Helen Dandurand (Host): Hello, listeners, and thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Helen Dandurand, and joining me today is Heart Failure Clinic nurse practitioner, Cheryl Rogers. She is out at our Bourbonnais campus. We'll be live with Cheryl after this message.

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Host: And we are back with Cheryl Rogers. Thanks for being here today.

Cheryl Rogers: Thanks so much.

Host: Yeah. So today, we are going to talk about the misunderstood symptoms between heart failure and asthma, which is something very interesting that I did not know was a thing until we started looking into this. So, I'm excited to talk about it. But before we do that, could you tell us a little bit about yourself?

Cheryl Rogers: Absolutely. Thank you for this opportunity to be here today. So, I am a nurse practitioner, certified in adult-gerontology and specifically certified in heart failure care, and I run the Heart Failure Clinic under the medical directorship of Dr. Vijay Haryani. We treat all patients in the Cardiology group with all physicians from the cardiology group who specifically have problems with their heart function that is deemed medically by the diagnosis heart failure.

Host: Okay. Awesome. So to start off with the questions more about this topic, heart failure is often seen as a condition that affects older adults. But we're seeing younger patients diagnosed. What factors do you see that are driving these trends? 

Cheryl Rogers: There are actually several things that drive the development of heart function issues and heart failure in particular. And we definitely are seeing as time goes on, younger and younger people diagnosed with heart failure.

Heart failure is caused by several things across several different conditions. We generalize it to say worsening cardiovascular health. What does that mean? Uncontrolled high blood pressure, obesity; sleep apnea is one that's new to people, they're not familiar with that as much; poor diet, poor control of stressors, which we're all under stress a lot.

And any combination of those things together can line up to be very hard on your heart and cause issues. There's two different types of heart failures actually, but several different causations. So when a person comes in with a new diagnosis of heart failure, we dive into those things real comprehensively to say, "What brought you here? What were the things happening to you? What were your symptoms prior to being diagnosed?" And oftentimes, this diagnosis comes after hospitalization because all these things can mimic other things in the list that I mentioned.

Host: I feel like failure seems like a scary word, but it is more comforting to know actually what that means, and that it's just like the function maybe not working as well as it could. So, how do lifestyle, including diet, exercise, and you already said stress contribute to younger individuals developing that then?

Cheryl Rogers: Well, and just to dovetail one moment on the last part, when people sit in front of me, they are scared. "Someone told me my heart is failing." So, we think of transplant. We think of death. We think of all those things. And what I do and connecting with people, it is about saying we're talking about your heart function and the degree of impairment to your heart function. And we're able to go into these things deeper to say, "Oh, well, this thing probably contributed here," or, you know, "These are the things that we can do." And I'm a person who says, "Let's take small things to make big changes."

So especially regarding lifestyle, that is a large part of what I deal with and what I talk to people about, because high blood pressure is called the silent killer for several reasons, right? And we don't always know. We have high blood pressure. And then, once it's diagnosed, we look at, "Well, how can we treat high blood pressure?" Obviously, a great part of the treatment is medicines. However, I'm a firm believer in holistic, "Let's make food your fuel, make food, your medicine. Let's see what things we can modify and change because stress causes high blood pressure," right?

So, we look at techniques/ what are things that are stressing you? How can we help with things to make you breathe easier? And so, that stress isn't so detrimental and coming along after that, obviously, the food that we eat, like I said, makes a big difference, as does exercise, eating the right kinds of foods, those types of things. And sometimes those together are so overwhelming for people to think. Because by the time they come to me, they know, "I'm sick. I am in trouble." And so, I try to take them on the journey and look at different things in different ways. Not being a hundred percent perfect in everything, but let's look at some ways we can make some small changes.

And it is amazing to me. That's why I love what I do. And making relationships with people and helping them in that journey and recognizing, "Wow, all I did right now was this piece and I can't believe how different I feel." So as life gets busier as stressors come more down on us no matter what age, but especially, a younger age, we are seeing the negative effects of uncontrolled high blood pressure, uncontrolled sleep apnea, obesity, eating, things like that. They definitely can play a part into your overall health risks and end up in a heart failure episode left unchecked, untreated.

Host: Yeah. And I think, as young people, you think I can do these things right now? "It's okay that I'm stressed and it's okay that I'm eating this way, because I'm young." But those things really do have effects. So, it's really a good thing to keep in check and keep in mind. Are there also kind of genetic or hereditary factors that make younger patients more susceptible to heart failure?

