Jamie Lewis (Host): What is heart failure? What are the symptoms and how is it treated? We'll learn the answers to those questions and more in my discussion with Sheenah Fernandez, registered nurse and Heart Failure Program Coordinator at Eisenhower Medical Center.

Host: This is Living Well with Eisenhower Health. I'm your host, Jamie Lewis. And with me is Sheenah Fernandez. Sheenah, hello. Thanks for joining me.

Sheenah Fernandez: Thank you for having me, Jamie.

Host: So, let's start with the definition of heart failure. What is it and how does it affect the heart's ability to pump blood effectively?

Sheenah Fernandez: Heart failure is a medical condition in which the heart becomes weakened and is unable to pump blood effectively. It occurs when the heart muscle is unable to contract or relax properly, causing blood to back up in the veins leading to congestion in the body's tissues. The heart is responsible for pumping blood throughout the body, and it does so by contracting and relaxing in a regular rhythm. In heart failure, the heart muscle weakens causing the heart to pump less blood than normal with each beat. As a result, the body doesn't receive the necessary amount of blood and oxygen it needs, which can lead to a lot of different symptoms that I'm sure we'll talk about.

Host: Okay. Yes. And actually, that's my next question. What are the common symptoms of heart failure, and how can a patient recognize them?

Sheenah Fernandez: So, the symptoms of heart failure, like most things, can vary from individual to individual and can depend on the type and severity of the condition. However, some common symptoms associated with heart failure include shortness of breath. Patients may experience difficulty breathing, especially during physical activity or while lying down. We see a lot when patients have propped themselves up with pillows while sleeping at night over time. Fatigue, one may feel tired or weak even after getting enough rest, which would be unusual, and that would be something concerning. Swelling, one may experience swelling in the legs, ankles or feet due to the buildup of fluid. And then, sometimes people get a rapid or irregular heartbeat. They experience a fast or irregular heartbeat, which can cause palpitations or a feeling of fluttering in the chest. Some individuals also experience a cough that may be a persistent cough that can be accompanied by pink or white phlegm, which would be indicative of possible heart failure. A reduced ability to exercise would also be concerning if the exercises that you've done over a long period of time are now becoming more difficult and you have a decreased ability to participate in physical activities or fatigue. Shortness of breath or other symptoms, that could be concerning as well.

Host: All right. On the clinical side, how do you diagnose heart failure, and what sorts of tests might you use in that diagnostic process?

Sheenah Fernandez: The diagnostic process of heart failure involves a combination of multiple tests and medical history evaluation. So, the first thing to do is start out with your physician and do a full medical history and physical examination. After that, the doctor will normally order some blood tests to evaluate kidney and liver function, as well as certain hormones and substances that can indicate heart failure, such as the brain natriuretic peptide or BNP. This is a very popular blood test in the heart failure community. So, a lot of people do get their BNPs checked regularly, and that would be something to look at in the beginning.

A chest x-ray can help provide an image of the heart, lungs and blood vessels. It can help to identify signs of an enlarged heart or fluid buildup in the lungs, which are common in heart failure. An ECG or electrocardiogram measures the electrical activity of the heart. It can help detect abnormal heart rhythms, previous heart attacks or other conditions that may contribute to heart failure. An echocardiogram uses sound waves. This is the one that people most associate with being an ultrasound, uses sound waves to create images of the heart structure and function. And this test provides information about the heart's pumping ability and the thickness and movement of the heart muscle and functioning of the valves.

The last two would be a stress test to evaluate the heart's response to physical activity or stress. And they can help determine how well the heart functions during exercise and if there are any abnormalities or limitations. And then, a cardiac catheterization, this is a procedure done inside the hospital. A thin tube or catheter is inserted into a blood vessel and guided to the heart, allows for direct measurement of blood pressure assessment and blood flow and full evaluation of the coronary arteries. So, these are just some of the tests that may be performed to diagnose heart failure. The specific test recommended will depend on the individual person's symptoms, medical history and their healthcare provider's clinical judgment.

Host: Well, when we talk about heart failure, are there several different types or just one type? And if there are several types, how do they differ in terms of symptoms and treatment?

Sheenah Fernandez: So, there are two main types of heart failure, systolic heart failure and diastolic heart failure. Systolic heart failure occurs when the heart muscle is weakened and unable to pump enough blood, the pump is weak. Whereas diastolic heart failure, which would be the other one, occurs when the heart muscle is stiff and does not relax properly, making it difficult to fill with enough blood. So, they're kind of opposite each other, and sometimes we do see both of them together as well.

Host: For patients like me, how can I manage symptoms of heart failure through lifestyle modifications like diet and exercise? Do those help?

Sheenah Fernandez: Yes, they absolutely do, and they're crucial. So, maintaining a heart-healthy diet by limiting sodium intake and really keeping track of how much fluid you're having per day. And your physician will guide you on how much fluid is appropriate for you. Regular exercise, avoiding smoking and excessive alcohol consumption, engaging in activities that are important to the individual and maintaining social connections can also really improve quality of life.

