"Tired, breathless? Heart failure could be the culprit."
- Category: General, Cardiology
- Posted On:
- Written By: Boulder Community Health
About 6.2 million Americans suffer from heart failure, and about one in five people will develop the condition in their lifetime. Heart failure is a serious condition that occurs when the heart becomes too weak to pump blood to the rest of your body.
"Many are unaware they have this potentially fatal heart condition because some of the most common symptoms — such as shortness of breath and fatigue — are often dismissed, 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, of Boulder Heart said in a recent free online health lecture on recognizing and treating heart failure.
Although the symptoms of heart failure can be very subtle, it's dangerous to ignore them. It can lead to serious complications, including kidney damage, heart valve problems, abnormal heartbeat (arrhythmia) and liver damage.
“Fortunately, about 80% of patients in a heart failure clinic can be stabilized and will get better with prescribed medication,” Dr. Blois said. "With early detection the heart can grow stronger, and you will have a much better chance of recovering from this chronic disease.”
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Watch Recognizing and Treating Heart Failure
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The FACES of heart failure
It’s very important to diagnose heart failure early for the best outcome as Dr. Blois' co-presenter Liana Quinn, PA, also of Boulder Heart, explained. To help quickly spot symptoms of heart failure, Liana shared a handy tool that goes by the acronym FACES.
- Fatigue—this happens mostly with exertion but can occur at rest.
- Activities limited—may be as simple as you notice that you can no longer use the stairs.
- Chest congestion—you detect fluid buildup occurring in your lungs, a cough and/or chest congestion.
- Edema/ankle swelling—fluid buildup is occurring in your legs and ankles and/or you’re experiencing weight gain.
- Shortness of breath—mostly with exertion but can occur at rest, especially at night when you’re lying flat, and you find you need to sit up to breathe.
Liana explained that heart failure can be misdiagnosed and mistaken for other diseases such as:
- Asthma
- Pneumonia
- Upper respiratory infection
- Depression and tiredness especially in the elderly
Causes and risk factors
Current and past medical conditions that either damage or weaken the heart can cause heart failure:
- 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.
Diagnosing heart failure
“When a patient arrives at our heart failure clinic—and we are concerned they may be experiencing heart failure—we will administer preliminary tests to understand their condition,” Liana explained, “We usually start with the electrocardiogram (ECG).”
- Electrocardiogram—the most important test to evaluate and confirm heart failure. It can indicate if there’s a thickening of the heart muscle, if the heart’s conduction system has slowed or if there’s evidence of a previous heart attack.
- Labs—are used to assess anemia, kidney, liver and thyroid function as a cause of heart failure.
- Chest x-ray—is used to identify if any fluid is in the heart that’s causing congestion or a cough.
- Echocardiogram—uses ultrasound technology to evaluate and measure how well your heart is pumping.
- B-type natiuretic peptide (BNP)—is a blood test that indicates if there has been abnormal strain on the heart. This test is a very important part of the heart failure diagnosis.
Follow-up tests
Liana explained, “Follow-up testing is recommended if someone is diagnosed with heart failure so that we can create a treatment plan.” These tests include:
- Heart catheterization, a coronary angiogram—evaluates cholesterol blockages of the heart arteries and takes pressure readings in the heart to understand your blood flow. This test enables your providers to see if there’s plaque compromising blood flow.
- MRI of the heart—creates detailed images to detect and monitor any cardiac disease that’s present.
- Stress test—checks your heart while you exercise on a treadmill to make your heart work progressively harder. Providers can assess how your heart reacts under stress.
- Labs and genetic testing—may be ordered to get a complete understanding of your heart’s health.
Diastolic vs. systolic heart failure
“Once we know heart failure has occurred,” said Dr. Blois, “there are two types of heart failure to consider: diastolic and systolic.”
- Diastolic heart failure - If you have diastolic heart failure, your heart's left ventricle has become stiffer than normal and can't relax between heart beats. "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 who have atrial fibrillation have heart failure."
New drugs are available to help with diastolic dysfunction. “However, we first want to treat the underlying cause. For instance,” said Dr. Blois, “for AFib we would want to slow down the heart rate and get it back to normal.”
- Systolic heart failure - 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.
“With the use of modern medications, 60% to 70% of those with systolic heart disease will experience their heart growing stronger.” Dr. Blois added, “While it’s a chronic disease that you will live with, it’s a very treatable disease.”
Treatment options
There’s no cure for heart failure. The goal of treatment is to slow down its progression.
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.
Dr. Blois said, “I would estimate that at least a third of patients experiencing heart failure will eventually need to have a pacemaker or defibrillator implanted. These devices use electrical pulses that prompt the heart to beat at a normal rate.”
Following recommendations about eating patterns, exercise and other habits can help alleviate heart failure symptoms, slow your disease’s progression and decrease the risk of serious complications:
- maintaining a healthy weight
- 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
“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.”
Click here to view/download a PDF of slides shown during the lecture.
Make an Appointment
Scott Blois, MD established the first heart failure clinic in Boulder County. To make an appointment with him or Liana Quinn, PA, call Boulder Heart at Anderson Medical Center at 720-443-0163.
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