Beating the Odds: Living Well with Heart Failure

By Dr. Ahmed Shahzad, MD and Dr. Madeeha Subhan Waleed, MD | Cardiology Department, Lower Bucks Hospital

Heart failure is a complex condition that often confuses many. Contrary to the common misconception that it signifies the heart has stopped working, heart failure actually means that the heart is unable to pump blood effectively, leading to insufficient oxygen and nutrients for the body to function properly. In this discussion, I'll cover the essentials of heart failure, its prevention, management, and how to live well despite the condition.

Understanding Heart Failure

Heart failure occurs when the heart muscle becomes too weak to pump blood effectively, failing to meet the body's organ needs, which results in reduced oxygen and nutrient delivery. According to the Heart Failure Society of America, around 6.7 million people aged 20 and older in the U.S. live with heart failure. This number is projected to rise to 8.7 million by 2030 and reach 11.4 million by 2050. The lifetime risk of developing heart failure stands at approximately 24%, indicating that about 1 in 4 individuals will face this condition at some point. Hospitalization rates for heart failure have been increasing since 2014, with a temporary decline during the COVID-19 pandemic.

Types of Heart Failure

There are two primary categories:

1. Heart Failure with Reduced Ejection Fraction (HFrEF): The heart muscle is weakened, leading to a reduced amount of blood pumped to the body.
2. Heart Failure with Preserved Ejection Fraction (HFpEF): The heart muscle is stiff, preventing it from filling adequately, which also impairs blood flow.

In both types, there's a decrease in blood flow to organs, often leading to fluid retention in the lungs, legs, and other body parts.

Common Causes of Heart Failure

Heart failure typically develops over time due to various factors, including:

• Coronary Artery Disease: Blocked arteries reduce blood flow to the heart, weakening it over time.
• Hypertension (High Blood Pressure): Uncontrolled hypertension strains the heart, causing it to work harder and eventually weaken.
• Previous Heart Attack (Myocardial Infarction): Damage from a heart attack can leave scars that impair the heart's pumping ability.
• Diabetes Mellitus: High blood sugar levels can damage blood vessels, increasing heart failure risk.
• Smoking: Damages blood vessels, elevating the risk for coronary artery disease and heart failure.
• Heart Valve Disease: Damage to heart valves can strain the heart muscle.
• Arrhythmia: Irregular heartbeats can hinder efficient heart function.
• Substance Abuse: Chronic alcohol or drug use can contribute to heart failure.
• Infections, Genetic Conditions, and Thyroid Disorders can also play a role.

Symptoms to Watch For

Symptoms of heart failure may initially seem mild but can worsen over time. Key symptoms to monitor include:

• Shortness of Breath (Dyspnea): Occurs during activity or when lying flat, worsening with exertion.
• Fatigue and General Weakness: Especially noticeable with exertion.
• Swelling (Edema): Particularly in the feet, ankles, legs, or lower abdomen; may lead to sudden weight gain.
• Palpitations: Fluttering, rapid, or irregular heartbeat.
• Persistent Cough or Wheezing: Worsens when lying down.

If you or someone you know experiences these symptoms, it's crucial to consult a healthcare provider.

Diagnosing Heart Failure

Diagnosis typically involves a combination of patient history, physical examination, and specific tests, such as:

• Echocardiogram: An ultrasound of the heart to assess function and detect weakness.
• Electrocardiogram (EKG/ECG): Evaluates heart rhythm and checks for signs of damage.
• Chest X-ray: Identifies fluid buildup in the lungs or enlargement of the heart.
• Blood Tests: BNP or NT-proBNP tests help detect strain on the heart.
• Stress Tests or Cardiac Catheterization: May be used to evaluate coronary artery disease.

Treatment and Management of Heart Failure

While heart failure is a chronic condition, it can be managed effectively with medications and lifestyle adjustments. Key treatment strategies include:

Medications

• ACE Inhibitors / ARBs / ARNIs: Relax blood vessels and reduce strain on the heart.
• Beta Blockers: Slow heart rate and improve heart function.
• Diuretics: Help reduce fluid buildup and alleviate symptoms like shortness of breath.
• Mineralocorticoid Receptor Antagonists: Protect the heart and kidneys.
• SGLT2 Inhibitors: Offer benefits for both heart and kidney health.
• Digoxin: Strengthens heart contractions and helps regulate rhythm.

Medications should be tailored to each patient, requiring time to find the optimal combination.

Lifestyle Changes

Lifestyle modifications are critical and can be as impactful as medications:

• Low-Sodium Diet: Limit salt intake to less than 2,000 mg/day to reduce fluid retention.
• Fluid Restriction: May be necessary for some patients to prevent fluid overload.
• Weight Monitoring: Sudden weight changes may indicate fluid buildup.
• Exercise: Tailored cardiac rehab or walking programs to enhance stamina and exercise tolerance.
• Smoking Cessation and Alcohol Limitation: Vital for overall heart health.
• Vaccinations: Stay current on vaccines to prevent infections.

Advanced interventions may include:

• Implantable Cardioverter Defibrillator (ICD): Prevents sudden cardiac death.
• Cardiac Resynchronization Therapy (CRT): Improves heart coordination.
• Valve Repair/Replacement or Bypass Surgery: For structural issues.
• Left Ventricular Assist Device (LVAD) or Heart Transplant: For end-stage heart failure patients.

Living with Heart Failure

Managing heart failure is akin to managing other chronic conditions like diabetes or hypertension. With effective control, one can lead a fulfilling life, traveling, working, and enjoying family events. Key aspects for patients include:

• Education: Understanding the condition and its management.
• Symptom Awareness: Knowing what symptoms to monitor and discussing them with a doctor.
• Medication Adherence: Taking medications as prescribed to keep symptoms under control.
• Communication: Promptly reporting any new or worsening symptoms to a healthcare provider.

Heart failure may seem daunting, but with early diagnosis and proper care, it is manageable. Improving daily habits can prevent complications, reduce hospitalizations, and enhance quality of life. If you experience fatigue, breathlessness, or swelling, don't ignore these signs-schedule an appointment with your cardiologist. Together, we can address the heart of the problem because your heart matters, and caring for it is essential.

Heart Services and Cardiac Cath Program

At Lower Bucks Hospital, we proudly serve patients from across the suburbs of Philadelphia with various heart conditions requiring specialized care. Under the leadership of Dr. Ahmed Shahzad, our Heart Services and Cardiac Cath Program focus on improving patient outcomes through a comprehensive approach to heart failure management. Dr. Shahzad, board-certified in multiple cardiology disciplines, emphasizes preventive care and individualized treatment plans that include lifestyle changes and advanced interventions. His expertise in diagnostic cardiac catheterization, stenting, cardiac rehab, and managing chronic conditions positions our program as a leader in cardiac care, dedicated to enhancing the quality of life for our patients.

Dr. Shahzad Ahmed MD, FACC, FSCAI, RPVI
BMC Cardiology-Lower Bucks Hospital
501 Bath Rd, Bristol, PA 19007
(215) 785-5100

To learn more about Lower Bucks Hospital's Cardiovascular Disease Fellowship Program, visit https://lowerbuckshosp.com/our-services/medical-education/cardiology-fellowship-program/