Heart Failure: Symptoms, Diagnosis and Treatment Options
Dr. Cesar Guerrero-Miranda discusses the symptoms, diagnosis and treatment options for heart failure.
Featured Speaker:
Cesar Guerrero-Miranda, MD
Dr. Guerrero-Miranda is certified by the American Board of Internal Medicine in Cardiovascular Disease and specializes in the treatment of patients with congestive heart failure. After graduating from Cayetano Heredia University, one of the most prestigious medical schools in Peru, Dr. Guerrero-Miranda relocated to the United States for his postgraduate medical training. He completed his residency in Internal Medicine at University of Miami, Jackson Memorial Health System in Florida. He then completed a fellowship in Advanced Heart Failure and Transplant Cardiology at Newark Beth Israel Medical Center in New Jersey and a fellowship in Cardiovascular Disease at Montefiore Medical Center in New York. Dr. Guerrero-Miranda is on the medical staff at Baylor University Medical Center at Dallas and Baylor Scott & White Heart and Vascular Hospital. He is fluent in English and Spanish. Transcription:
Heart Failure: Symptoms, Diagnosis and Treatment Options
Scott Webb: Nearly 6 million Americans are living with heart failure. That's a staggering figure here to discuss. Heart failure symptoms, diagnosis, and treatment options is Dr. Cesar Guerrero-Miranda. He's an advanced heart failure and transplant cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital and Baylor University Medical Center in Dallas. This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. I'm Scott Webb. Doctor, thanks for joining me today. Who's living with heart failure?
Dr. Guerrero-Miranda: So heart failure is the leading cause of mortality and hospitalization in the United States. So it's a disease who we're dealing with very frequently, and it has a very high chance to get people with significant comorbidities in the future. This is a disease that can affect people in any ages, but always is more frequently on, as we're getting older. But heart failure it’s considered as deadly and with significant comorbidities as the most dangerous cancers.
Host: Yeah, I know that it affects, you know, nearly 6 million Americans. What causes heart failure?
Dr. Guerrero-Miranda: It's a family of many different etiologies. The most common diagnosis for heart failure is, what do we call idiopathic. We don't have a specific physiology. There are people who can have very dilated and fully contracted heart that doesn't have any specific cause about it. That's what we would call Idiopathic. Another big group of patients with heart failure that has been secondary to lack of flow or circulation to the heart, that when we have coronary disease that at the end decreased blood circulation into the heart and produced the heart started getting weaker. But these are the two most common causes of Heart failure. There are many other entities like uncontrolled blood pressure. It's more of a damage of their branches from the coronary. They will grow microvascular damage to their heart, that can produce heart failure as well. These other entities that are diseases will get a deposit in them, in the muscle of the heart, in the myocardium. That in the future then makes the heart very stiff and not allowing the heart to contact that well. So that's another type of heart failure. So there's many entities that we deal with it.
Host: Yeah. It sounds like you're dealing with a number of factors there. So assuming there are symptoms, what are the symptoms and how is it diagnosed?
Dr. Guerrero-Miranda: Well, just the heart failure is a syndrome, syndrome is caused when we have a combination of symptoms, this is what the patient reports when they see a provider, physician, and specific clinical findings they had on the physical exam with a combination of some blood tests. So congestive heart failure is related with most symptoms as significant tiredness, fatigue, inability to produce your normal daily activities because that produces a significant lack of energy. Consequence of having a heart that is not pumping well is the combination of fluid in different organs that can lead the patients to be having significant shortness of breath because the lung start getting wet with a combination of fluid or having less performance because the pressures inside of the lungs start getting higher. The same happening with other organs like liver, kidney, so that produces enlargement on the liver due to a fluid accumulation and incur on the kidney function that produce what we call renal failure at the end. It's a syndrome the starts with one organ but over the time kind of go and affect many organs that decreases significant quality of life of patients and increase mortality. So diagnosis is a combination of symptoms from the patient physical exam that we can assess during the patient visits in the hospital or in clinic, plus several tests that we use in the blood, as well as imaging on the heart that we can put all together, all this can give us specific diagnosis for heart failure. And what is it type of our heart failure the patient has.
Host: I've heard this before. I want to make sure I've got this right. What exactly is this number that the patients can be given this ejection fraction, what does that mean and why is that important?
