How to manage the rising epidemic of heart disease
Heart disease is the leading cause of death for both men and women in the United States.
While heart attacks and strokes get much of the attention when it comes to heart-related conditions, there is another common killer: congestive heart failure.
In fact, recent statistics indicate that more than five million Americans are living with congestive heart failure (CHF), and nearly 550,000 new cases are diagnosed each year.
Unfortunately, many people aren’t even aware that they are living with this very deadly disease.
“The difficult thing about heart failure is that it doesn’t have just one way that it presents itself,” says Samer Najjar, MD, director of the Advanced Heart Failure Program at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center. “With heart attacks and strokes, when you have symptoms, you have to go to the hospital very early because there are things that can be done. The longer you wait, the more injury can happen. Heart failure is different. There is a myriad of different types of symptoms people can have, which makes it harder to distinguish who has heart failure and who does not.”
Once a patient has been diagnosed with heart failure, Dr. Najjar explains it’s quite likely he or she will need to continue treatment for a lifetime. “This is not just a condition of something happened and you ended up in the hospital, we treat you and you go home and it’s over with. Not at all. Heart failure is something people live with for the rest of their lives.”
LISTEN: Dr. Samer Najjar discusses heart failure in this podcast.
Signs & Symptoms
Common symptoms of CHF include swelling of the legs, shortness of breath, lethargy, loss of appetite and abdominal pain.
Dr. Najjar explains there are two different types of heart failure. In one form, the heart is trying to pump but the muscle is too weak to do so efficiently. “If the muscle is weak, it’s having a hard time pumping the blood forward. Therefore, the blood will back up. It will back up into the lungs which is what causes shortness of breath and then it backs up into the rest of the body and that’s how patients start retaining fluid.”
The other form of heart failure, known as preserved ejection fraction, can be deceiving, because despite the fact that the heart appears to be squeezing normally, it’s having difficulty getting blood to the rest of the body. “That’s something that we in the medical field have struggled with for some time, because it’s not immediately obvious to us,” says Dr. Najjar.
Anything that can cause injury to the heart puts people at risk for having heart failure. For example, high blood pressure, high cholesterol, high blood sugar, previous heart attack(s), smoking–all of these can contribute.
However, approximately 30 to 40 percent of those with heart failure have no discernible risk factors.
Still, Dr. Najjar is quick to emphasize that while some cases seem to appear out of nowhere, “there are known risk factors, which is why these risk factors have to be addressed during one’s lifetime.”
There are also lifestyle choices that are very important. “Exercise is a huge risk factor modifier and our population needs to do much more physical activity and exercise than what is common.”
Advancements in medical science have provided a variety of treatment options, including oral medications.
“There are a lot of medications that have been studied, and several have been shown without any doubt that they actually improve survival. People live longer and feel better,” says Dr. Najjar. With these medications, it’s important for patients to keep close contact with their doctors until the correct dosage has been determined.
Other treatment options include devices such as pacemakers and defibrillators.
And, there are steps patients need to take to ensure these treatments remain viable. For example, salt is a huge culprit in terms of fluid retention. Patients also need to monitor how much fluid they take in on a daily basis. Consistent weigh-ins can be helpful to monitor fluid retention and identify a problem prior to the appearance of any other symptoms.
Once a patient has heart failure, Dr. Najjar explains it’s quite likely he or she will need to continue treatment for a lifetime.
The crucial thing to remember is that you cannot ignore risk factors. “You don’t want to wait until you have a problem, either a heart attack or heart failure,” says Dr. Najjar. “You have to be able to modify those risk factors in middle age, in young age, as soon as you find out that they happen, because when you’ve already developed the disease, you’ve already lost the opportunity to prevent them.”