Transcription:
Understanding Heart Failure

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Helen Dandurand: According to the CDC, about 6.2 million adults in the United States have heart failure. The way to help combat this is to become more educated on what heart failure is and how it can be treated. And that is exactly what we're going to learn and more about today.

Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Cheryl Rogers, a nurse practitioner at Riverside's Heart and Vascular Institute, to dive into everything you need to know about heart failure.

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Helen Dandurand: And we're back with Cheryl Rogers. Thank you for joining me today.

Cheryl Roberts: Thank you so much for having me. I'm delighted to be here.

Helen Dandurand: Good, good. So, let's jump right in to heart failure. So, let's start with the basics here. What is heart failure?

Cheryl Roberts: So, heart failure actually is a term that is used to describe the heart's decreased ability to pump oxygen around to the lungs. It's known as a syndrome and it actually is something that can get a lot worse over time. There are a couple different types of heart failure. Actually, we have two sides of our heart. We have the right side of our heart and the left side of our heart. And they work together, but they can actually fail individually as well as at the same time. So, it's definitely a condition that is a little bit scary to people. But I'm here today to hope to plant some hope and some understanding to know what we can do to deal with this.

Helen Dandurand: Got it. So, what causes that?

Cheryl Roberts: There are so many different causes of heart failure, and that's what makes my job very interesting and complex and several things that our heart does for us. But the causes to weaken the heart actually come from things like arrhythmias. People are familiar with if they hear the term atrial fibrillation or atrial flutter, which is just the top of your heart beats separately at a different pace than the bottom of your heart. So, that can make that muscle very confused and get weak over time. Also, sudden cardiac arrest is another term that people are familiar with out in the community, sometimes because of television and whatnot. But obviously in that situation, the heart is very sick and there's something that's stopped its ability to function and pump that blood. Some people have trouble with heart valves. We have five valves in our heart. Heart valves are an issue for people. We have valves that pump blood to the heart that bring blood back, let it into the heart, and those valves also can weaken over time. So, those cause problem with fluid retention, fluid overload.

People are very familiar sometimes with lung diseases. We have COPD, asthma, those types of things that actually put a stress on the lungs, so the lungs are connected to the heart and they all go together, that can cause heart failure. Pulmonary hypertension is another thing, which is a blood pressure in the lung that causes issues. Regular old hypertension, which is what we're all familiar with, high blood pressure, that's actually one of the number one causes of heart failure issues. Liver problems also can lead to heart failure, malnutrition, alcohol abuse, drug abuse, and then stress, which we're all familiar with stress. So, several causes that can play together individually as I listed, or sometimes people are dealing with multiple of these problems.

Helen Dandurand: Yeah. Well, that runs the gamut of so many things that could lead to that. So, I guess that's like stressing the importance of making sure you stay on top of your health and knowing what's going on. But with all those things, what are the common symptoms that people have for heart failure?

Cheryl Roberts: Yes. So, sometimes these symptoms that I'm going to list off are very subtle and we would throw them off to just, "Oh, well that's just a different kind of a symptom" or "I'll wait and see how it goes." But most often what people are used to experiencing is shortness of breath. A lot of times shortness of breath with your normal activity, which, "I used to be able to go up the stairs and not have to take a pause at the top because I can't breathe." Or oftentimes people have trouble when they lie down to sleep. And they don't realize they're having night awakenings. And it's like, "Why am I waking up?" But they're not cognizant to understand, "Oh, it's because I can't breathe." So, that's a typical symptoms, shortness of breath with activity.

Generalized fatigue and weakness. Now, we all run a really busy life and our calendars are full and we're running sometimes 18 hours plus a day. So, who's not tired, right? Who's not fatigued? And honestly, that's a lot of things when patients come to see me as we go retrospectively back to the last one to three or even six months, they'll identify, "I have just been tired."

A lot of times patients do feel their heartbeat just rapidly taking off. And it's an irregularity, but it goes away. It's like transient. So, they're like, "Oh, that was weird." You know, and then they go on with things. But that's that atrial fibrillation starting to sneak in. A lot of times it's decreased ability to even exercise. If you used to be able to go to the gym and do your walk or do your lightweights or whatever, and just for whatever reason, you're like, "Darn. That is really hard for me now."

Sometimes it's as simple as a persistent cough. Now, anytime you get an upper respiratory infection or something like that, I don't want anybody thinking "I have heart failure." But it's as an individual symptom that can go along with some of these other things and just the wherewithal to go, "Wow, these things together just don't seem right. Maybe I need to go to the doctor."