Host: Aside from lifestyle, which you just suggested different ways to maintain a heart-healthy lifestyle, what role do medications play in the treatment of heart failure? How can patients ensure that they're taking them correctly?

Sheenah Fernandez: Medications play a crucial role in the treatment of heart failure. They're prescribed to manage symptoms, improve heart function, reduce the risk of complications, and enhance the patient's overall quality of life. Some common medications that we use to treat heart failure include angiotensin-converting enzyme inhibitors, which are ACE inhibitors, along with ARBs, angiotensin-receptor blockers. These medications both help relax blood vessels, lower blood pressure and reduce the workload on the heart. So, they're kind of helping by reducing that workload on the heart, allows the heart to pump a little bit more effectively for those patients. Beta blockers help to slow the heart rate and reduce blood pressure and improve the heart's pumping ability. Diuretics are very, very common. They help reduce excess fluid from the body. As we talked about, you can experience some swelling, which is very uncomfortable, and contribute to things like fatigue and shortness of breath and diuretics help to reduce that swelling, relieving symptoms and making patients feel overall better. We have an extensive array of medications that we use for heart failure, and it's very individualized, depending on the patient and their specific heart function.

Host: Well, I think a lot of us picture heart failure as a Hollywood version of a heart attack, something that's very dramatic and all at once. And so, what do people sometimes get wrong about heart failure? And what are the common misconceptions? How can patients and their families overcome those misconceptions?

Sheenah Fernandez: Some common misconceptions about heart failure include that it's a normal part of aging or that it cannot be treated. And it's not a normal part of aging and it can be treated and we can greatly increase patients' quality of life. With proper management, patients can live full and active lives with heart failure. However, it does require that you have a very close relationship with your physician, and also take those initiatives to lead a heart-healthy lifestyle. And if you're willing to do those things, you can live long and full life with heart failure.

Host: What are some of the potential complications of heart failure? How can patients minimize their risk of developing them?

Sheenah Fernandez: Complications of heart failure can include fluid buildup in the lungs, extremities or other organs; irregular heart rhythms and blood clots. We can minimize those risks and complications by managing the condition effectively through being compliant with medications, having a heart-healthy diet, maintaining an active lifestyle as tolerated and having that open relationship with your physician by reporting any changes in your symptoms, and working with your healthcare team to really focus on what we can do to improve those things going forward.

Host: So, we all know the importance of community and extended education, learning more and more about these conditions. So, I'm wondering what resources are available to patients with heart failure, like support groups or educational materials.

Sheenah Fernandez: So, resources for patients include, like you said, support groups, educational materials, and online resources such as the American Heart Association's website is great. Eisenhower also has the only dedicated heart failure clinic in the Coachella Valley. They are called the Glickman Cardiac Care Clinic, and they are solely dedicated to the care of heart failure patients. The clinic exists for the sole purpose of helping our patients with heart failure live comfortable, and productive lives while avoiding the emergency department and admissions into the hospital. We have highly skilled staff that work closely with our patients and their cardiologists to design individualized treatment plans involving medications, diet and exercise, and lifestyle modifications.

Host: Okay. So as a family member or a caregiver, how can we support patients who have heart failure and address heart failure? How can we help them both emotionally and practically?

Sheenah Fernandez: So as a family member or caregiver, we can support our loved ones by providing emotional support, helping with daily tasks, maybe on the days when they're not feeling well, but also encouraging them to stay active, also by ensuring that they're following their treatment plan and being supportive of that plan, especially when it comes to diet and medications.

Host: All right. Now as far as Eisenhower goes, what does it mean for a hospital to be heart failure accredited through the American College of Cardiology?

Sheenah Fernandez: So, accreditation improves the clinical processes for the early assessment, diagnosis, treatment and followup care for heart failure patients. Eisenhower has proven proficiency in caring for their heart failure patients and providing valuable resources within the community to help manage the disease.

So by adopting the ACC Heart Failure Accreditation Standards and committing to the implementation of process improvement methodologies, we have the ability to reduce variations in care, improve cardiac patient outcomes, improve the implementation of the latest evidence-based guidelines and quality initiatives. And it really ensures best practice while improving the efficiency and effectiveness of patient care. Eisenhower was the first hospital in California to obtain heart failure with outpatient services accreditation, and we are truly committed to continuously providing the highest quality of care to our heart failure patient population.

Host: It's so wonderful that we have access to that in the Coachella Valley. Thank you so much, Sheenah, for taking the time to educate us on this really important condition.

Sheenah Fernandez: Thank you so much, Jamie, for having me today.

To learn more about Eisenhower Health's Glickman Cardiac Care Clinic and the services it offers, visit eisenhowerhealth.org/services/cardiology. Thanks for listening to Living Well with Eisenhower Health, healthcare as it should be. I'm your host, Jamie Lewis.