Deborah Howell (Host): Today is all about matters of the heart. Heart failure occurs when the heart muscle doesn't pump blood as well as it should and shouldn't be confused with a heart attack. Leading an advanced treatment can help improve the symptoms of heart failure and may help some people live longer.

Today our guest is Dr. Andrew Yoon, Medical Director of Heart Failure at the Memorial Care Heart and Vascular Institute at Long Beach Medical Center. He's with us to explain how Memorial Care Heart and Vascular Institute at Long Beach Medical Center helps those with heart failure live longer while preserving their quality of life.

Hello, Dr. Yoon. So glad you're with us today.

Andrew Yoon, M.D.: Thank you for having me.

Host: All right. It's our pleasure. And let's dive right in. What exactly is heart failure and how is it different from a heart attack or other heart episode?

Andrew Yoon, M.D.: Well, heart failure is when the heart is unable to pump blood sufficiently to the rest of the organs in the body. And there are a lot of different causes of heart failure. One is certainly a heart attack. Coronary artery disease is very prevalent in the United States of America. And about 50 percent of cases of heart failure are caused by coronary artery disease and that sometimes includes heart attacks.

But heart failure can also be caused by other things, such as, untreated high blood pressure or untreated atrial fibrillation. There are a variety of conditions which can also cause heart failure that are unrelated to heart attacks.

For example, there are certain infections which can cause heart failure. I think a lot of people are pretty familiar with COVID, with the pandemic and everything, that sometimes COVID virus can cause myocarditis, which can cause the heart to get weak. But also there have been situations where on rare occasion the vaccine to prevent COVID, can also cause a myocarditis or the heart to get weak. But there's also other things as well which can also cause heart failure such as substance abuse, such as alcoholism or, methamphetamine abuse, which we see a lot in the community. But it can also run in families too. It can also be genetic.

Host: Okay, that's a variety of reasons. And who is at highest risk of heart failure?

Andrew Yoon, M.D.: As we're learning more and more about heart failure, there's actually different types of heart failure. There's two broad categories. There's one called heart failure reduced ejection fraction, and heart failure preserved ejection fraction.

And we know certainly that for people with heart failure with preserved ejection fraction, that there are a variety of risk factors which can predispose you to this, such as older age, obesity, untreated high blood pressure. So these are all factors which can predispose you to developing heart failure.

Host: What about just sedentary lifestyle?

Andrew Yoon, M.D.: Absolutely, absolutely. Exercise, physical activity is strongly correlated with cardiovascular outcomes, so that's clearly a factor.

Host: Okay. And how can someone recognize the early signs of heart failure?

Andrew Yoon, M.D.: Typically, heart failure presents with progressive feelings of shortness of breath and fatigue and it can be tricky because there are a lot of things that which can cause shortness of breath and fatigue such as asthma or someone who is a chronic cigarette smoker. But as these symptoms go on, patients with heart failure may notice that they're developing fluid accumulation known as edema in their legs, as well as shortness of breath that is more profound when they're lying down and sleeping at night.

So these are all signs and symptoms that you might be developing heart failure.

Host: Okay, got it. I wanted to ask you, Doctor, what are the different stages of heart failure and how do they progress?

Andrew Yoon, M.D.: The earliest stage of heart failure is actually people who are at risk of developing heart failure. So this is people who, for example, have coronary artery disease or high blood pressure, but do not yet have heart failure. But we certainly know that they're at risk of developing heart failure.

So our treatment guidelines and algorithms, suggest that we should treat these people aggressively so that they don't develop heart failure. And as heart failure progresses, as you start to slowly develop symptoms, then yes, we get more aggressive with our treatment strategies.

Host: Okay, that makes sense. And what are the symptoms of heart failure and when do they start to become noticeable?

Andrew Yoon, M.D.: Symptoms of heart failure include shortness of breath or fatigue, typically initially with exertion. That meaning, such as when you're walking, either outside or when you're walking up a flight of stairs. People usually, tell me that they start to feel a little winded. And it's when they start to develop more of that shortness of breath, especially when they're lying down sleeping at night in a flat position, or when they start to notice the fluid developing in their ankles, that's when they know that there's something going on.