Dr. Guerrero-Miranda: Ejection fraction is the ratio of the total volume that the heart can acquire for every beat and that is divided by the amount of blood that the heart is detecting when the phase of the contraction is ending. When the heart started receiving blood, this is what we call diastole, when a heart start collecting blood from the organ. And then there is squeezing part of ABB is called systole and that's the amount of blood that the heart is ingesting. The ratio of the volume of these two stages on every beat is where we call the Ejection Fraction. So it's the estimation of how much blood has been sent to the organs every beat. So that's one important evolution for congestive heart failure and one entity of heart failure, that we call heart failure with reviews ejection fraction. Those patients tend to have a lower number. And this is one of the aspects of the testing that we do that help us to diagnose congestive heart failure, but it's a [inaudible 05:38] group of congestive heart failure that they have normal or reverification fraction that despite having a normal ejection fraction, they still have congestive heart failure. And this is the type of patients that have the heart, but it's a stiff and has a very poor way to relax and extra volume that is coming into the heart, because the heart is stiff and very poor lack in the blood being coming back to the organs, to the lungs, to the abdomen, to the liver, to the kidney, and produce symptoms close to the heart failure. These ejection fraction is one of the markers that was followed, but it depends, but it's some type of heart failure that we're looking at in that patient.
Host: Okay, I think I've got it right. So ejection fraction is important but it doesn't necessarily paint the whole picture for all patients. So can heart failure be prevented?
Dr. Guerrero-Miranda: Absolutely. The focus for any providers to prevent congestive heart failure, the best that we can is very well known about the recycles that can lead patients to have a normal heart, to be, have a very dysfunctional heart. Ended up having all of the things that we call congestive heart failure. When we call it congestive heart failure, we call different stages like that happen in other chronic diseases like chronic kidney disease or cancer. So we have the stage A through the stage B. Stage A Is where we have strong recycles that kind of lead to have congestive heart failure but we don't have the symptoms of congestive heart failure at that point. And stage B I are the patients who are required to come back to the hospital because they are really sick. Their heart is terminal, there's no more medications that can help them and they have to start looking for options to replace heart.
Either a heart transplant or a mechanical pump or have a conversation about end of life discussions. So when we tried to prevent to have congestive heart failure we're talking about stage A, they have many risk factors that we have to take into concentrations like high blood pressure, diabetes that is not well controlled, obesity. Many other entities that is in a group would call metabolic syndrome. That is related to poor control, blood pressure, poor control diabetes, uncontrolled weight, lack of exercise that can make the heart performance to be weaker and in the future have high risk to have congestive heart failure. Also smoking, certain medications that we need to try [inaudible08:09] long-term produce congestive heart failure. This is [inaudible 08:13] that we can prevent heart rate due to low congestive heart failure.
Host: A heart failure is more common in people over the age of 75 of course, but there are young people being diagnosed with heart failure, what are the reasons for young adults to be having or experiencing heart failure? Is it just the risk factors?
Dr. Guerrero-Miranda: Younger population, they can have more unrecognized disease because this is the population that, the rest of the body has a body has a medical reserve. The symptoms are obscure for better overall performance of the patients, so it's different if you have a heart that works poorly and you're 25 years old. Comparing with a patient who is 65, 70 years old, I had a heart that is not working well. So the symptoms are different. In younger population, there are certain entities that can increase the chance to have congestive heart failure like congenital heart disease, congenital or genetic anomaly for the heart like for instance, Bipolar disease, that can produce to make heart be overloaded and at the end have an early manifestation of congestive heart failure diseases that made it hard to be stiff. Things that we have been born and over the time, the heart getting more enabled to contract well and have a normal function of other deposit disease, diseases that get deposited in the heart, that it can make the heart weaker like cardiac amyloidosis. Protiens have normal function in the body but in some patients is broken, started getting unfolded and have different configurations that are getting deposited in the heart and that produce the heart to be stiff. So there are certain entities that can attack the heart early and produce early manifestation of congestive heart failure.
Host: Living with heart failure, not the easiest thing to do, but I'm sure there are some really great, you know, revolutionary treatment options. So let's go through some of those.
