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Tuesday, Feb. 20, 2024

Heart Failure


The most common types of heart disease

Have you ever had a family member or friend say, “I’m getting old, and I can’t keep up; I need to rest,” or “I don’t know why my weight keeps going up, and my legs swell,” or perhaps “I sure am dizzy lately? “If so, did you think, “they may have a heart problem and need to see their doctor?”

Heart disease is the leading cause of death and disability in the United States. It affects men, women, and people of all racial and ethnic groups, with one person dying every 33 seconds from cardiovascular disease. We are two times more likely to be affected in Northern Louisiana than the rest of the US as more of us have medical problems, social situations, and lifestyle choices that place us at greater risk, including diabetes, hypertension, being overweight, not being physically active, smoking and consuming excessive alcohol.

The most common type of heart disease that accounts for one in eight deaths in the US is heart failure, which means that the heart cannot push enough blood out to the body to allow the muscles and organs to work correctly at rest or with exercise resulting in fatigue or shortness of breath. If the heart does not allow the blood to return to the heart, you can have swelling in the legs and tummy. If the extra fluid accumulates in the lungs, you might have coughing episodes when you lay down or exert yourself. Another symptom can be irregular heartbeats, most commonly due to atrial fibrillation.

These symptoms are related to which parts of the heart are affected. The heart has four “rooms” or chambers. The two on the top of the heart are termed atria, one for the right and one for the left. There are also two chambers on the bottom called ventricles. Blood flows back to the heart into the right atrium into the right ventricle, which pumps it into the lungs, where oxygen is replenished. From the lungs, it flows into the left atrium into the left ventricle, which delivers blood to the body’s organs and muscles.

There are four main types of heart failure.

A weak heart results in a decrease in the pumping function, most often determined by a heart ultrasound test of the amount of blood that is ejected. This is termed heart failure due to reduced ejection fraction and may be abbreviated as HFrEF.

A stiff heart that will not allow blood to completely empty from the lungs. This most often results in shortness of breath, easy fatigue, and atrial fibrillation. This is called HFpEF, as the ejection fraction number is normal or preserved.

Narrowing or leakage of heart valves, most commonly the aortic valve, which allows blood to flow out of the left ventricle into the body, or the mitral valve, which allows blood to flow from the lungs into the left ventricle.

Abnormal material (amyloid) accumulates in the heart muscle cells, interfering with cell contraction.

The most common forms of heart failure are a weak heart with decreased heart pumping (HFrEF) and a stiff heart (HFpEF), each accounting for about 45% of heart failure cases.

Diagnosing heart failure is most often done during an outpatient visit to your doctor, who will examine you and perform blood tests to evaluate the electrolytes, the oxygen level, and most importantly, imaging tests of your heart to determine the size, structure, and function of your heart muscle and heart valves. Using this information, your doctor can assist in determining how you should be treated and if you would benefit from being referred to doctors specializing in treating heart failure patients.

In the setting of a weak heart that does not deliver enough blood to the body, it can compensate by beating faster to increase the total amount of blood flow, or it can enlarge, which increases how much blood is ejected with each beat, or it can increase the size or number of the heart muscle cells to increase the strength of contraction.

Treatment of a weak heart includes lifestyle changes treating any underlying condition such as hypertension, artery blockages, and diabetes, along with specialized medications that improve heart function. If you have a heart valve problem that weakens your heart, you should see a heart valve specialist who may be able to repair your valve and strengthen your heart. Some patients may progress to the point that they require a special pacemaker to improve heart contraction (resynchronization) or even an implantable heart pump (LVAD). A small number of patients may even need a heart transplant.

Treating a stiff heart also involves lifestyle modification and treatment of any other medical conditions. These individuals may also benefit from some of the medications used to treat weak hearts. As many have atrial fibrillation, special attention is paid to trying to establish a normal heart rhythm or control the heart rate. New investigational treatments that shunt a small amount of blood from the top left chamber to the top are showing promise. More information about this treatment can be found at treatmyheartfailure.com.

For those patients with this rare form of heart failure who are found to have heart muscle infiltration with amyloid, it is important to determine the type of amyloid and what involvement is present in the body. A heart failure specialist can guide patients about when new medications treat specific types of amyloid heart disease that cause heart failure may be useful.

This is Love Your Heart Month. Heart failure is common and often not recognized early when it is the most treatable. If you or a loved one has unexpected fatigue, shortness of breath, swelling, exercise-associated cough, dizziness, or trouble sleeping due to feeling short of breath, see your healthcare provider to evaluate your heart so we can all live better longer.

Steven Bailey, MD MACP, MSCAI, FAHA, FACC, is a cardiologist, professor of medicine, and principal investigator for “CORVIA Trial” at LSU Health Shreveport.


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