Caitlin Whyte (Host): Welcome to another episode of Flushing Hospital Med Talk. I'm your host, Caitlin Whyte. Today, we're joined by the esteemed Director of the Cardiology Division at the Medisys Health Network Flushing Hospital. Dr. Manuel Lopez will be discussing the important and increasingly prevalent health issue of heart failure.

Well, doctor, it is so great to have you on our show today. To start us off, we'll start pretty basic. What is heart failure?

Dr. Manuel Lopez: Essentially, it's when the heart is unable to meet the demands of the body, the metabolic demands of the body. Just by the title of the problem, the heart fails to provide enough blood to the rest of the body, and thereby producing symptoms, which can basically limit your functional status. And it also implies a lot of different issues that can come back and basically harm you in the future.

Host: And what are the symptoms of heart failure?

Dr. Manuel Lopez: So, heart failure, it's a broad syndrome. The common finding is generally swelling of the feet. You can have exertional shortness of breath. You can have trouble laying flat on the bed. You can have very limited functional capacity and patients tend to feel fatigued. So, those are the main findings that you're going to have.

Host: Now, when should you see a doctor about these symptoms?

Dr. Manuel Lopez: These symptoms generally tend to be insidious. They will be progressive. And I don't think that the waiting until you present with florid heart failure is the time to go to the doctor. Obviously, you have to go. But because heart failure is dependent on multiple risk factors, if you're following with your physician, an attentive physician will pick up on findings that can indicate heart failure and may somehow mitigate the progression of the disease. If you're experiencing shortness of breath, if you're experiencing swelling of your ankles, if you're having trouble laying flat on your bed, those are key features that would indicate a visit to your physician and/or cardiologist. It's important to do that because basically what's happening is that your body is becoming waterlogged. And it's going to limit your functional capacity. And in some cases, the water will start to build up in the lungs and you will then may require hospitalization.

Host: Well, now that we know some of the symptoms and what to look out for, I mean, what causes heart failure?

Dr. Manuel Lopez: So, causes of heart failure. There's a myriad of issues. And one would think that heart failure is a problem in and of itself, but it's usually the consequence of many other issues. And the things that basically will put you at risk for heart failure are the same symptoms that will cause the failure.

For example, if you have uncontrolled hypertension, if you are obese, if you have diabetes, coronary artery disease, chronic kidney disease, these are all issues that will basically increase the risk of you having congestive heart failure in the future. One of the bigger and most common problems we run into is coronary artery disease, and that one is when the arteries that supply blood to the heart become obstructed, the muscle itself will become weak. And basically, we try to revascularize. When I say revascularize, we will basically try to open up those vessels to improve the blood flow to the heart if it hasn't had any type of infarction. And infarction is when the heart muscle itself dies because of lack of blood supply. And that's the traditional name of the heart attack. So if you prevent that, your heart muscle will actually improve.

The key feature to keep in mind is that, in congestive heart failure, we are basically working with the heart and how well it pumps blood to the rest of the body. We look at something called the ejection fraction. The ejection fraction is the amount of blood that the heart can pump with each beat. A normal ejection fraction is greater than 55%. If you have congestive heart failure, basically, we can divide it into two different types. One is with preserved ejection fraction, where the ejection fraction is actually normal and you still have heart failure, and one with diminished ejection fraction where the heart muscle is weak. That issue can determine the different treatment strategies that we may present.

So if you have preserved ejection fraction, the cause of that type of a problem, for whatever reason, the heart muscle becomes stiff and is unable to relax, the muscle is able to contract, but is not able to relax and the water build up in the lungs, and you develop what's called congestive heart failure. In the weak heart, the heart is unable to pump. The blood will then back up into the lungs, and you develop water in your lungs, swelling of the ankles and shortness of breath. So in both scenarios, you are in heart failure, but the mechanisms are different and they may have different types of management strategies.

So to answer your question, what can develop it, if you have uncontrolled high blood pressure, that can weaken the heart. If you have coronary disease and you develop a weak muscle from a muscle that's not receiving enough blood supply, that can cause congestive heart failure.

There are other issues where you can have congestive heart failure. For example, if you have a stress cardiomyopathy, you have a relative who passed away quickly, and it is known typically as a broken heart syndrome. You can develop a bout of congestive heart failure and so on and so forth.

So, all these different risk factors that are easily mitigated can lead to heart failure, if not treated appropriately. And the top ones that you want to be aware of-- we'll repeat again-- is high blood pressure, diabetes, kidney disease, and high cholesterol. In addition to that, there are other people who have valvular diseases, which can also make the heart unable to pump blood adequately.

Host: So, Doctor, who is at risk of heart failure?

Dr. Manuel Lopez: Patients that are basically hypertensive, overweight, sedentary lifestyle, uncontrolled diabetes, people who smoke, people who drink because alcohol can also produce heart failure. These are different entities that we need to be cognizant of and treat them appropriately to avoid the progression of heart failure.

Host: And on that note, you just listed a few, but are there other conditions that can lead to heart failure?

Dr. Manuel Lopez: There are. And some of them could be immunologic where you have autoimmune responses, viral infections. If you, for example, have chemotherapy, some of them are toxic to the heart. If you, for example, are having a rapid heart rate, it's something called atrial fibrillation, that can make the heart weak as well. So, adequate control of these issues also help prevent the progression of heart failure.

