Heart Failure Daniel E. van Buren, M.D. New England Heart Institute Androcsoggin Valley Hosptital

How Many People Have Heart Failure? Heart failure is very common It is the number one reason why people are admitted into hospitals in the U.S. Heart failure effects nearly 5 million Americans An estimated 400,000 to 700,000 new cases are diagnosed each year

Heart Failure What is Heart Failure?

Heart Failure Does NOT mean… Your heart has stopped working Your heart is about to stop working You have had a heart attack

Heart Failure What is Heart Failure? The heart is not pumping as well as it should Usually, the heart has been weakened by an underlying condition Blocked arteries Heart attack High blood pressure Diabetes Infections Heart valve abnormalities

Heart Failure What is Heart Failure? Heart failure can involve the left or right side of the heart or both Usually the left side is affected first Heart failure occurs when either side of the heart cannot keep up with the flow of blood

Heart Failure What is Left Heart Failure? Involves the left ventricle (lower chamber) of the heart Systolic failure The heart looses it’s ability to contract or pump blood into the circulation Diastolic failure The heart looses it’s ability to relax because it becomes stiff Heart cannot fill properly between each beat and less blood in means less blood out.

Heart Failure What is Left Heart Failure? In both types, blood may “back up” in the lungs causing fluid to leak into the lungs (pulmonary edema) Fluid may also build up in tissues throughout the body (edema)

Heart Failure What is Right Heart Failure? Usually occurs as a result of left heart failure The right ventricle pumps blood to the lungs for oxygen Occasionally isolated right heart failure can occur due to lung disease or blood clots to the lung (pulmonary embolism)

Heart Failure How fast does heart failure develop? Usually a chronic disease The heart tries to compensate for the loss in pumping function by: Developing more muscle mass Enlarging Pumping faster

Heart Failure What Causes Heart Failure? Health conditions that either damage the heart or make it work too hard Coronary artery disease Heart attack High blood pressure Abnormal heart valves Heart muscle diseases (cardiomyopathy) Heart inflammation (myocarditis)

Heart Failure What Causes Heart Failure? Congenital heart defects Severe lung disease Diabetes Severe anemia Overactive thyroid gland (hyperthyroidism) Abnormal heart rhythms

Heart Failure What Causes Heart Failure? Coronary artery disease                             What Causes Heart Failure? Coronary artery disease Cholesterol and fatty deposits build up in the heart’s arteries Less blood and oxygen reach the heart muscle This causes the heart to work harder and occasionally damages the heart muscle

Heart Failure What Causes Heart Failure? Heart attack                             What Causes Heart Failure? Heart attack An artery supplying blood to the heart becomes blocked Loss of oxygen and nutrients damages heart muscle tissue causing it to die Remaining healthy heart muscle must pump harder to keep up

Heart Failure What Causes Heart Failure? High blood pressure Uncontrolled high blood pressure doubles a persons risk of developing heart failure Heart must pump harder to keep blood circulating Over time, chamber first thickens, then gets larger and weaker                            

Heart Failure What Causes Heart Failure? Abnormal heart valves Heart muscle disease Damage to heart muscle due to drugs, alcohol or infections Congenital heart disease Severe lung disease                            

Heart Failure What Causes Heart Failure? Diabetes Tend to have other conditions that make the heart work harder Obesity Hypertension High cholesterol                            

Heart Failure What Causes Heart Failure? Severe anemia Hyperthyroidism Not enough red blood cells to carry oxygen Heart beats faster and can become overtaxed with the effort Hyperthyroidism Body metabolism is increased and overworks the heart Abnormal Heart Rhythm If the heart beats too fast, too slow or irregular it may not be able to pump enough blood to the body                                                               

What Are The Symptoms of Heart Failure? Think FACES… Fatigue Activities limited Chest congestion Edema Shortness of breath

Heart Failure Signs and Symptoms of Heart Failure Shortness of Breath (dyspnea) WHY? Blood “backs up” in the pulmonary veins because the heart can’t keep up with the supply an fluid leaks into the lungs SYMPTOMS Dyspnea on exertion or at rest Difficulty breathing when lying flat Waking up short of breath                            

Heart Failure Signs and Symptoms of Heart Failure Persistent Cough or Wheezing WHY? Fluid “backs up” in the lungs SYMPTOMS Coughing that produces white or pink blood-tinged sputum                            

Heart Failure Signs and Symptoms of Heart Failure Edema WHY? SYMPTOMS Decreased blood flow out of the weak heart Blood returning to the heart from the veins “backs up” causing fluid to build up in tissues SYMPTOMS Swelling in feet, ankles, legs or abdomen Weight gain                            

