Heart Failure Causes, Symptoms and Treatment Options from Inova’s Experts

“Heart failure” is something of a misnomer. Although many people think that heart failure means a person’s heart abruptly stops beating, heart failure is not the same as cardiac arrest. Heart failure simply means that a person’s heart is not pumping optimally, to keep up with the body’s needs.

“Many patients come to me with a concern and focus on the name of my specialty,” said advanced heart failure and transplant cardiologist Timothy S. Welch, MD, FACC, who practices in the Arlington, Fairfax and Loudoun offices of Virginia Heart and is Associate Medical Director of Inova Heart and Vascular Institute’s (IHVI) Cardiac Intensive Care Unit.  “In reality, advanced heart failure doctors are friendly experts who teach people about their heart function and what options are available to help treat their condition.”

Heart failure’s causes and symptoms

Heart failure is the number one most common heart condition, affecting more than 6 million Americans, according to data collected by the Centers for Disease Control and Prevention. It tends to get progressively worse over time unless steps are taken toward treatment. There are many risk factors for heart failure, including:

  • Coronary artery disease, valvular heart disease and other heart-related disorders
  • Diabetes and high blood pressure
  • Obesity
  • Certain genetic conditions
  • Excessive alcohol use
  • A diet high in fat and sodium
  • Lack of exercise
  • Sleep apnea

One key symptom of heart failure is shortness of breath with minimal activity. For example, people with heart failure may feel short of breath after walking across the house, tying their shoes or conducting normal activities of daily living. Sometimes, patients can feel shortness of breath after lying down. People with heart failure may also experience a loss of appetite and general weakness or fatigue.

Many of these symptoms result from fluid buildup. When the heart can’t pump blood efficiently throughout the body, fluid can back up into the lungs, causing shortness of breath, or can back up into the abdomen, causing a feeling of fullness and loss of appetite. When a person lies down, fluid can move from the lower body back to the chest, making the heart work harder and causing the person to develop shortness of breath hours after lying down to rest.

“Heart failure is measured by how well the heart pumps blood. Symptoms can vary based on how well a person’s body is able to compensate,” Dr. Welch said. “Advanced heart failure experts also treat people who have rarer conditions that affect the heart’s ability to relax between beats,” such as cardiac amyloid, cardiac sarcoid and hypertrophic cardiomyopathy.

Treatment options for heart failure

As a first step, a heart failure expert will work with the patient to try to determine the cause of the heart failure. Some causes, like coronary artery disease, sleep apnea and excessive alcohol use, can be reversible.

“We do everything possible to find out why heart failure is happening and reverse it if we can,” Dr. Welch said. “No matter what the cause, we focus on treating the condition with medication to help the person’s heart function improve.”

Some heart failure treatments focus on fluid management, with the goal of getting the extra fluid out of the body. They can include diet changes and medications. Lifestyle changes, such as quitting smoking and increasing activity levels, can also be helpful.

If a patient’s heart function doesn’t get better with medication, or if medications are no longer working well, there are other treatment options available. “This is where Inova’s advanced heart failure program is so strong. We have the complete range of treatments available, from infusions of medicine to mechanical support for the heart, all the way to heart transplant,” Dr. Welch said.

IHVI’s heart transplant program is the region’s busiest and most robust, completing three times more transplants than a typical program does. “There are 148 heart transplant programs in the United States, and Inova’s program is among the top 15 busiest programs,” Dr. Welch said.

The transplant program is supported by one of the busiest cardiac ICUs in the country and multiple cardiac critical care modalities, including a nationally recognized cardiogenic shock program.

When to see an advanced heart failure specialist

Patients can be referred to an advanced heart failure specialist by their primary care doctor or general cardiologist if they are having difficulty with fluid management, are having shortness of breath or are no longer finding their current heart failure medications effective.

“Most of the time, patients don’t need a transplant, but they do need specialized care to help their heart function better over time,” Dr. Welch said. Even though heart failure is a chronic condition, the goal, he noted, is to help people live well with heart failure. “From mild to severe, we’re here to help them through the experience of having heart failure, and hopefully make everything better for them,” he said.

Learn more about Inova’s Heart Failure and Advanced Therapies Program

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