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Extending Quality of Life for Heart Failure Patients

February 04, 2022

Heart failure is exactly what it sounds like, when the body’s most important muscle doesn’t work properly. When the heart doesn’t pump blood effectively, fluid often backs up and can build up in the lungs, causing shortness of breath, or in the legs, causing swelling. This is commonly referred to as congestive heart failure, and it can be life-threatening.

Heart failure is a growing public health issue. As many as one in five people are expected to develop heart failure during their lifetime.

There are two pieces of good news, however. The first is by being proactive, and choosing a lifestyle conducive to good heart health, you can stave off heart failure later in life. If you’ve already racked up some bad choices, making changes to your lifestyle can help improve your health.

The key to preventing heart failure is to reduce your risk factors.

Lifestyle changes you can make to help prevent heart failure include:

• Not smoking.
• Controlling certain conditions, such as high blood pressure and diabetes.
• Staying physically active.
• Eating healthy foods.
• Maintaining a healthy weight.
• Reducing and managing stress.

The other good news is that there is emerging evidence that suggests drugs called sodium-glucose co-transporter-2 (SGLT‐2) inhibitors may be effective in prevention of heart failure in patients with (and without) comorbid type 2 diabetes (T2D). A recent meta‐analysis of three studies showed that SGLT‐2 inhibitors, as a class, reduced the risk of hospitalization with heart failure by 31 percent. Individuals with Type 2 diabetes often also have congestive heart failure.

Symptoms of Heart Failure

• Shortness of breath with activity or when lying down.
• Fatigue and weakness.
• Swelling in the legs, ankles and feet.
• Rapid or irregular heartbeat.
• Reduced ability to exercise.
• Persistent cough or wheezing with white or pink blood-tinged mucus.
• Swelling of the belly area (abdomen).
• Very rapid weight gain from fluid buildup.
• Nausea and lack of appetite.
• Difficulty concentrating or decreased alertness.
• Chest pain if heart failure is caused by a heart attack.

What It Means When Your Heart ‘Fails’

Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart’s main pumping chamber. It often develops after other conditions have damaged or weakened the heart.

In heart failure, the main pumping chambers of the heart (the ventricles) may become stiff and not fill properly between beats. In some people, the heart muscle may become damaged and weakened. The ventricles may stretch to the point that the heart can’t pump enough blood through the body.

Over time, the heart can no longer keep up with the typical demands placed on it to pump blood to the rest of the body.

Causes of Heart Failure

Coronary artery disease and heart attack. Coronary artery disease is the most common cause of heart failure. The disease results from the buildup of fatty deposits in the arteries, which reduces blood flow and can lead to heart attack. A heart attack occurs suddenly when a coronary artery becomes completely blocked. Damage to your heart muscle from a heart attack may mean that your heart can no longer pump as well as it should.

High blood pressure. High blood pressure means your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to properly pump blood.

Faulty heart valves. The valves of the heart keep blood flowing in the proper direction. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces the heart to work harder, which can weaken it over time.

Damage to the heart muscle. Heart muscle damage can have many causes, including certain diseases, infection, heavy alcohol use, and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy.

Inflammation of the heart muscle (myocarditis). Myocarditis is most commonly caused by a virus, including the COVID-19 virus, and can lead to left-sided heart failure.

Congenital heart defect. If your heart and its chambers or valves haven’t formed correctly, the healthy parts of your heart have to work harder to pump blood, which may lead to heart failure.

Abnormal heart rhythms (arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.

Other diseases. Diabetes, HIV, an overactive or underactive thyroid, or a buildup of iron or protein — also may contribute to chronic heart failure.

I Have Heart Failure. Now What?

Doctors have an array of tests they can use to diagnose heart failure. The American College of Cardiology/American Heart Association created a classification system for patients to help determine next steps:

• Stage A. There are several risk factors for heart failure but no signs or symptoms.
• Stage B. There is heart disease but no signs or symptoms of heart failure.
• Stage C. There is heart disease and signs or symptoms of heart failure.
• Stage D. Advanced heart failure requires specialized treatments.

There is a wide variety of medications doctors can choose from to treat heart failure, depending on symptoms. The majority of heart failure patients can be managed with medications and lifestyle modifications, but surgery or other procedures to implant cardiac devices may be recommended to treat the underlying problem that led to heart failure.

Surgery or other procedures for heart failure may include:

• Coronary bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it below and above the blocked arteries in your heart. The new pathway improves blood flow to your heart muscle.
• Heart valve repair or replacement. Surgeons can repair the valve by reconnecting valve flaps or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve.
• Implantable cardioverter-defibrillators (ICDs). An ICD is a device similar to a pacemaker and is used to prevent arrhythmia complications of heart failure. It’s implanted under the skin in your chest with wires leading through your veins and into your heart.
• Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren’t pumping in sync with each other. A device called a biventricular pacemaker sends electrical signals to the ventricles. The signals trigger your ventricles to contract in a more coordinated way, which improves the pumping of blood out of your heart. CRT may be used with an ICD.
• Ventricular assist devices (VADs). A VAD — also known as a mechanical circulatory support device — is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both ventricles of your heart, it is most frequently implanted in the left ventricle.
• Heart transplant. Some people have such severe heart failure that surgery or medications don’t help. A team of doctors at a transplant center will evaluate you to determine whether the procedure may be safe and beneficial for you.

Dr. Xingchen Mai, a Hartford HealthCare Heart & Vascular Institute cardiologist, is accepting new patients at 111 Salem Turnpike, Norwich. To schedule an appointment, call 860.886.0023.