One other thing that people deal with, it's one of the symptoms, is a rapid weight gain. Sometimes patients come to me and say, "I've gained 15 to 20 pounds in the last month." That's not really feasible in fat weight, but fluid weight comes on. And that's another thing. It's like when they come and they're just full of fluid everywhere. A lot of things that people are familiar with are swelling to your feet, sometimes to the abdomen, that's a sign of fluid imbalance, fluid overload. Again, going back to the heart's decreased ability to pump oxygen to the lungs creates these symptoms that come on.

Sometimes it's nausea and lack of appetite because you're so full of fluid in the abdominal spaces that you don't have an appetite or hunger anymore. And then the other things, sometimes you can have decreased concentration or decreased alertness. And then, obviously, chest pain also can be a symptom that the heart's in trouble for whatever reason.

Helen Dandurand: Wow. So, that's a lot of symptoms. Some things that you would think of when you think of heart, some things you might not, so really good to know. And moving on from that, what are the treatment options for heart failure?

Cheryl Roberts: So, the goal always for treatment is to improve your heart function and improve its ability to push blood around so that, we call it, perfuse your organs, or just to get oxygen everywhere. The biggest, easiest thing to do, and I don't mean to say easy, but in thinking and putting thoughts together, are lifestyle modifications. So, think about moving more. You don't have to be gymnast or a weight lifter or somebody at the gym pounding in at 4:00 AM every day. Really, it's about moving blood through your body, using your muscles, walking as you can. The lifestyle modifications are key. Treating your high blood pressure. Don't forget your high blood pressure pills. Don't let that appointment with the doctor get away from you and now, it's six months or a year or don't stop taking your blood pressure medicines because, again, high blood pressure is probably the most treatable key in preventing heart failure because you want to keep the blood moving through your body well, not at high pressures. And that's just really helpful all over to all of your organs and that.

So, along with lifestyle modifications, I would be remiss not to say healthy diet. And not even diet, healthy eating. Yes, so more fruits and vegetables, more lean proteins, less carbohydrates, less of the white stuff; that truly now the research is coming out, they're showing like it's even a plant-based diet that people are saying is very helpful. Now, a lot of people that just turns off right away. And you don't have to do plant-based. But a lot of times when I see people in the clinic, it's hard to change habits, right? So, I talk about adding in good things before you actually try to get into the, "I can't have this, I can't have that." And it's simply more fruits and vegetables and more proteins and, along those lines, I say eat from the rainbow. That's really an important key. More color is better. If you're eating only green or only white, or not even any colors of the rainbow, that's a big thing because overall heart health starts with nutrition.

Also, the treatment options that we have. We know now based upon a lot of research, medication management is key. So when patients come in to see me, I'll say 50% of balancing your health is right medicines, right time, not missing medications. And the other 50% is what you can do for yourself. Moving more, eating well, taking care of yourself, rest, decrease stress or find a stress management habit, things like that. And as far as medications, the research is showing we do have gold standard medications now. It's a better time than ever, I would say, if you're going to suffer from something like this, that we have the right drugs, we have the right medications that we can offer to help rebalance everything.

And then, along with the heart pump function, you know, there are extra things that sometimes people need. Sometimes people need a pacemaker. If we talk about those arrhythmias, we have therapies like that for pacemaker, defibrillator. We actually have a very exciting therapy that's called the CardioMEMS. And what that is is a small little chip, I'll call it, that goes in the vessel of the lungs. And what that helps us do, it transmits fluid pressures in your chest. So, that transmits to a website that we go on and we can actually see real-time, day-to-day, are you collecting fluid in your chest? Are you dry? Are you balanced? And that really helps us see things even ahead of time because it can help ward off a heart failure exacerbation.

Helen Dandurand: That's so interesting.

Cheryl Roberts: It's really cool. It's very, very neat. We have, oh my goodness, I think about almost 25 patients in the community who are implanted with the CardioMEMS. So, it's really cool. It's a really nice therapy. It helps prevent heart failure hospitalizations. I tell my patients, it helps us know the right thing to do, because we can actually see into your chest rather than guessing by your symptoms, which is challenging.

I was remiss to start out and say 5.5 million people are affected by heart failure and, every year, half a million people are newly diagnosed with heart failure. Those are some staggering statistics. And so, this awareness is key. This understanding the domain and what all we have to offer. And some people actually need heart transplants, because their heart is so sick. And we have those options too. We are connected with all of the hospitals in Chicago. We have places to refer to if that truly is what's happening to you. So, I always tell my patients who come in and they're so scared and then I say, "There is hope. There are therapies. There are things that we can do. So, don't lose hope." And when they come in to see me, I say, "I don't say heart failure. I say heart function and we're going to rebalance your function." So within medicine, now is the time that we have a lot of therapies and a lot of things that we can do for you.