Dr. Guerrero-Miranda: I think we have an increasing amount of different approaches for managing congestive heart failure. One definitely is evolution in our different subtypes of medications that we can use to treat a specific congestive heart failure. I think that has been growing over the time and we have different tools and medicines that we can use to try to stop the progression of congestive heart failure. That's number one. There are other more towards devices that they kind of shows that have increased the chance to have a heart to recover and improve quality of life on patients like specific type of defibrillators who insert in patients who are characteristic electrical disturbance in the heart that can get benefit to get both right and left side of the heart synchronized beating. That helps the heart to get stronger. We have a different implantable devices that can get an early detection of patients who has recorded congestive heart failure, that make the provider recognize that the patient is not doing well even before the patient's targeting symptoms. And you can act there quicker and avoid more common reasons to have the patients needed to be hospitalized. And in later stage of congestive heart failure, we have, what we call a band heart failure therapies where we're emulating what are the options to have that heart to be replaced or assist to prove survival and prevent loss of life. So I think in the whole spectrum of congestive heart failure from prevention to any state, there are many options that patients can go through. Depends on the stage the patient are, we can definitely provide better survival and quality of life.
Host: Yeah, definitely. Sounds like it. And I wanted to talk to you about that. What qualifies or classifies heart failure as advanced?
Dr. Guerrero-Miranda: When we talk advanced heart failure are the sickest of the patients with congestive heart failure. So are patients who have demonstrated over the time that the disease is being progressed to a level that the quality of life is poor. Where the patients who were treated for congestive heart failure with different medications, but now the same doses of medications made those patients sick because they're unable to tolerate equally dose that they were using before, those patients will start getting more tired, more fatigue, more fluid accumulation that requires escalation of medications that we call water pills to let the fluid come out from the body. There are patients who obviously been getting more, having more symptoms for congestive heart failure are required to be back in the hospital many times or have malignant arrhythmia that can [inaudible 13:23] patients have defibrillators that are getting a shock because that heart is producing these lethal heart rate means that there's a manifestation how thick the heart is. So when we detect those patients where unfortunately pharmacologically, you know, conventional treatment for heart failure is not sufficient, is when we start thinking that we need to have a strategy, how to repair the heart and that we call advanced heart failure or end stage heart failure.
Host: So let's talk about cardiac replacement therapies. Maybe describe what they are or what that means. Maybe discuss a LVADs, take us through that.
Dr. Guerrero-Miranda: Heart replacement therapies is definitive therapy for what we call end stage heart failure, when we know that the heart has failed to a level that conventional therapy is not sufficient. So when we have end stage heart failure is like end stage cancer. We have, the survival is a poor and the morbidity is very high. So if in certain patients who have passing several screening testing to see if they qualify for heart replacement therapies, what we can offer them is replace the heart orally, with a new heart, that is we call heart transplant or have his own heartbeat assisted by a mechanical pump that we call left ventricular assist device or LVAD. That is a mechanical pump who will assist the patient's own heart to get a better flow, have a better quality of life. There are certain patients who have a significant motor comorbidities that may not be, these two therapies will be not beneficial, that may have lower tests or survival or have more comorbidities, if we pursued to do a higher replacement therapies. So in those patients we also have continues IV medication and we call, Inotropes that we use as palliative to get into patients to feel better. But definitely will not improve survival or improve mortality. So, in summary, when we have end of stage heart failure, we have to think that is a later stage of a disease. There are very limited options to replace the heart. And if the patients have specific indications after dedicated screening testing that we do, we may offer them a replacement therapy as heart transplant or mechanical pump.
Host: I know that Baylor university medical center in Dallas has a very busy heart transplant program. Lastly today, doctor, does heart failure mean that a patient should be considered for a heart transplant?
Dr. Guerrero-Miranda: No, absolutely not. Heart transplant is the latest door that we would like to open. So we definitely would like to reduce the amount of heart transplant when needed, when we don't have more alternatives to offer to patients who are very sick on this trajectory of congestive heart failure. So when we decided that a patient's needs a heart transplant it's because we have exceeded any other potential therapies that can help them to have a better quality of life or increased survival. Congestive heart failure has mania stages from the stage of having just risk factors to the end stage heart failure, every different stages of congestive heart failure have a different treatment strategy that we need to try to implement on patients and avoid patients to progress to the advanced stages. But unfortunately, sometimes they do continues to progress despite the treatment started on those patients. And that's when we need to start activating options for advanced heart failure including a heart transplant.
