expensive, however, some of them will become generic in the near future.
The number of heart failure patients studied with beta blockers actually exceeds the number of heart failure patients studied with ACE inhibitors. Only metoprolol succinate and carvedilol are approved for heart failure. There is a strong relationship between the dose of beta blockers and the long-term benefits.
Higher Risk of Sudden Cardiac Death:
Heart failure patients are at increased risk of sudden cardiac death. Unlike a heart attack, sudden cardiac death is caused by an electrical problem in the heart. It can strike without any symptoms or warning. Optimal medical therapy provided by a heart failure specialist and device therapies can significantly decrease the risk of sudden cardiac death.
Several cardiac devices are available. Pacemakers treat slow heart rate. Implantable defibrillators treat heart rhythm problems in the lower chamber in the heart known as ventricular tachycardia and ventricular fibrillation. Heart failure devices on the other hand, are a special type of cardiac device that helps improve the heart pumping function at the same time they help prevent and treat sudden cardiac death. These devices are so advanced that they can monitor and treat most rhythm abnormalities, and can be checked remotely.