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What you should know about heart failure

  • Dr. Serena Day of the Concord Hospital Cardiovascular Institute —Courtesy

Concord Hospital
Published: 8/22/2021 2:00:11 PM

Here is an explanation of heart failure, a serious condition affecting over six million Americans.

What is heart failure? 

Heart failure is simply when the heart, due to various reasons, is unable to function as well as it should. It is mainly a clinical diagnosis based upon physician findings on exam. In fact, there is only one diagnostic lab test; a blood test measuring the levels of a protein the heart makes called brain natriuretic peptide (BNP).  

 What are the signs and symptoms?

The various patient-reported symptoms that could possibly indicate heart failure include shortness of breath, low appetite or trouble eating, swelling in the belly and/or legs, confusion, and a persistent cough.  Signs discovered by a physician upon examination that could lead to a heart failure diagnosis include crackles in the lungs, edema, jugular venous distension, gallops, confusion, skin cold to the touch, and low urine output. 

What are the different types of heart failure?

The two main types are heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Ejection fraction is how much blood is pumped out of the heart with each beat. A normal value for ejection fraction is around 60 percent. Less than 40 percent is considered reduced and greater than 50 percent, preserved. HFrEF occurs when the heart muscle can no longer pump well because it has becomes stretched out and flimsy or weak. HFpEF occurs when the heart muscle has stiffened, though it leads to the same signs and symptoms clinically. 

What causes heart failure? And whom does it affect?

In the United States, the most common cause for HFrEF is ischemic heart disease and the resulting heart attacks. Though heart failure, in general, affects men and women equally, this type affects predominantly men. Other causes can include toxins, such as chemotherapy or radiation, viruses, thyroid problems, atrial fibrillation, and genetic mutations. Although more common, HFpEF is less understood. It affects more women than men and is suspected to have inflammatory origins. Chronic inflammation can lead to scar tissue forming in the heart, stiffening it and inhibiting function. Risk factors include hypertension, diabetes, older age, and obesity. As with HFrEF, genetics may also play a role.

What are treatment options? 

Prevention is extremely important given that despite medical treatment, heart failure has a 50 percent mortality rate after five years. The American Heart Association suggests you manage your blood pressure and weight, eat a diet of whole foods consisting mostly of plants, drink lots of water, participate in physical activity, keep your cholesterol in check, do not smoke, and manage your blood sugars. 

Once a person is diagnosed with heart failure, treatment options depend on the type. There are numerous medications that can help HFrEF patients with symptoms and survival rates. Also, devices such as small internal defibrillators can help avoid rhythm problems and cardiac rehab can improve many symptoms. Unfortunately, there is only one medication available for patients with HFpEF and it only helps with symptoms, not survivability. For these patients, it comes down to treating their other underlying medical problems and managing symptoms. For those heart failure patients that do not respond to other treatment and management, they could be assessed for an L-VAD, which is a pump that connects to the heart, or even a heart transplant.

Dr. Serena Day of the Concord Hospital Cardiovascular Institute is a board-certified physician in internal medicine, cardiovascular disease, nuclear cardiology, and cardiovascular echocardiography. Dr. Day recently presented on heart failure at the July Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Day’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.

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