Host: Yeah, it sounds like it's a last resort, but a fairly common if you will, procedure nowadays. And great to know that patients have the options and have someone like you ready, willing, and able to help them, address their risk factors, help them along the way and deal with it if their heart failure gets to the advanced stage. Thank you so much for your time today, doctor. Really appreciate it. That's Dr. Guerrero-Miranda advanced heart failure cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas. And thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff, please call +1 844-279-3627 or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon. Baylor Scott and White Heart and Vascular Hospital in Dallas in Fort Worth, joint ownership with physicians.
Heart Failure: Symptoms, Diagnosis and Treatment Options
Scott Webb: Nearly 6 million Americans are living with heart failure. That's a staggering figure here to discuss. Heart failure symptoms, diagnosis, and treatment options is Dr. Cesar Guerrero-Miranda. He's an advanced heart failure and transplant cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital and Baylor University Medical Center in Dallas. This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. I'm Scott Webb. Doctor, thanks for joining me today. Who's living with heart failure?
Dr. Guerrero-Miranda: So heart failure is the leading cause of mortality and hospitalization in the United States. So it's a disease who we're dealing with very frequently, and it has a very high chance to get people with significant comorbidities in the future. This is a disease that can affect people in any ages, but always is more frequently on, as we're getting older. But heart failure it’s considered as deadly and with significant comorbidities as the most dangerous cancers.
Host: Yeah, I know that it affects, you know, nearly 6 million Americans. What causes heart failure?
Dr. Guerrero-Miranda: It's a family of many different etiologies. The most common diagnosis for heart failure is, what do we call idiopathic. We don't have a specific physiology. There are people who can have very dilated and fully contracted heart that doesn't have any specific cause about it. That's what we would call Idiopathic. Another big group of patients with heart failure that has been secondary to lack of flow or circulation to the heart, that when we have coronary disease that at the end decreased blood circulation into the heart and produced the heart started getting weaker. But these are the two most common causes of Heart failure. There are many other entities like uncontrolled blood pressure. It's more of a damage of their branches from the coronary. They will grow microvascular damage to their heart, that can produce heart failure as well. These other entities that are diseases will get a deposit in them, in the muscle of the heart, in the myocardium. That in the future then makes the heart very stiff and not allowing the heart to contact that well. So that's another type of heart failure. So there's many entities that we deal with it.
Host: Yeah. It sounds like you're dealing with a number of factors there. So assuming there are symptoms, what are the symptoms and how is it diagnosed?
Dr. Guerrero-Miranda: Well, just the heart failure is a syndrome, syndrome is caused when we have a combination of symptoms, this is what the patient reports when they see a provider, physician, and specific clinical findings they had on the physical exam with a combination of some blood tests. So congestive heart failure is related with most symptoms as significant tiredness, fatigue, inability to produce your normal daily activities because that produces a significant lack of energy. Consequence of having a heart that is not pumping well is the combination of fluid in different organs that can lead the patients to be having significant shortness of breath because the lung start getting wet with a combination of fluid or having less performance because the pressures inside of the lungs start getting higher. The same happening with other organs like liver, kidney, so that produces enlargement on the liver due to a fluid accumulation and incur on the kidney function that produce what we call renal failure at the end. It's a syndrome the starts with one organ but over the time kind of go and affect many organs that decreases significant quality of life of patients and increase mortality. So diagnosis is a combination of symptoms from the patient physical exam that we can assess during the patient visits in the hospital or in clinic, plus several tests that we use in the blood, as well as imaging on the heart that we can put all together, all this can give us specific diagnosis for heart failure. And what is it type of our heart failure the patient has.
Host: I've heard this before. I want to make sure I've got this right. What exactly is this number that the patients can be given this ejection fraction, what does that mean and why is that important?