Heart Failure Signs and Symptoms of Heart Failure Tiredness, fatigue WHY? Heart can’t pump enough blood to meet needs of bodies tissues Body diverts blood away from less vital organs (muscles in limbs) and sends it to the heart and brain SYMPTOMS Constant tired feeling Difficulty with everyday activities                            

Heart Failure Signs and Symptoms of Heart Failure Lack of appetite/ Nausea WHY? Blood backs up causing swelling of the digestive tract The digestive system receives less blood causing problems with digestion SYMPTOMS Feeling of being full or sick to your stomach                            

Heart Failure Signs and Symptoms of Heart Failure Confusion/ Impaired thinking WHY? Changing levels of substances in the blood ( sodium) can cause confusion SYMPTOMS Cognitive slowing Memory loss or feeling of disorientation Relative or caregiver may notice this first                            

Heart Failure Signs and Symptoms of Heart Failure Increased heart rate WHY? The heart beats faster to “make up for” the loss in pumping function SYMPTOMS Heart palpitations May feel like the heart is racing or throbbing                            

Your Doctor May Run These Tests… Electrocardiogram (“EKG” or “ECG”) Echocardiogram (“Echo”) Chest x-ray Cardiac Catheterization (“Cath”)

What is Ejection Fraction (“EF”)?

Heart Failure Treatment Options The more common forms of heart failure cannot be cured, but can be treated Lifestyle changes Medications Surgery and device implantations                            

Heart Failure New York Heart Association (NYHA) Functional Classification                             Class % of patients Symptoms I 35% No symptoms or limitations in ordinary physical activity II Mild symptoms and slight limitation during ordinary activity III 25% Marked limitation in activity even during minimal activity. Comfortable only at rest IV 5% Severe limitation. Experiences symptoms even at rest

Heart Failure Lifestyle changes Stop smoking Loose weight Avoid alcohol Avoid or limit caffeine Eat a low-fat, low-sodium diet Exercise                            

Heart Failure Lifestyle changes Reduce stress Keep track of symptoms and weight and report any changes or concern to the doctor Limit fluid intake See the doctor more frequently                            

Heart Failure Medications used to treat Heart Failure ACE Inhibitors Cornerstone of heart failure therapy Proven to slow the progression of heart failure Vasodilator – cause blood vessels to expand lowering blood pressure and the hearts work load Directly inhibit “remodeling” Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality                            

Heart Failure Medications used to treat Heart Failure Beta-blockers Lower the heart rate and blood pressure Decrease the workload of the heart Inhibit “remodeling” Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality                            

Heart Failure Medications used to treat Heart Failure Aldosterone antagonists Alters hormones that are damaging to the heart Given for advanced heart failure Inhibit “remodeling” Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality                            

Heart Failure Medications used to treat Heart Failure Vasodilators Cause blood vessel walls to relax Occasionally used if patient cannot tolerate ACE inhibitors Decrease workload of the heart                            

Heart Failure Medications used to treat Heart Failure Diuretics (water pills) Prescribed for fluid build up, swelling or edema Cause kidneys to remove more sodium and water from the bloodstream Decreases workload of the heart and edema Fine balance – removing too much fluid can strain kidneys or cause low blood pressure Improves symptoms and reduces hospitalizations                            

Heart Failure Medications used to treat Heart Failure Digitalis preparations Increases the force of the hearts contractions Relieves symptoms Slows heart rate and certain irregular heart beats Improves symptoms and reduces hospitalizations                            

Heart Failure Medications used to treat Heart Failure Potassium Most diuretics remove potassium from the body Potassium pills compensate for the amount lost in the urine Potassium helps control heart rhythm and is essential for the normal work of the nervous system and muscles                            

Heart Failure Treatment options Surgery and other Medical Procedures Coronary artery bypass Angioplasty Valve replacement Automated Implantable Cardioverter-Defibrillator (AICD) Biventricular pacemaker (BiV or CRT) Left ventricular assist device Heart transplant                            

AICD

AICD Monitors heart rhythm Shocks to reset rhythm Can be interrogated Does not alter symptoms

Biventricular Pacemaker Reserved for patients with symptoms despite optimal medical therapy Conduction disease Improves symptoms Reduces mortality

Left Ventricular Assist Device

LVAD Reserved for patients awaiting transplant and for patients with continued severe symptoms despite optimal therapy

Is There a Cure for Heart Failure? No, currently there is no cure But, early diagnosis and proper treatment can: Slow the progression of disease Keep you out of the hospital Save your life

Can a Person Live with Heart Failure? YES! See your physician regularly Limit your salt intake Weigh yourself each day Take your medications Exercise at levels recommended by your physician

For More Information About Heart Failure Visit “The Heart Failure Society of America” Individuals – www.abouthf.org Health Care Professionals – www.hfsa.org

Thank You!