Specialities: Heart failure, cardiomyopathy, cardiac transplantation and mechanical circulatory support devices
Hello. My name is Dr. Randall Starling. I am the section head for heart failure here at the Sydell and Arnold Miller Family Heart & Vascular Institute. I’d like to talk to you today about medical treatments for heart failure and address some of the commonly asked questions we hear from our patients.
Heart failure can be frightening, but it doesn’t mean your heart has stopped working. Heart failure results when muscles of the heart are weaker than normal, or the lower chambers of the heart cannot relax and fill with blood like they normally do. Basically, the heart isn’t pumping blood like it’s supposed to. Therefore, the heart works harder to do its job, pumping blood to your organs and tissues and putting the muscle under quite a bit of stress. Over time, the heart muscle walls weaken and/or stiffen.
Heart failure is frequently results from past heat attack, untreated high blood pressure, diabetes, sleep apnea, abnormal heart valves and various forms of heart muscle disease. Essentially, wear-and-tear on the heart muscle weakens it and causes heart failure.
The good news: heart failure can be managed, and there are lots of options for patients who are diagnosed with this condition.
First, let’s identify the two types of heart failure. Systolic heart failure is when the left ventricle heart muscle doesn’t contract with enough force, so less blood is pumped throughout the body. It is generally associated with an enlarged, weak heart. Diastolic heart failure is when the heart contracts normally, but ventricles do not relax or are stiff, so less blood enters the heart.
To determine the best treatment for you, a doctor will perform a test called ejection fraction, referred to as EF. This test measures how well your heart pumps with each beat. EF can be measured in your doctor’s office with an echocardiogram (which is an ultrasound of the heart), MRI scan of the heart, nuclear stress test, or cardiac catheterization.
A normal heart pumps a little more than half the heart’s blood volume with each beat and the EF is over 50 percent. An EF of 35 to 40 percent may confirm a diagnosis of systolic heart failure. Someone with diastolic failure can have a completely normal EF. Meanwhile, an EF of less than 35 percent is a red-flag for potential sudden cardiac arrest, which is loss of heart function due to a life threatening abnormal heart rhythm. Of course, these are worst-case scenarios. You should have your EF measured when you are first diagnosed with a heart condition, and again as needed. Your doctor will recommend how often to get your EF checked. Your EF can go up and down based on your heart condition and therapies your doctor prescribes.
Aside from these tests, how will you know if you have heart failure? There are some signs to look for including: shortness of breath; persistent coughing or wheezing; swelling in the feet, legs, ankles or abdomen, or weight gain; fatigue and difficulty carrying out everyday activities like shopping or climbing stairs; lack of appetite or nausea; confusing or impaired thinking; and increased heart rate. If you experience one or more of these symptoms, see a doctor.
As for therapies, Cleveland Clinic physicians medically manage heart failure patients with state-of-the-art medications that help slow the disease’s progression, keep patients out of the hospital, and reduce morality. We’re continually researching new drugs and treatment options.
Generally, doctors will use a combination of medications to address heart failure. The most common of these include: angiotensin-converting enzyme, or ACE inhibitors, which widen blood vessels and lower blood pressure to improve blood flow so the heart doesn’t have to work so hard. Angiotensin II receptor blockers, or ARBs are an alternative for those who can’t tolerate ACE inhibitors. Digoxin, also referred to as digitalis, increases the strength of heart muscle contractions and reduces heart failure symptoms. Beta blockers slow heart rate and reduce blood pressure. They can also reduce some abnormal heart rhythms; beta blockers can help strengthen the heart. Diuretics can prevent water from collecting in the body.
There are stem cell trials at the Cleveland Clinic for heart failure patients with enlarged hearts and reduced EF (systolic heart failure). Our hope is that stem cell therapies will improve EF or heart muscle pumping strength and improve symptoms.
Now, you may be wondering whether you should get genetic testing for heart failure if the condition runs in the family. Approximately 1 in 5 patients with heart failure have a positive family history of heart failure. That’s why doctors take time to gather a detailed family history so they can make an informed decision about necessary screenings, which typically include an exam, echocardiograph (ECG) and echocardiogram.
If you are diagnosed with heart failure, you can get better and improve your quality of life. There is no cure, but the condition can be managed. Take your medications as directed and see your doctor regularly. Often a cause is identified that can be treated and make a huge difference. Make important lifestyle changes such as exercising, reducing salt in your diet, managing stress, treating depression, quitting smoking, managing “bad” cholesterol and maintaining a healthy blood pressure. These healthy behaviors in combination with medical treatments recommended by your doctor can improve your symptoms and help your heart work more efficiently. Thank you.
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