Heart Failure

Many medical conditions can damage your heart muscle and cause heart failure. We specialize in treating all types, including:

• Heart failure with reduced ejection fraction (EF) or systolic heart failure.
• Heart failure with preserved ejection fraction (diastolic heart failure).
• Heart failure due to cancer therapies.
• Heart failure due to valve disease.
• Heart failure due to arrhythmias.
• Inherited (born with it) conditions that cause heart failure.

Sometimes, the signs of heart failure can be clear. You may feel tired or weak, or find it hard to catch your breath. Maybe you’ve noticed swelling (edema) in your legs, ankles and stomach. Or you might have a dry, hacking cough that won’t go away. Other times, you may only have mild symptoms or none at all.

Because heart failure typically gets worse over time, you may notice more symptoms as it moves from one stage into another. These stages include:

• Stage A: Pre-heart failure that flags you as high risk because of a family history or having certain medical conditions.
• Stage B: Pre-heart failure because your healthcare provider has diagnosed you with systolic left ventricular dysfunction, but you haven’t had heart failure symptoms.
• Stage C: You’ve had symptoms and have been diagnosed with heart failure.
• Stage D: Your symptoms have gotten worse (advanced) and aren’t getting better with treatment. This is the final stage of heart failure.

What to expect at your first visit

Hearing you may have heart failure can be unsettling. But we want you to feel comfortable moving forward with the next steps. So, when you come see us for the first time, we’ll take some time to talk.

Your provider will ask what symptoms you have, when you first noticed them and if they’re getting worse. We’ll go over your medical history and ask if any family members also have heart disease.

Then you’ll have a physical exam. Your provider will look for signs of heart failure and other conditions that could affect your heart. You may also have tests that use some of the most advanced technology. You could have:

• Blood tests.
• NT-pro B-type natriuretic peptide (BNP) blood test.
• Cardiac catheterization.
• Chest X-ray.
• Echocardiogram (Echo).
• Electrocardiogram (EKG or ECG).
• Magnetic resonance imaging (MRI).
• Multigated acquisition scan (MUGA scan).
• Stress test.

These tests check for things like ejection fraction (EF) to help us find out how severe your heart failure is. EF measures how well your heart is pumping blood. Understanding this can help us decide what treatment will work best for you.

Meet Our Heart Failure Team

When you come to Cleveland Clinic, you’ll benefit from our team-based approach to care. This means we handpick a team of providers from different specialties based on your unique needs and what’s causing your heart failure. A cardiologist will likely lead this team, but it could also include:

• Cardiothoracic surgeons.
• Radiologists.
• Anesthesiologists.
• Nurse practitioners.
• Physician assistants.
• Cardiac rehabilitation specialists.
• Transplant coordinators.
• Social workers.

Every heart failure diagnosis is unique. That’s why we work with you to craft a highly personalized treatment plan, focused on your stage and specific needs. You may have a variety of treatments in this plan.

Lifestyle changes

Eating healthy foods, exercising, staying at a weight that’s healthy for you and taking your medications as prescribed are all important. Doing these things can help keep your heart failure from getting worse and help you feel better. It might somewhat improve how your heart works.

You may need to make changes, like exercising regularly, stopping alcohol, tobacco and recreational drug use, and following a heart-healthy diet that’s low in salt (sodium). Cardiac rehab is a great way to get moving and make important lifestyle changes.

Medications

Heart failure medications can reduce your symptoms and slow or stop more damage. These drugs can also treat the underlying causes of your heart failure, like diabetes or kidney disease. They may also help you live a longer, healthier life and avoid having to go to the hospital.

Your providers make sure you take the right types and amounts of heart failure medications. Common ones are ACE inhibitors and beta-blockers. But there are other kinds you may need to take, depending on the stage of your heart failure and what’s causing it.

Remote monitoring

Depending on your diagnosis, your provider may decide to implant (place) a monitoring device (CardioMEMS™) in your body using a minimally invasive procedure.

This small (size of a paper clip) device keeps track of your heart rhythm and health and sends that information to a computer. It alerts your providers before you might even notice symptoms, so they can adjust your medications and keep you out of the hospital.

Electrical devices

If you have advanced heart failure, we may use an implantable cardiac device to keep your heart beating at a normal rhythm. Many of these devices have built-in features that help your providers keep track of your heart rhythm, your activity level and how well your heart is working.

Your provider will go over options, like:

• Implantable cardioverter defibrillators (ICDs) can track your heartbeats and prevent life-threatening abnormal heart rhythms.
• Cardiac resynchronization therapy (CRT), also known as biventricular pacing, can improve how your heart works. A pacemaker sends safe electrical pulses to your heart to keep it pumping.

Interventional management

Cleveland Clinic’s heart failure team can provide treatment without surgery (intervention). This is helpful if you’re at moderate-to-high risk for having surgery because of your heart’s health. Interventional treatments include:

• Transcatheter aortic valve replacement (TAVR) for treating aortic valve disease.
• MitraClip™ and transcatheter mitral valve replacement (TMVR) for treating mitral valve disease.
• Percutaneous coronary intervention (PCI), or coronary angioplasty, for treating complex coronary artery disease (CAD).

Surgery for heart failure

Surgery is an option if other treatments haven’t worked to control your heart failure. We use the latest advances in minimally invasive procedures when possible. This includes robotic-assisted surgery, percutaneous (through the skin) and endoscopic treatments and thoracoscopy. Some of these minimally invasive treatments include catheter ablation and coronary angioplasty and stent.

We can also use a left ventricular assist device (LVAD). This is a mechanical pump that your provider places at the bottom of your heart, inside your chest. It helps a weak left ventricle pump blood to your aorta and throughout your body. It’s often used as a “bridge” between treatment and a heart transplant. This treatment option can also help if you aren’t able to have a heart transplant. It’s sometimes called destination therapy. An LVAD can help your heart pump blood for the rest of your life. Your provider will let you know if an LVAD is right for you based on your current health, symptoms, body size and if you have any other medical conditions.

Our surgeons are pioneers in high-risk:

• Conventional heart surgery.
• Coronary artery bypass surgery (also known as CABG).
• Valve surgery.

And we’re leaders in using minimally invasive temporary assist pumps (mechanical circulatory support devices) as an alternative to a heart transplant or a VAD implant.

Heart transplant

Cleveland Clinic is also a leader in heart transplant surgery for severe heart failure. This surgery replaces a damaged heart with a healthy donor heart. You’ll need to meet specific requirements to qualify for this surgery. And you may need to wait a long time until a suitable donor heart is available.

After your transplant, you’ll need to have regular medical care for the rest of your life. The good news is that many people live for years, or even decades, after getting a new heart. Your care team will go over everything you need to know about this surgery if they feel this is the right option for you.

Taking the Next Step

Learning you have heart failure can leave you with a lot of questions. What does my future look like? Do I need surgery? Will I be OK? We’re here with the answers, support and personalized treatment you need — and deserve. Our experienced providers listen carefully and walk you through every step of your diagnosis, treatment, recovery and ongoing care. You can rest easy knowing you have a top care team on your side.