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Dr. Blois: 'Tired, Breathless? Heart Failure Could be the Culprit'

  • Category: General, Cardiology
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  • Written By: Boulder Community Health
Dr. Blois: 'Tired, Breathless? Heart Failure Could be the Culprit'
Heart failure is a frighteningly common but sometimes overlooked life-threatening condition that occurs when your heart becomes too weak to pump blood to the rest of your body.

"Heart failure tends to make you feel tired all the time and short of breath, so many people dismiss these symptoms, thinking they are signs of 'just getting old.' Other times it is wrongly attributed to asthma, pneumonia, upper respiratory infection or depression,” BCH heart failure specialist Scott Blois, MD, said during a free health lecture on recognizing and treating heart failure.

"Although the symptoms of heart failure can be very subtle, it's dangerous to ignore them," he said.

Heart failure can lead to serious complications, including kidney damage, heart valve problems, abnormal heartbeat (arrhythmia) and liver damage. Up to half of those who develop heart failure die within five years of diagnosis, if not put on appropriate therapies. Early diagnosis offers the best response to treatment and a better prognosis.


VIDEO: Watch Dr. Blois' lecture on Recognizing and Treating Heart Failure

FACES of heart failure
There are about five million cases of symptomatic heart failure in the U.S., yet many people with this condition don't know they have it. To help quickly spot symptoms of heart failure, Dr. Blois shared a handy tool that goes by the acronym FACES.
F = Fatigue
A = Activities limited
C = Chest congestion
E = Edema or ankle swelling
S = Shortness of breath

Any one sign may not be cause for alarm. But if you have any of these symptoms and they persist despite initial treatment, Dr. Blois said to report them to a health care professional and ask for a heart evaluation that includes a chest x-ray, an echocardiogram — the most important test to evaluate and confirm heart failure — and the B-type natiuretic peptide (BNP) level blood test. Results of these tests can help your doctor determine the cause of your signs and symptoms and the most appropriate treatment.

Causes and risk factors
Dr. Blois said that currently an estimated 1 in 5 people will develop heart failure in their lifetime. It's caused by current and past medical conditions that either damage or weaken the heart:

  • uncontrolled high blood pressure (hypertension)
  • past heart attack
  • coronary artery disease
  • heart valve disease
  • diabetes
  • alcohol dependence

One of these risk factors can be enough to cause heart failure, but a combination of factors greatly increases your risk.

There are other causes of heart failure such as chemotherapy and different types of infection. Talk to your health care provider about your risk for heart failure.

Types of heart failure
There are two types of heart failure: systolic and diastolic.

With systolic heart failure, your heart's left ventricle, which pumps most of the blood, has become weak and doesn't pump blood out to the body as well as normal. "Ejection fraction is a measurement of the amount of blood that your heart pumps each time it beats. A person who doesn't have heart problems usually pumps around 50 to 70% of the blood from the left ventricle out into the body. If the left ventricle can't pump out more than 40% of the blood on each heartbeat, that's called systolic heart failure," Dr. Blois explained.

If you have diastolic heart failure, your heart's left ventricle has become stiffer than normal and can't relax the way it should. "The heart's left ventricle is actually strong and pumping, but it's thickened and not relaxing. On each heartbeat your heart needs a second for it to relax and fill up with blood before it pumps blood out," Dr. Blois stated. "With diastolic heart failure, the heart ventricle has gotten stiff and doesn't relax well, causing blood to back up. This type of heart failure is very common in somebody who has long-standing high blood pressure or an arrhythmia called atrial fibrillation, though not all people that have atrial fibrillation have heart failure."

Risk of heart failure and COVID-19
"We know that a heart failure patient has a much higher risk of severe disease if they get COVID-19," stated Dr. Blois. "Early data showed that for the initial strains of the virus, there was a one percent chance of mortality for someone who really had no health problems. However, according to this early data, patients with chronic heart failure who had gotten COVID infection, had a 10% mortality in registries. So we really make sure our heart failure patients are getting their COVID-19 vaccines and boosters."

Treatment options
Doctors usually treat heart failure with a combination of medications. You may also need to take other heart medications as well — such as diuretics for shortness of breath or leg swelling — along with heart failure medications.

According to Dr. Blois, following recommendations for lifestyle modification can help slow the disease’s progression, improve symptoms and decrease the risk of serious complications. These include:

  • managing blood pressure
  • limiting fluid intake (limit to 6 to 8 glasses of total fluid per day)
  • limiting salt intake (limit to 1800 mg per day of sodium)
  • engaging in moderate exercise (3 to 4 times per week for 30 minutes each session has survival benefit in heart failure)
  • adhering to your medication regimen
  • avoiding regular use of NSAIDs
  • cutting back on heavy alcohol use and smoking
  • immunizing for the yearly flu and pneumonia

NEW medications for diastolic heart failure
"In the past, there wasn't really any clear medications for diastolic heart failure besides those that help get blood pressure under control. But now there's a lot of exciting recent studies that show SLGTs inhibitors, ARNI agents and mineral corticoid antagonists are helpful for diastolic heart failure," said Dr. Blois. 

Advanced therapies for heart failure
"Fortunately, the increase in heart failure patients has inspired researchers to look for new ways to treat it and delay its progression. Many new medications, pacemakers, defibrillators and surgical procedures have been developed that can strengthen the heart muscle and make heart failure a chronic, yet tolerable disease,” Dr. Blois added.

He stated that even more advancements are underway and will become available in the not-to-distant future, including:

  • genomic testing to determine which medications may work best for you
  • stem cell replacement in the heart via surgical injection
  • gene replacement to grow new muscle cells in the heart
  • surgical mechanical heart pumps (VADs) with superior materials

As he wrapped up his lecture, Dr. Blois made a critical point about where to go for care.

“If you have heart failure, it’s important to go to a specialized heart failure clinic, like the Heart Failure Clinic we have at Boulder Heart,” he said. “We can offer the latest treatment options for managing the condition and the best chance of maintaining a good quality of life.”

Dr. Scott Blois established the first heart failure clinic in Boulder County. Appointments are available by calling Boulder Heart at 303-442-2395.

Click here to view/download a PDF of slides shown during Dr. Blois' lecture on "Recognizing and treating heart failure." 

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