Other things that have nothing to do with basically your actual health are social determinants of health. For example, people in the low socio-economic strata are also at increased risk, basically by the virtue of not seeking medical attention early and are more likely to develop heart failure than the general population.

Host: So, how then is heart failure diagnosed?

Dr. Manuel Lopez: So, heart failure is diagnosed with a thorough physical exam that is basically one of the hallmarks that you can use to trigger an investigation that's going to lead down a rabbit hole, so to speak, so that you can diagnose the problem. The main issues you're going to be looking for: exertional, shortness of breath, fatigue, swelling of the ankles. Some people may experience chest pain. Some people may present with palpitations. Females tend to present slightly later in life than men and may present with atypical presentations, just short of breath and other atypical presentations.

The primary diagnostic tool that we're going to use is an echocardiogram. And the echocardiogram is a sonogram of a heart, which will give us and demonstrate the ejection fraction. In addition to that, we're able to assess valvular function. We're able to assess how the valves are working, if there's any leaking. And it gives us a very clear insight as to how the heart is actually working.

Other techniques we may use as an electrocardiogram. And basically, these are the main diagnostic tools we'll use. If you present in a situation where congestive heart failure is suspected, your doctor may request a blood test called NT-proBNP, which is a marker of fluid overload. And that can also be used to assess the presence or not of congestive heart failure. It doesn't necessarily exclude it, but it helps us guide the workup to establish whether or not you have congestive heart failure.

Host: Well, once we know what we're dealing with, how is heart failure then treated?

Dr. Manuel Lopez: Heart failure is very broad, so to speak. There are patients that have a mild form of heart failure. There are patients that have moderate forms, and there are patients that have very severe forms of heart failure. And based on those findings, we have a category system and we can establish their functional class.

So, the patients that have very mild forms are usually treated with-- obviously, the first thing we want to do is lifestyle modification. That's diet, exercise, weight management, blood pressure control, diabetes control, and try to mitigate unnecessary risk factors such as smoking and alcohol. That pretty much applies to all patients.

Then, after that, we would institute a myriad of medications, which would include medicines from different groups, beta blockers, ARNIs, and diuretics. These medications help the heart work better. Some of them actually improve your survival, and they can improve the function of the heart and make people feel better. So, those are the primary goals that you want to achieve.

I always tell my patients that you live as long as your heart is good. If your heart is weak, you're not going to live too long. So, we want to improve the function and these medications achieve that, because frequently they will be on a number of medicines and they'll be reluctant to take their medicines. They'll skip doses here and there, and that's something you want to try to avoid. A person who has congestive heart failure may improve their ejection fraction from a very low ejection fraction to a near normal one in some cases on medical therapy if they adhere to the dietary restrictions and they adhere to their medications. So, it is important for you to follow the directions of your physician.

There are other procedures which are more invasive, and that could be placing a defibrillator. And sometimes we do something called resynchronization, where the pacemaker will actually help the heart pump better, because it's enlarged and it'll synchronize the ventricle to work more cohesively. If you have any type of valvular lesions, if you have any type of blocked coronary arteries, repairing those can improve the heart function. So, those are other considerations that we may have.

Host: And doctor, can heart failure be prevented at all?

Dr. Manuel Lopez: It can. And here, we'll return to the beginning of the conversation, treating underlying risk factors, which include high blood pressure, diabetes, cholesterol, and keeping a healthy lifestyle, diet, exercise, and weight management. These are key features that are going to prevent heart failure in the future. Can it erase all of them? Perhaps not, because there are some that are not dependent on that. But by and large, you will get a lot of bang for your buck by doing those, following those measures. And it's something that is not difficult to do and you should be doing anyway.

Host: Well, on that note, my last question for you today, Doctor, are there any lifestyle changes we can apply to lower the risk of heart failure?

Dr. Manuel Lopez: The National Institute of Health has a diet called the DASH Diet, and it stands for Dietary Approach to Stopping Hypertension. And basically, it's not a diet per se, it's more of guidance where you would do things that are kind of obvious. Decrease your red meat intake, decrease the full fat dairy products, decrease or eliminate your sweets, decrease your salt intake, keeping it down to below 2 grams daily. And you want to increase your intake of vegetables. You want to increase the intake of fat-free dairy products. You want to increase fish intake. And you want to basically have healthy nuts, which would be almonds, walnuts, things of that nature. You can go online and pull up this DASH diet. It's very helpful.

You want to adhere to the exercise recommendations from the American College of Cardiology, which include about 30 minutes of exercise, five times a week, about 150 minutes a week. And those are recommendations for a minimum. If you can do an hour, that's even better. Those are the things that you want to do. You want to decrease, stay away from smoking; stay away from alcohol, and obviously try to control your diabetes, cholesterol, and the blood pressure. And you can do this with your primary care physician very easily. And goals are set for you to achieve and they're pretty reasonable. In addition to that, taking all of your medication on a regular basis will also help prevent the progression of heart failure.

Host: Thank you, Dr. Lopez, for being a guest on our show today. And thank you for listening to this episode of Flushing Hospital Med Talk. We hope today's conversation has provided valuable insights into heart failure and how to better manage your heart health. For more information about the services Flushing Hospital offers, visit our website at flushinghospital.org/podcasts.

 Content of this podcast is intended for general information only and is not a substitute for professional medical advice. Always consult with a healthcare provider for personal advice.