Helen Dandurand: Absolutely. We're going to take a quick break to talk about heart care at Riverside.

The Riverside Heart Team is a skilled group of experts specializing in treatments that heal hearts throughout the region. Working together, the Riverside Heart Team is committed to preventing heart disease by bringing the latest, most effective treatments to Kankakee and the surrounding communities.

For more information about Riverside Heart and Vascular Institute, visit riversidehealthcare.org/heart. At Riverside, your heart's in the right place.

All right, so jumping back in, I think you kind of touched on this, the last one, but I don't know if you'll have anything else to add here, but what can I do to prevent this or manage it, I guess.

Cheryl Roberts: Absolutely. I wanted to circle back to that, because I put it on feel key. It's like cause and effect. So, life balance is really important. And we know in today's world it's really hard to be in balance. So, I talk specifically even one or two positive changes that you can make can make a big, big difference in your overall heart health. And I specifically specialize in the nutrition part of it. As I said, putting more fruits and vegetables into your diet, controlling your blood pressure, monitoring your blood pressure. I know a lot of times, people are on blood pressure medicines and I say, "So, how's your blood pressure running at home?" "Well, I don't know. I don't check it." And hypertension is what they call the silent killer. So, that's why you don't necessarily until it's really bad, feel bad, having high blood pressure. But high blood pressure is one of the first things that hurts those valves in your heart, as I spoke of before. So, that's why managing your blood pressure is really important to help the health of those valves and nutrition from a standpoint of really why I feel passionate about nutrition, especially if you're older, getting heart failure.

Malnutrition is a big deal. And people can be malnourished and not recognize it. When I talk about nourishment, I think about the health of the cells, keeping your cells healthy. And that is more fruits, more vegetables, good proteins, having that cell strong so things can't necessarily attack it and/or, when we start medications and stuff, you're in a good, strong place for them to work well for you.

Helen Dandurand: Absolutely. I think so many people, they associate eating healthy with just weight loss. And they're like, "Well, if I don't need to, I don't need to," you know. So, realizing that it has to do with so much more. It has to do with your cells, it has to do with making sure you stay healthy longer is so important.

Cheryl Roberts: Right, right. I know I try to put things in a positive perspective instead of deprivation perspective, because it's hard. We're already stressed and now come in, "I can't do this, I can't eat that. I can't do this." And so, that's why I like to talk in those terms and say, "Let's look at what we can do. What is value-added benefit?" And because of the risk when you get older, your body doesn't necessarily tell you what it needs, that's just a normal aging factor. So, we add things in and say, "Eat more vegetables." Oftentimes with older folks, sometimes we talk about the Ensure or Boost or Glucerna or something like that for diabetic patients, just to keep them well-rounded and give them some fights in their cells.

And the prevention factor really, it's a mindset as much as it can do and should do type of things. So, we also know preventing heart failure along with the heart health, obviously lower salt diets are very important. We live in a world where the fast food industry and the grocery stores and that. How do you preserve things and make them taste good? You throw a lot of salt on it. So, that's a negative impact in the heart function world and it makes you retain fluid on a greater level. So, that's, again, to that let's eat the fruits and vegetables, let's pick the less processed things, let's pick the lower sodium things, so we can make everything work the best for us.

Helen Dandurand: Absolutely. And when you add those things in, then you don't miss the other things.

Cheryl Roberts: Correct. You know, it's amazing how when you talk about adding good things in. When we eat more whole or healthy, it's amazing how our taste buds wake up. It's amazing. I have patients all the time that will tell me they've gone through the journey and they're, you know, a year or two into it, stable, doing well, and they will recognize immediately if they take a bite of something that has more salt in it than needs to be. So, those things are very, very important as we desensitize our bodies to things that weren't healthy that we didn't even know weren't healthy. And overall, that helps your blood pressure, that helps everything. And then, we do talk about with heart, not over excessively drinking fluids. Although that's a finer balance and not everybody is on a strict, strict fluid restriction, but sometimes someone will say, "Oh, I know my aunt has heart failure and she can't drink this, or she can't drink that." Those are the individualized things that we work on. So, we, again, have the right thing for the right patient at the right time.

Helen Dandurand: Got it. So, what are the important questions that if you maybe suspect you have this or if you do have this, that you should be talking with your provider about?

Cheryl Roberts: I think, first and foremost, honesty is the best policy because oftentimes when we go into the doctor, there's subtle things in that list that I gave you. Lack of appetite, just tired all the time, a little bit short of breath when I go up the stairs. Sometimes we don't disclose enough to our doctors. I always recommend if you know you're going to a doctor appointment with problems, you write down three or four things because it's so easy for all of that to get past you in the short time of the appointments, and you forgot to tell them, or you forgot to say this.

