Living With Advanced Heart Failure Take Heart

There is no doubt that the person best equipped to manage your heart failure is a specialist. To monitor symptoms in yourself or a loved one, here are three things to know:

1) Be on the Lookout
Be vigilant about noticing symptoms that won’t go away. Typically, the most common symptoms of advanced heart failure are shortness of breath (especially associated with exercise), fatigue, and swelling of the lower extremities, sometimes in the abdomen. You could have a rapid or irregular heartbeat. You could have chest pain, coughing or wheezing, or a more frequent need to urinate at night.

If these symptoms persist, be very proactive and ask for a consultation with a cardiologist.

2) Put Your Heart in the Care of a Specialist
I am always puzzled when patients with symptoms of heart failure are not referred to a specialist. When a patient has a diagnosis of cancer, they go to see a cancer specialist.

Yet there are almost 6 million patients living with this disease in the United States right now. There are approximately a quarter million patients dying of this issue each year, a surprisingly high number. And approximately a million new cases are diagnosed annually.

3) You Will Receive Expert Care at the MedStar Heart & Vascular Institute
If you are at risk of heart failure, or have started to exhibit symptoms, make an appointment to be examined by one of our specialists. We offer the full spectrum of therapies to treat and manage your disease, and we have one of the busiest, most advanced programs in the country. For example, we have implanted over 700 left ventricular assist devices (LVADs), mechanical devices that help the heart pump blood. We have also performed more than 300 heart transplants.

MedStar Heart & Vascular Institute has the best multidisciplinary team to care for patients with advanced heart failure. Our heart transplant program has the best survival rates in the area, and patients can take part in a unique patient support program that can help improve their quality of life.

Why It’s Important to See a Specialist Sooner Rather Than Later

Let’s focus on symptoms. Patients may not realize it, but they can pass through a series of phases before becoming extremely sick. We need to see these patients when symptoms first appear.

Heart failure has four stages—A, B, C, and D:

• Stage A refers to patients at risk. These patients don’t have any apparent changes in their hearts, but may have high blood pressure or diabetes, for instance, and this puts them at risk of developing heart failure.
• Stage B includes patients who have had changes in their heart, but who still manifest no symptoms.
• In Stage C, patients begin to exhibit symptoms, although not severe. Patients can perhaps still perform routine physical activities around the home, but probably not very physical ones. They're typically not taking a lot of medication.
• Stage D is the end stage, and these patients are the most symptomatic. If we get a referral for a patient who needs a heart transplant or LVAD at the very end of Stage D, that patient may not be eligible for treatment. Ideally, patients should be examined much earlier, before things reach this critical stage.

The Right Treatment at the Right Time

There are always opportunities to take action at each stage of heart failure, and we have many viable approaches and treatment options, such as medications, pacemakers, minimally invasive surgeries, LVADs, and transplants.

But the first thing patients can do in the early stages of the disease is to begin adopting a healthier lifestyle—for example, quitting smoking or losing weight. Avoid alcohol. Eat a well-balanced diet. Engage in more physical activity and stress management. All these approaches are important and helpful.

Medications: Second Line of Defense

If patients exhibit advancing disease, several medications may prove useful.

Some medications lower the blood pressure, while some slow down the heart rate. Others aid kidney function. Diuretic medications help the body to eliminate water. Certain medications act on the muscle cells in the heart to stop the destructive changes that heart failure can cause.

And an array of newer medications looks promising. Although not a cure, these medications are very effective, may delay the need for surgery or more invasive approaches, and are beginning to play a key role in management of the disease.

...And Beyond Medication

• Defibrillators and Pacemakers When a patient is using medication and has already made lifestyle changes, yet the disease continues to progress, the specialist has several options, such as introducing an implantable cardioverter defibrillator (ICD), or a newer, more complex pacemaker based on cardiac resynchronization therapy (CRT), which optimizes the way your heart beats and improves the coordination between the two ventricles.
• Surgical Management Some patients have conditions amenable to surgical management. For example, where blocked coronary arteries are involved, a bypass operation may reverse the condition and be a life-saving solution.Along with the bypass operations, we know that valvular surgery is very important. For some patients, the disease is caused because one or two valves are not functioning well, so valve surgery can be an important tool there as well.I frequently operate on patients whose hearts are weak, with blockages of the coronary artery. Six to twelve months after we perform a bypass, their cardiologist calls to say “Remember your coronary artery bypass on my patient whose heart contraction strength was very low? We just did an echocardiogram in the clinic, and his heart looks normal.” That sort of result is not unusual.
• Advanced Surgical Therapies Certain patients are not candidates for bypass because their arteries are too damaged or other issues are present. In these cases, we can apply two more advanced forms of therapy—LVAD implantation and heart transplantation.When patients develop this advanced form of heart failure, their mortality is as bad as some of the deadliest cancers, such as lung and pancreas cancer. LVAD and heart transplantations may become the only life-saving alternatives at this point. However, patients are often referred late, when they are too sick to be candidates.

Early Referrals Can Improve Lives

Early referrals are key to achieving good outcomes for our patients. When it comes to advanced heart failure, your care team at MedStar Heart & Vascular Institute will recommend and implement treatment options that will help to best mitigate the ongoing risk to your heart.

So, take heart. We’re here for you.