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

How Many People HaveHeart 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• 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• 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

• 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?

– 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 35% 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

AICDMonitors 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

LVADReserved 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!