Heart failure (HF) is a common condition affecting millions of Americans. It is a focus of national attention because, of all medical conditions associated with hospitalization, HF is the one most likely to be associated with a new readmission within 30 days of hospital discharge. This points to the difficulty in treating the condition, and the importance of patient and family education.
HF is a condition in which the pumping function of the heart muscle is weakened. This causes the heart to work harder to achieve its work, leading to more cardiac stress and, over time, a vicious cycle. The main symptoms--shortness of breath, swollen ankles and feeling tired--are due to the “backing up” of fluid in the system. HF is a serious condition, but there are multiple therapies available to help patients feel better and live longer.
There are many causes of HF. The most common are hypertension, coronary artery disease and valvular disease. Occasionally, the cause is unknown. The treatment of the condition does depend, to some degree, on the underlying cause.
The diagnosis of HF begins with a history and physical examination. Although a chest x-ray and EKG are helpful, the most important test is an echocardiogram. This is a non-invasive (and non-painful!) ultrasound examination of the heart which quantifies muscle function and evaluates the anatomy of the heart valves. Depending upon the echocardiographic results, other tests such as stress testing or cardiac catheterization may be indicated.
The first line of care is patient education and self-management. Diet (particularly salt restriction), weight monitoring (three times weekly with a call to your physician if there is a three pound weight gain), approved exercise, tobacco cessation and limited alcohol intake are all essential. Most patients should also be put on a number of medications that act in concert to relieve the pressure against which the heart pumps, controls the buildup of fluid and decreases the heart’s workload. The need to take so many medications is often frustrating to the patient, but following a regimen is essential. Obstacles to compliance must be discussed with your primary care provider.
HF can be associated with a number of complications, such as heart attack, rhythm disturbances or acute decompensation with severe shortness of breath. Often these complications are preceded by days or weeks of increasing “low level” symptoms, so patient self-awareness and communication with your doctor regarding symptom changes is essential
Cardiologists are the experts in HF and should be involved in the care of HF, although your primary care provider may act as your first contact. NuHealth is proud of our recently opened Heart Failure and Arrhythmia Center under the leadership of Dr. Sanjay Doddamani. Dr. Doddamani is our Chair of Cardiology, the Chair of the North Shore-LIJ System Task Force on Heart Failure and one of less than 300 physicians in the country board certified specifically in HF. For an appointment to see his team, please call 516-296-4992.