Cheryl Rogers: Actually, there are subsets of genetic conditions, we call them familial traits that can predispose someone younger, like very early to heart failure. And oftentimes, those are caught by the parent or grandparent being diagnosed. And when we identify that in an older person and have those genetic tests, then we definitely test the families. Those are a little bit more on the rarer side, genetic or hereditary factors. However, one thing I hadn't mentioned prior, but diabetes is a big risk factor for heart function issues, cardiovascular disease, we call it blockages in the heart, damage from uncontrolled diabetes can take away the diabetic's pain sensors in the heart artery so they can have a heart attack that's almost sometimes silent or presents differently than the person, non-diabetic person who's very aware, "I have crushing chest pain, I have jaw pain. It's radiating down my arm." Those are classic.

And I think we've done well over the years with people recognizing I need help. But when we have these other, we call them comorbidities, conditions like uncontrolled or undiagnosed, uncontrolled sleep apnea, diabetes, cardiovascular disease, you know, high cholesterol, all those things, they can come together in a picture that is very significant and can very much cause a lot of heart damage.

Host: Got it. What would you say with those things are some early warning signs of heart failure that young people should be aware of? I know you just mentioned like more heart attack, kind of symptoms, but just things that we should be aware of for heart failure and how can they maybe differentiate them from other conditions?

Cheryl Rogers: That's a great question. A lot of times, when I meet patients for the first time and we go back because hindsight's 20/20, right? And I'll say, you know, in my appointment, "So, tell me what was happening the month or two prior to you coming to the hospital." And a lot of times it is kind of a generic, "I just didn't feel well, but I couldn't put my finger on it." And some of that I attribute to stressors, to busy lifestyle. We don't take the time to kind of key in. Because then with some further questioning, they can say, "Well, yeah, I kind of noticed I couldn't walk as far as I had been in the grocery store," or "Whenever I laid down to go to bed, my heart was racing and I thought I was just stressed," or "I just thought it was a bad air day outside. And I couldn't breathe very well." And we tend to just let those things go until we can't let them go. So, that's one thing. They just can't put their finger on it.

As I just alluded to arrhythmias or irregular heartbeats. Now, sometimes there's a phenotype of people that are very in tune and they're calling all the time, "I had a skipped beat," we do that. But then, there's times people ignore them because they don't have time, they don't want to think about it, and it went away. So, it's really about overall just pausing to say, "Oh, well, this is not a normal thing. So, where do I go next to have that figured out?" Lots of different other causations, sometimes anemia can mimic heart failure in and of weakness, tiredness, breathlessness. But that cause is because you don't have enough hemoglobin circulating around because of an anemia, which is low hemoglobin.

So, that can throw things, you know, like a curve ball. I already discussed diabetes out of control. And then, sometimes asthma comes into the picture. "Oh, we thought I had asthma," and things like that, which we'll dive into a little bit more. So , there's many factors that go into it.

Host: Yeah, that's really interesting. What challenges are there that younger heart failure patients face compared to older ones, particularly regarding like the diagnosis, treatment, lifestyle adjustments?

Cheryl Rogers: Yeah. A lot of times, a younger person has a full-time job. And outside of their full-time job, they have a family things that are taking their time and their energy. And once you've had a heart failure diagnosis, it's a bit of a redesign and looking at, "Okay, where can we insert the healthy things that you need? How can we help keep you on point with the right medications at the right time?" And monitoring and slowing down a bit as you can, understanding, you know, it's key to their life. They want to work, they need to be at work. Sometimes they have to take a pause from work, depending on how significant their heart function is decreased, until we get them on the good medical therapies that improve their heart function. And it is about-- I call it like a rebalancing phase that's anywhere from three to six months, sometimes longer because of the lifestyle changes. It's not difficult per se for someone to say, "These are the meds you need to take. Take them like this and go about your business." There's just more layers on top of it. And that's why I appreciate the Heart Failure Clinic because we're given the time within the specialty to dive in a little bit deeper and, help people achieve their goals and monitor is this working, is it not?

That's very important overall in the health scheme and making someone feel important, like, I do care about how you feel and I want to get you feeling better, because life's about feeling the best that we can with what we have.

Helen Dandurand (Host): Yeah. Could you tell us like what the Heart Failure Clinic entails kind of?

Cheryl Rogers: Absolutely. So, we are an accredited heart failure clinic, one of very few. if there's even 30 across the nation, I'm not sure. But we are accredited through the American College of Cardiology and what that means is we have been validated to provide the highest standard of care in heart failure. And I think September was our fourth re-accreditation. So, we're very, very proud of that. And it's a team, it is not just the heart failure clinic, but we're blessed to have in the community this type of a clinic that is able, like I've been saying, to do a little bit deeper dive. I don't practice independently, but I practice with the other physicians. So, I'm the collaborator with them regarding patients in transition from hospital, back to home and the rebalancing phase that, I call it; the education phase. There's a lot. I'm able to do a lot, a lot of education in my appointments. And then, I follow them three to six months, sometimes longer, just depending. And the heart failure clinic is just one pathway in that accreditation, but it's from ER early stabilization. We partner with the ambulance, we partner with the ER, we partner with the floors, we partner with the outpatient side of it. So, it's really robust and comprehensive and we're very proud, of all the hard work that everyone puts into it.