Dr. Guerrero-Miranda: Ejection fraction is the ratio of the total volume that the heart can acquire for every beat and that is divided by the amount of blood that the heart is detecting when the phase of the contraction is ending. When the heart started receiving blood, this is what we call diastole, when a heart start collecting blood from the organ. And then there is squeezing part of ABB is called systole and that's the amount of blood that the heart is ingesting. The ratio of the volume of these two stages on every beat is where we call the Ejection Fraction. So it's the estimation of how much blood has been sent to the organs every beat. So that's one important evolution for congestive heart failure and one entity of heart failure, that we call heart failure with reviews ejection fraction. Those patients tend to have a lower number. And this is one of the aspects of the testing that we do that help us to diagnose congestive heart failure, but it's a [inaudible 05:38] group of congestive heart failure that they have normal or reverification fraction that despite having a normal ejection fraction, they still have congestive heart failure. And this is the type of patients that have the heart, but it's a stiff and has a very poor way to relax and extra volume that is coming into the heart, because the heart is stiff and very poor lack in the blood being coming back to the organs, to the lungs, to the abdomen, to the liver, to the kidney, and produce symptoms close to the heart failure. These ejection fraction is one of the markers that was followed, but it depends, but it's some type of heart failure that we're looking at in that patient.
Host: Okay, I think I've got it right. So ejection fraction is important but it doesn't necessarily paint the whole picture for all patients. So can heart failure be prevented?
Dr. Guerrero-Miranda: Absolutely. The focus for any providers to prevent congestive heart failure, the best that we can is very well known about the recycles that can lead patients to have a normal heart, to be, have a very dysfunctional heart. Ended up having all of the things that we call congestive heart failure. When we call it congestive heart failure, we call different stages like that happen in other chronic diseases like chronic kidney disease or cancer. So we have the stage A through the stage B. Stage A Is where we have strong recycles that kind of lead to have congestive heart failure but we don't have the symptoms of congestive heart failure at that point. And stage B I are the patients who are required to come back to the hospital because they are really sick. Their heart is terminal, there's no more medications that can help them and they have to start looking for options to replace heart.
Either a heart transplant or a mechanical pump or have a conversation about end of life discussions. So when we tried to prevent to have congestive heart failure we're talking about stage A, they have many risk factors that we have to take into concentrations like high blood pressure, diabetes that is not well controlled, obesity. Many other entities that is in a group would call metabolic syndrome. That is related to poor control, blood pressure, poor control diabetes, uncontrolled weight, lack of exercise that can make the heart performance to be weaker and in the future have high risk to have congestive heart failure. Also smoking, certain medications that we need to try [inaudible08:09] long-term produce congestive heart failure. This is [inaudible 08:13] that we can prevent heart rate due to low congestive heart failure.
Host: A heart failure is more common in people over the age of 75 of course, but there are young people being diagnosed with heart failure, what are the reasons for young adults to be having or experiencing heart failure? Is it just the risk factors?
Dr. Guerrero-Miranda: Younger population, they can have more unrecognized disease because this is the population that, the rest of the body has a body has a medical reserve. The symptoms are obscure for better overall performance of the patients, so it's different if you have a heart that works poorly and you're 25 years old. Comparing with a patient who is 65, 70 years old, I had a heart that is not working well. So the symptoms are different. In younger population, there are certain entities that can increase the chance to have congestive heart failure like congenital heart disease, congenital or genetic anomaly for the heart like for instance, Bipolar disease, that can produce to make heart be overloaded and at the end have an early manifestation of congestive heart failure diseases that made it hard to be stiff. Things that we have been born and over the time, the heart getting more enabled to contract well and have a normal function of other deposit disease, diseases that get deposited in the heart, that it can make the heart weaker like cardiac amyloidosis. Protiens have normal function in the body but in some patients is broken, started getting unfolded and have different configurations that are getting deposited in the heart and that produce the heart to be stiff. So there are certain entities that can attack the heart early and produce early manifestation of congestive heart failure.
Host: Living with heart failure, not the easiest thing to do, but I'm sure there are some really great, you know, revolutionary treatment options. So let's go through some of those.
Dr. Guerrero-Miranda: I think we have an increasing amount of different approaches for managing congestive heart failure. One definitely is evolution in our different subtypes of medications that we can use to treat a specific congestive heart failure. I think that has been growing over the time and we have different tools and medicines that we can use to try to stop the progression of congestive heart failure. That's number one. There are other more towards devices that they kind of shows that have increased the chance to have a heart to recover and improve quality of life on patients like specific type of defibrillators who insert in patients who are characteristic electrical disturbance in the heart that can get benefit to get both right and left side of the heart synchronized beating. That helps the heart to get stronger. We have a different implantable devices that can get an early detection of patients who has recorded congestive heart failure, that make the provider recognize that the patient is not doing well even before the patient's targeting symptoms. And you can act there quicker and avoid more common reasons to have the patients needed to be hospitalized. And in later stage of congestive heart failure, we have, what we call a band heart failure therapies where we're emulating what are the options to have that heart to be replaced or assist to prove survival and prevent loss of life. So I think in the whole spectrum of congestive heart failure from prevention to any state, there are many options that patients can go through. Depends on the stage the patient are, we can definitely provide better survival and quality of life.