Host: Yeah, is there also a tightness in the chest?

Andrew Yoon, M.D.: Certainly some patients do have tightness in the chest, not all patients, but that is a common symptom as well, yes.

Host: Okay. Now the key question and really why we're doing this podcast is when should patients seek medical intervention for potential heart failure symptoms?

Andrew Yoon, M.D.: Anytime someone develops symptoms of shortness of breath or fatigue, as a cardiologist, that's something that I would be concerned about. And it might not be the heart. Again, as I mentioned previously, there are a lot of things which can cause shortness of breath or fatigue.

But if it's persistent or progressive, then for sure, one of the most important things we do want to check is the heart to make sure that it's okay.

Host: And what treatment options are available for managing heart failure?

Andrew Yoon, M.D.: Going back to what I mentioned before, there are actually two types of heart failure. And, to differentiate between the two types of heart failure, you'll need a echocardiogram, which is an ultrasound of the heart. And what the echocardiogram is looking at, is how strong is your left ventricle.

We measure something called an ejection fraction. Ejection fraction is how much of the blood within the left ventricle gets pumped out of the heart to the rest of the body with each heartbeat. And a normal ejection fraction is 55 percent or higher. Now, there's two types of heart failure, broadly speaking.

There's heart failure with reduced ejection fraction, which is when the ejection fraction is 40 percent or less, or heart failure with preserved ejection fraction, which is when the ejection fraction is 40 percent or higher. And the medications that we use to treat, depending on whether that ejection fraction is 40 percent or less or 40 percent or higher, are different.

But, for heart failure with reduced ejection fraction, that's 40 percent or less, we use four different classes of medication primarily, beta blockers, Entresto, spironolactone, and SGLT2 inhibitors.

Now for patients with heart failure preserved ejection fraction, that's 40 percent or higher,

we use Entresto, spironolactone, SGLT2 inhibitors, and a fourth class of medication which you've probably heard a lot about, the GLP1 agonist, such as semaglutide, also known as Wegovy, Ozempic.

Host: Getting a lot of press these days.

Andrew Yoon, M.D.: Yeah, very hot medication, but it has incredible effects on the heart separate from the weight loss, separate from, you know, its ability to improve obstructive sleep apnea or, things like that, or improve diabetes. It's also a very, very powerful drug for treating cardiovascular disease as well.

Host: And how recent, has it been around for five years now?

Andrew Yoon, M.D.: GLP1 agonist, they've been around for quite a while, about 10 years or so as far as I'm aware with the research, but it's only been very recently that we've recognized its powerful profound cardiovascular benefits.

Host: Got it, okay. Let's get more specific about how does the Heart Failure Clinic at Long Beach Medical Center help patients with heart failure?

Andrew Yoon, M.D.: Well, we have two heart failure specialists, myself and my colleague, Dr. Kevin Shaw. We are both Board Certified in Advanced Heart Failure, which is a further certification beyond just general cardiology. And so we also have a team of nurse practitioners who are also heart failure specialists as well.

So we really have a team of expertise focused not just on cardiology or other fields of cardiology, but specifically for the heart failure patient.

Host: Okay. Is there anything you'd like to add, Dr. Yoon, before we wrap up?

Andrew Yoon, M.D.: If there's anyone who has any questions about their cardiovascular health, by all means they should contact their doctors to get their hearts checked out.

Host: Absolutely. Well, thank you so, so much, Dr. Yoon, for your time and your expertise today. We really enjoyed having you on the podcast.

Andrew Yoon, M.D.: You're very welcome. Thank you for having me.

Host: To learn more about the Heart Failure Clinic, visit memorialcare.org/lbheart, or you can call 844-662-6484. And to listen to a podcast of this episode, go to memorialcare.org. That's all for this time, I'm Deborah Howell. Have yourself a terrific day.