Host: That's great. I didn't know that we were only one of so few that have those services at that level. So, that's awesome. We are going to take a quick break to talk about primary care at Riverside.

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All right. And we are back, and we are kind of splitting this into two parts. So now, we're gonna talk about the heart failure presenting as asthma, which was just such an interesting thing that I hadn't heard of before. So, why does heart failure sometimes mimic asthma, with symptoms like wheezing, shortness of breath, et cetera?

Cheryl Rogers: Very good question. So. It isn't uncommon that, as I mentioned earlier, sometimes shortness of breath is pretty renowned, robust symptom, right? I'm short of breath. Well, why are you short of breath? What's happening? Asthma itself is a narrowing of the airways, that's related more to an inflammatory process or muscle spasm in the airway that's causing obstruction of airflow. Mostly, you can't get it out. But then, if you can't get it out, you can't bring it back in, right?

Heart failure revolves around low pump function that causes a myriad of things in our body as it tries to help itself, and ultimately ending up in fluid overload, meaning there's fluid collecting in the spaces in your body. Most often, we recognize it all the way built up into the lungs. So also, when you imagine fluid building up in your lungs and around your heart, there's less space there. So, that deep breath you also cannot take in. And they're two different etiologies, but they have that similar symptom. So, the ER's really very good if someone comes in with shortness of breath, kind of quickly trying to parse apart what is this.

But asthma generally in the outpatient is controlled with the primary care provider. Inhalers, nebulizers, things like that, that actually reduce the thickness and open those airways. And then, with asthma, they're essentially clear airways. You may have some phlegm in that, but it's relief from that inhaler. So, sometimes a heart failure patient will come in and say, yeah, I was taking my inhalers for six weeks or more, and they just didn't seem to be helping, but they also didn't necessarily tell their provider because we're so busy, right? "Got this inhaler. I'm going to just take a couple puffs as they told me to." And we get busy and busy until it becomes overwhelming and it's not that, and not every asthma patient by far has heart failure. And not every heart failure patient has asthma, but it is really about, as I said, kind of keep in tune. We think it's that, your primary care provider's treating you for that. Stay in touch with them. Let them know if it's resistant or it's not helping. There are many other heart failure symptoms besides the shortness of breath, but also the coughing is a symptom often confused, and wheezing.

So, wheezing with the asthma patient is related to, like I said, those thickened obstructive airways trying to pull air through wheezing in heart failure patients because you're trying to breathe through all that water. So, it's a similar symptom. The tests that they like to do for asthma outpatient wise-- not in a flare-- is a pulmonary function testing where you do a lot of deep breathing and they measure your excursion and your strength of your breath and things like that. A patient in a heart failure exacerbation could not do that because they don't have the bandwidth or the energy because of the fluid volume overload.

And also, whether heart failure or asthma, everyone should be screened for obstructive sleep apnea because obstructive sleep apnea. Untreated, undiagnosed begets a myriad of health issues, and we're finding more and more and more now. Some of these chronic conditions stem from untreated, undiagnosed sleep apnea. So, that kind of falls into the respiratory realm with that. But many, many, many heart failure patients have sleep apnea, either obstructive or the other kind, that's central sleep apnea. So, that kind of falls into the wellness too. You know, How is your sleep quality? Do you sleep well? Who sleeps well nowadays? I mean, I'm sure it is an inverse relationship to where it used to be, and we have many reasons to not be sleeping well overall. You know, I actually, when I hit really hard-- what's your caffeine intake? How well are you sleeping? How much coffee do you drink? How much soda do you drink? Because that all can beget heart failure issues.

One other thing in treating asthma if you're worried that it's not getting better, is to kind of think about, do I also have problems with swelling or lower extremity swelling? And am I on a diuretic? Because we need to dive into the reasons you're swelling. And that you need that diuretic. Likewise, are you on blood pressure meds? Do you take your blood pressure meds all the time or not? Do you miss meds? That's a big thing that I go over. And if they are missing meds, we dive into, "Okay, well, what kind of things can we put in place to help you. Is it a pill organizer? Is the timer on your watch? What can we do to help to cover you and blanket you in the supports to help your heart function?"