Host: Yeah, definitely. Sounds like it. And I wanted to talk to you about that. What qualifies or classifies heart failure as advanced?
Dr. Guerrero-Miranda: When we talk advanced heart failure are the sickest of the patients with congestive heart failure. So are patients who have demonstrated over the time that the disease is being progressed to a level that the quality of life is poor. Where the patients who were treated for congestive heart failure with different medications, but now the same doses of medications made those patients sick because they're unable to tolerate equally dose that they were using before, those patients will start getting more tired, more fatigue, more fluid accumulation that requires escalation of medications that we call water pills to let the fluid come out from the body. There are patients who obviously been getting more, having more symptoms for congestive heart failure are required to be back in the hospital many times or have malignant arrhythmia that can [inaudible 13:23] patients have defibrillators that are getting a shock because that heart is producing these lethal heart rate means that there's a manifestation how thick the heart is. So when we detect those patients where unfortunately pharmacologically, you know, conventional treatment for heart failure is not sufficient, is when we start thinking that we need to have a strategy, how to repair the heart and that we call advanced heart failure or end stage heart failure.
Host: So let's talk about cardiac replacement therapies. Maybe describe what they are or what that means. Maybe discuss a LVADs, take us through that.
Dr. Guerrero-Miranda: Heart replacement therapies is definitive therapy for what we call end stage heart failure, when we know that the heart has failed to a level that conventional therapy is not sufficient. So when we have end stage heart failure is like end stage cancer. We have, the survival is a poor and the morbidity is very high. So if in certain patients who have passing several screening testing to see if they qualify for heart replacement therapies, what we can offer them is replace the heart orally, with a new heart, that is we call heart transplant or have his own heartbeat assisted by a mechanical pump that we call left ventricular assist device or LVAD. That is a mechanical pump who will assist the patient's own heart to get a better flow, have a better quality of life. There are certain patients who have a significant motor comorbidities that may not be, these two therapies will be not beneficial, that may have lower tests or survival or have more comorbidities, if we pursued to do a higher replacement therapies. So in those patients we also have continues IV medication and we call, Inotropes that we use as palliative to get into patients to feel better. But definitely will not improve survival or improve mortality. So, in summary, when we have end of stage heart failure, we have to think that is a later stage of a disease. There are very limited options to replace the heart. And if the patients have specific indications after dedicated screening testing that we do, we may offer them a replacement therapy as heart transplant or mechanical pump.
Host: I know that Baylor university medical center in Dallas has a very busy heart transplant program. Lastly today, doctor, does heart failure mean that a patient should be considered for a heart transplant?
Dr. Guerrero-Miranda: No, absolutely not. Heart transplant is the latest door that we would like to open. So we definitely would like to reduce the amount of heart transplant when needed, when we don't have more alternatives to offer to patients who are very sick on this trajectory of congestive heart failure. So when we decided that a patient's needs a heart transplant it's because we have exceeded any other potential therapies that can help them to have a better quality of life or increased survival. Congestive heart failure has mania stages from the stage of having just risk factors to the end stage heart failure, every different stages of congestive heart failure have a different treatment strategy that we need to try to implement on patients and avoid patients to progress to the advanced stages. But unfortunately, sometimes they do continues to progress despite the treatment started on those patients. And that's when we need to start activating options for advanced heart failure including a heart transplant.
Host: Yeah, it sounds like it's a last resort, but a fairly common if you will, procedure nowadays. And great to know that patients have the options and have someone like you ready, willing, and able to help them, address their risk factors, help them along the way and deal with it if their heart failure gets to the advanced stage. Thank you so much for your time today, doctor. Really appreciate it. That's Dr. Guerrero-Miranda advanced heart failure cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas. And thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff, please call +1 844-279-3627 or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon. Baylor Scott and White Heart and Vascular Hospital in Dallas in Fort Worth, joint ownership with physicians.