What is heart failure?
Heart failure is often misunderstood. Many people think heart failure means that their heart will stop beating. If you have heart failure, it means that your heart has lost some of its ability to pump blood.
There are two kinds of heart failure. In the first kind, the heart muscle has weakened and cannot pump enough blood out with each beat. This is called systolic heart failure. In the second kind, the heart pumps normally but the heart muscle has become stiff. Your heart has lost its ability to relax and does not completely fill with blood. This is called diastolic heart failure.
Don’t be discouraged by the word failure. For most patients, heart failure cannot be cured, but you can help to keep it from getting worse or even make it better by taking your medicine, eating the right foods, watching your fluids and exercising. If you take care of your heart, you can feel better and enjoy life more.
What causes heart failure?
Any disease that weakens the heart muscle can lead to heart failure. The most common causes of heart failure are:
- Blockages in the blood vessels that may lead to a heart attack
- High blood pressure that may cause diastolic heart failure
- Disease of the heart valves
- Diabetes
- Infections of the heart muscle
- Cancer drugs
- Genetic abnormalities that run in families
In many cases, the cause is never known, in which case it is called “Idiopathic Cardiomyopathy.”
What are the symptoms of heart failure?
- Weight gain of more than 2 pounds overnight or 5 pounds in a week
- Shortness of breath after climbing a flight of stairs or getting dressed
- Difficulty breathing when lying down
- Cough
- Weakness or tiredness
- Swelling in your ankles or legs
- Loss of appetite
- Belly pain and fullness
(Note: All of these symptoms are common to many medical conditions and may not indicate heart failure. If you have any concerns, consult your doctor.)
How is heart failure diagnosed?
To effectively diagnose heart failure, patients receive a comprehensive evaluation, which may include one or more of the following tests:
- Chest x-ray
- Echocardiogram (“Echo”)
- Electrocardiogram (“EKG” or “ECG”)
- Magnetic Resonance Imaging (“MRI”)
- Stress test
- Positron Emission Tomography (“PET” scan)
- Blood tests
- Heart Catheterization
What treatments are available for heart failure?'
Do not be discouraged by the word “failure”. For most patients, heart failure cannot be cured, but you can prevent it from getting worse and often help it get better. Here are some things that you can do to feel better:
- Lifestyle changes (eat low salt food, watch your fluid intake, exercise, weigh yourself daily, quit smoking, avoid alcohol, go to your doctor’s appointments)
- Medications (diuretics, ACE Inhibitors, Angiotensin Receptor Blockers, Beta Blockers)
- Regular aerobic exercise, which provides remarkable benefits in restoring circulatory regulation as well as general well-being in heart failure and has been shown to decrease the need for hospitalization
- Budgeting your energy for those activities that are most important to you, allowing time for rest and recharging
For some patients, further therapies may be considered, such as:
- Devices to improve the timing of heart function, such as biventricular pacemakers
- Reconstructive surgical therapy, including bypass, valve repair and ventricular reconstruction
- Cardiac assist devices to provide mechanical support for pumping the left side or both sides of the heart
- Heart transplant
When is an assist device or transplantation considered?
New treatment approaches can prevent many patients with advanced heart disease from ever needing a heart assist or replacement. However, in cases where severe symptoms persist despite maximal medical therapy, patients may be considered for assist devices or for a heart transplant. Careful evaluation is required to identify patients who would benefit from these procedures.
What type of health care providers treat advanced heart disease?
- Heart Failure Cardiologists – the Brigham Heart Failure faculty have led research into major advances in the care of heart failure, particularly the strategies for individualizing therapy, and have helped to create the current national and international guidelines for care of Advanced Heart Disease.
- Heart Failure Nurse Practitioners – work closely with cardiologists in providing outstanding personalized care for patients with Heart Failure and Cardiomyopathy, and lead educational efforts for other nurses learning to provide this specialized care.
- Electrophysiologists – have been pioneers in the use of biventricular pacing, ICD placement, and ablation of cardiac arrhythmias.
- Cardiac Surgeons – have introduced new techniques for valve repair, ventricular reconstruction, heart transplants, and mechanical circulatory support
What innovative treatments are being performed at BWH?
The Advanced Heart Failure/Cardiomyopathy Program offers a variety of clinical trials for patients. The Program is pioneering efforts in a number of areas, including:
- Implantable hemodynamic monitors that allow patients to transmit cardiac information from home to physicians for adjustment of therapies
- New left ventricular assist devices which are smaller, quieter, and more comfortable for continuous support of the circulation. The devices consist of pumps implanted, inflow and outflow conduits, and a driveline that exits the body and attaches to an external battery pack
- New therapies to improve kidney function in the setting of heart disease
- New Hybrid Therapies combining percutaneous interventions (injected or absorbed through the skin) and open surgical procedures (conventional or minimally invasive) for safe, effective, and durable therapy with minimal surgical trauma
- Intermittent outpatient infusions of vasoactive medications
- Percutaneous mitral valve repair
- New therapies that may allow valve repair without surgery
What specialized areas are available within the Advanced Heart Failure/Cardiomyopathy Program at Brigham and Women’s Hospital for diagnosis and treatment of heart failure?
- The ACT Unit (Advanced Cardiac Therapy) – our inpatient unit allows complex monitoring and intervention in a comfortable setting without the stress of an intensive care unit. Our ACT Unit also features an ultrafiltration process – a new technique to remove extra fluid build-up due to heart failure with a minimally invasive catheter in the arm veins.
- Clinical Cardiovascular Genetics Program – patients and their family members who have genetic diseases are evaluated by a specialist and obtain blood testing for genetic cardiac disorders. This is the first program of its kind in New England.
- Diastolic Heart Failure Program – this program evaluates heart failure patients with normal heart contraction (about 40% of heart failure patients).
Who are the experts in the BWH Advanced Heart Failure/Cardiomyopathy Program?
The Advanced Heart Failure/Cardiomyopathy Program at Brigham and Women's Hospital provides world-class evaluation and treatment for patients with heart failure and cardiomyopathy. Our faculty members have been instrumental in the research that has led to new strategies of care. We are involved in the generation of national guidelines for the care of heart failure patients and are honored as one of only 7 centers in the United States selected to lead an NIH Heart Failure Clinical Research Network.
