Atrial Fibrillation

Heart failure doesn’t mean the heart is about to stop. It means your heart is not pumping blood as effectively as it should. This causes blood to back up in the blood vessels around the lungs, leading to fluid buildup and difficulty breathing. Many people with heart failure also experience swelling in their legs and feet, known as edema. This is why it’s often called “congestive heart failure.” Although serious, heart failure can be managed with proper treatment, medications, and lifestyle changes, allowing many patients to live fulfilling lives.

Warning Signs and Symptoms of Heart Failure

• Shortness of Breath (SOB): Can occur with activity, at rest, or while sleeping. SOB happens because the heart can’t pump enough blood, leading to fluid buildup in the lungs.
• Persistent Cough or Wheezing: Caused by fluid in the lungs.
• Swelling in Legs, Feet, or Abdomen: Blood flow from the heart slows down, causing fluid to accumulate in the tissues.
• Sudden Weight Gain: Often due to fluid retention.
• Fatigue and Tiredness: The weakened heart muscle struggles to pump blood efficiently, causing reduced energy levels.
• Lack of Appetite and Nausea: A result of reduced blood flow to the digestive system or fluid buildup in the stomach or liver.
• Rapid or Irregular Heartbeat (Arrhythmias): Feeling a racing or fluttering heartbeat due to a weakened heart muscle.

Common Causes of Heart Failure

• Heart Attacks
• High Blood Pressure (Hypertension)
• Heart Valve Disease
• Heart Muscle Disease or Inflammation
• Congenital Heart Disease (heart defects from birth)
• Severe Lung Disease
• Diabetes
• Sleep Apnea

Prevention & Treatment of Heart Failure

• Managing Risk Factors: Controlling high blood pressure, diabetes, and other underlying conditions can help prevent heart failure.
• Healthy Lifestyle Changes: A balanced diet and regular exercise are essential.
• Medications: Following a medication regimen can help improve heart function and reduce symptoms.
• Implantable Devices: Some patients may benefit from pacemakers or defibrillators to regulate heart rhythm.
• Surgical Procedures: In some cases, surgery may be needed to correct heart valve issues or blocked arteries.

Evaluation of Heart Failure

• Symptoms Assessment: Monitoring SOB, fatigue, swelling, and weight gain.
• Volume Status: Checking for fluid buildup in the legs, abdomen, and lungs.
• Activity Level: Evaluated using the New York Heart Association (NYHA) classification.
• Diagnostic Tools:
  • Electrocardiogram (EKG): To detect heart attacks or arrhythmias.
  • Chest X-ray: To check for fluid in the lungs or heart enlargement.
  • B-type Natriuretic Peptide (BNP): A blood test that helps diagnose heart failure.
  • Echocardiogram: Assesses heart muscle, valve function, and blood flow.
  • Coronary Angiogram: Checks for blockages in the coronary arteries.

Self-Monitoring and Treatment Plan

• Medication Adherence: Take prescribed medications regularly to reduce symptoms and improve survival.
• Daily Weighing: Weigh yourself every morning, after using the bathroom, on the same scale. Notify your doctor if you gain more than 2–3 pounds overnight or 5 pounds in a week.
• Fluid Restriction: Limit fluid intake (usually less than 1800 mL per day) to prevent fluid buildup.
• Reducing Salt Intake: Limit salt to 2000–4000 mg per day to prevent fluid retention.
• Regular Exercise: Gradually increase your exercise to 30–45 minutes a day, five times a week, with doctor approval.
• Smoking Cessation: Quitting smoking is essential for heart health.

Heart Failure Medications

• Beta Blockers: Improve heart pumping, regulate heart rhythm, lower blood pressure, and reduce hospital admissions.
• Entresto® (Sacubitril/Valsartan): Reduces the risk of cardiovascular death and hospitalizations.
• SGLT2 Inhibitors: Improves heart failure symptoms and reduces hospitalization.
• Verquvo® (Vericiguat): Improves blood vessel function, reducing hospitalization and cardiovascular death risk.
• ACE Inhibitors: Help lower blood pressure and decrease strain on the heart.
• ARBs: Used when ACE inhibitors are not tolerated.
• Diuretics (Water Pills): Remove excess fluid to reduce swelling.
• Aldosterone Antagonists: Improve survival and reduce hospital admissions.
• Digoxin: Strengthens heart contractions and reduces hospitalizations in some patients.
• Corlanor® (Ivabradine): Reduces the risk of hospitalization for stable chronic heart failure.

Advanced Monitoring Systems for Heart Failure

• CardioMEMS: A small, implantable device placed in the pulmonary artery to monitor heart pressure in real time.
• Pleural Fluid Home Monitoring System: Monitors fluid buildup in the lungs, enabling early intervention to prevent hospitalizations.

Advanced Heart Failure Treatments

• Implantable Cardioverter Defibrillators (ICD): A device implanted to monitor heart rhythm and deliver shocks if dangerous rhythms are detected.
• Cardiac Resynchronization Therapy (CRT): A pacemaker that helps synchronize the heart’s chambers.
• Left Ventricular Assist Device (LVAD): A mechanical pump to assist the heart in patients awaiting a transplant.