And the same way goes, you know, with asthma treatments and things like that. And obviously, if you're being treated for asthma and not getting better, maybe you're on a water pill diuretic, the go-to test is usually the echocardiogram, which then gives us a good idea of the pumping function of your heart. How is the valve function in your heart? Is your heart enlarged? Is it weak? Things like that. So, really trying to prevent that first hospitalization in the outpatient side is the key.

Host: You did mention a few different tests that patients could undergo in order to kind of help diagnose. But when they go to like their primary care provider, how would those providers distinguish between heart failure and asthma during their like initial evaluation?

Cheryl Rogers: Well, it's kind of like I said, they would do a deep dive into asking about the symptoms. Asthma, again, has many causations, but a lot of time it's an inflammatory syndrome that's either from allergens, environmental allergens, you know, things like that, that are making irritation in the airways. They're very good at diagnosing asthma, and it is just more about the initial diagnosis, the test, the treatments. Is it working or not? And as I had mentioned before, if it's not working okay, why is it not working? What is the issue? Do we have to dive a little deeper or look at things that might be causing that shortness of breath or that wheezing or that cough that we hadn't yet a different pathway.

Host: Got it. And you mentioned before fluid retention in the lungs, playing a role in that. Could you tell us why the fluid retention happens and how that creates the asthma like symptoms? I know you mentioned before a little bit about that.

Cheryl Rogers: In heart function issues in the heart failure patient, the reason it becomes fluid retention and imbalance is because your body's actually very smart. And when it senses a reduction in the blood flow from a weakened heart or from a stiff heart that can't relax. It has mechanisms within it that, for a while, pulls the cart along until they burn out, is how I like to say it.

Then, you go into the secondary rescue, which is actually a counterproductive mechanism where those kidneys try to bring more volume into your body, thinking that heart is weak or stiff, and I need to give it volume. So, it feeds our body, and so they grab onto excess salt that you're eating as well as fluid that you're drinking, fluid follows salt, but your heart's not strong enough to pump it out and off. I always say like it's not a two-way window that the heart can't turn around and say, quit doing that. We need medicines to help strengthen the heart, medicines to help rebalance that fluid imbalance.

Host: I feel like you touched on each of these a little bit before. But just to dive into that a little more. What are those specific tests, or diagnostic tools that end up ruling out asthma, confirm heart failure, as the cause of someone's breathing issues?

Cheryl Rogers: So, we have a test that's called the BNP, which stands for brain natriuretic peptide, which is actually a blood test. It's a measurement of an enzyme that is released by the heart when it is under what I call stretch strain or strain from lack of blood flow. So, these are measurements in time of a test that can tell us, "Oh, you have some stress going on in your heart. You have an elevated BNP." And so, we need to look into that a little bit further and decide, which pathway you're going to fall into the evaluation. Some people need a stress test. Some people need a different type of stress test. Everyone ends up getting an echocardiogram so we can have a better look at the function. And then, once we determine what type of heart failure you have, there's two different pathways of things that we do to help support and strengthen your heart.

Host: So, what advice would you give to someone who maybe has been misdiagnosed or feel that they may have been misdiagnosed with asthma, but actually have an underlying heart condition or think they might after hearing this?

Cheryl Rogers: Really, I'm just a big proponent of keeping in touch with your primary care person to reach out and look at the avenues. "Have we done all the tests that I need? Do you know why I might still be short of breath?" Every good primary care person knows a good family history and especially, you know, "Oh, my father has high blood pressure. My father has heart failure," things like that. Primary care is very good at their assessment of looking further.

So that's when, as we started, I said, our lives are so busy. People's lives are so busy. Young people are busy. They're trying to work, support a family, maybe two jobs. I mean, I have people sitting, they're like, "I work two jobs. I don't have time for this." And so, the conversation becomes, how can we make some time for this? What can we do? So, just keeping in contact with your provider, making sure you're honest. Provide them all the information. Follow their plan of care and they're good to refer to us as needed and when needed. Because a lot of times they are managing the patient because they have an echocardiogram or that, but sometimes you do run into a barrier like, "Well, this doesn't seem to be working anymore, so let's see who else we can pull in for an evaluation." So, it's really a collaborative effort. And that's the other thing I love about the Heart Failure Clinic, because I reach out to the primary cares all the time in collaboration and feedback with their patients and things.

Host: That's great. That sounds like great advice. And I think we are lucky to have such a great team, such great providers here that are willing to work on this and collaborate and help out our community. So, with that being said, thank you for tuning into the Well Within Reach podcast with Cheryl Rogers and your host, Helen Dandurand. Thank you, Cheryl, for being here today.

Cheryl Rogers: Thank you so much. It's been my pleasure.

Host: Yes. And to learn more about the Riverside Heart and Vascular Institute, you can visit riversidehealthcare.org/heart.