So, the other thing I find out with the older generation who I love and adore, they have been keyed in to toughen it out. There are patients that just tough it out and I say, "It's not the time to tough it out now. You know, let us know how you're doing, so we can meet you where you're at and figure out if we need to do more things."

Medication compliance, as I mentioned, that's key because oftentimes we might let a prescription run out and be out of it for a while. And when you have heart function issues, if you make a break in your medications, like you're out for however long, it's very hard for that heart to compensate and get back to baseline when you get them filled. Call your doctor's office. Oftentimes, you know, I have patients say all the time, "I called for a refill," or "The pharmacy's supposed to call for a refill." I feel like now more than ever, you need to be your own advocate. So, definitely follow whatever the directions have been as far as those refills, but don't let more than a day go by and follow up, "Did you get my refill request? Do you know where it's at?" Because it's tenuous. And those are just situations now that we're dealing with.

The goals of management for heart function issue to talk about with your doctor, blood pressure control, weight balance, I call that. Because at a certain age, obviously, we talk about, "Yeah, you should lose weight." But when that nutrition comes in factor, you don't want to be malnourished trying to lose weight. So, we want to gain balance with eating the right things.

Exercise, again, I say exercise responsibly and that's not out at the gym every day, but that's actively moving. If it's even around your house and you're going to walk three laps around your house, or you go to the store and you make sure instead of getting the electric cart, if you can walk the first couple aisles, you know. Anything, any kind of movement is better.

And then, honestly, report your symptoms, if you're starting to have symptoms. And then, awareness of your family history, because sometimes we don't know all of that, and that's a big deal as you come into your overall heart health. So, what's my family's heart health? And we can't avoid sometimes there are preventable things and unpreventable things and the genetics are one of the things we cannot change.

Helen Dandurand: Right. Absolutely. All right. So, I guess my final question here is what does the Heart Failure Clinic here at Riverside do? And I think you kind of answered that, like I said before with, well, everything we've talked about, but is there anything specific we should know that is special about it?

Cheryl Roberts: Well, the Heart Failure Clinic, actually we are a heart failure-accredited program from the ACC, and we provide-- I say it to my patients like this, "You have your cardiologist. I work with your cardiologist on your treatment plan, and you come to the heart failure clinic for extra support, monitoring, lifestyle management. What are the things that we can help you with? Outreach to other things that you might need at home that I'm able to help with." And a lot of times, it's people coming out of the hospital, brand new diagnosis, or "I thought I was doing everything right and it didn't work. I still ended up in the hospital." And the heart failure clinic, we dive into those things to help get you to the right place, with the right therapy, with the right treatment. Oftentimes, people need other testing, a sleep test. I've negated to say untreated sleep apnea is a cause of heart function issue. So, oftentimes people haven't able to get those tests.

Again, medication education is key, understanding, "Okay, well, Cherie, you gave me all these meds. What do they do? What are they supposed to do? And how do I know if they're working?" That's where my clinic comes in to help with the heart doctor, making sure especially if you've come out of the hospital that your first three months we're getting you back to stabilization and baseline. And the heart failure clinic manages the CardioMEMS program with the cardiologist. So like I said, I have about 25 patients that have implantable CardioMEMS, so checking them often and making sure we prevent hospitalizations. And at the least sometimes, we know that it's not your heart that's the issue when we have the CardioMEMS. So, that's really cool. That's very, very nice. Monitoring lab work, lab chemistries are important when you come out of the hospital, the things that we did or changed, we need to make sure that they're still okay, how do we get back to your optimum dose, lots of things, add-on therapies. There's just a whole lot that goes on in the heart failure clinic.

Helen Dandurand: That's amazing. I mean, really bridging the gap. I think that sometimes you can feel a little lost or scared not knowing who to ask these questions to or what exactly is going on with your body. So, that's amazing that you guys are there for those patients. That's awesome.

Cheryl Roberts: Yeah. We love our patients.

Helen Dandurand: Yes. Do you have anything else you want to add?

Cheryl Roberts: I just think that, overall, what I tell my patients when they come in, you know, having heart failure or heart function issues is not a no-hope situation. It definitely lets us help you find the balance that's needed to address your individual symptom and your individual problem. Often, patients might have to go for a procedure called a TAVR, which is the helping of the heart valves. We have a couple of doctors locally that are fabulous, that work with that. We provide that within the community now. Some people need open heart surgery. We have a full open heart surgery program, great people that work within that. I'm very proud of all of our cardiologists and I enjoy working with them, so we really can provide holistic care to people in our community.

Helen Dandurand: That is so great to know. Well, thank you so much for joining us, Cherie. And thank you listeners for tuning into the Well Within Reach Podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org/heart.