Joey Wahler (Host): It's a very common diagnosis in hospitalized patients over age 65. So, we're discussing congestive heart failure, also called CHF, and how it's treated. Our guest is Dr. Gregory Macaluso. He's a Heart Failure and Transplant Cardiologist, and he's Director of the Heart Failure Clinic at Silver Cross Hospital.

 Welcome to Silver Cross Hospital's I Matter Health podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. Thanks for joining us. I'm Joey Wahler. And hi there, Dr. Macaluso. Thanks for being with us here today.

Gregory Macaluso, MD: Hey, thanks so much for having me.

Host: So first I alluded to it a moment ago, just how common is congestive heart failure and simply put, what exactly is it?

Gregory Macaluso, MD: So congestive heart failure is incredibly common. It's the number one diagnosis admitted to the hospital next to the newborn baby. And the disease itself is a condition where the heart can't pump enough blood to the vital organs in the body. There's a couple of different forms of it, but one of which is where the pump is weak and another is which is where the pump is stiff and either way, the heart can't relax and get enough blood to the organs and fluid backs up, really all over the body, in the lungs, in the soft tissues, so people experience swelling and shortness of breath.

Host: And so what causes this?

Gregory Macaluso, MD: There's a number of causes. In this country, the most common is high blood pressure and then also coronary artery disease or blocked arteries. There's some other conditions that are less common that we can help figure out, including those that are related and heritable amongst family members. So they're genetic, and less commonly also things like viruses, even the common cold virus can cause it. And then in a significant portion of patients, we don't really know why it develops.

Host: So, CHF typically affects those in their mid 60s and older, but how young could someone experience this?

Gregory Macaluso, MD: Yeah, so if you look at the distribution across ages, really in that sort of 60 year range, but we see patients, unfortunately, who've had heart failure, even as young as their early teens. We don't take care of young adults that young, but certainly over the age of 18. Fortunately it's not that common for the young to develop this.

But yeah, I would say about that age range in their fifties and sixties is the more common time that people will start experiencing some of this.

Host: As unusual as it may be, as you said, if someone younger gets this, what would typically be the reason then as opposed to in an older person?

Gregory Macaluso, MD: Yeah. So younger patients may experience it from a virus that's affected the heart. So they get one of these common viruses, like a common cold virus, that can attack the heart. Other reasons may be that they were born with a, what's called a congenital abnormality, or an abnormality of the heart muscle and tissues that was unrecognized, which can happen. And then they can develop congestive heart failure.

Host: So you say a common cold can affect the heart to that degree, huh?

Gregory Macaluso, MD: The common cold viruses, some of them, can significantly affect the heart. You might have felt like congested when you've had a cold yourself and most people are able to actually clear the virus from most of their tissues or the heart and the heart tissue. But for some patients, the virus can actually stay dormant in the heart and it can lead to congestive heart failure.

Host: Wow, so what are CHF's typical symptoms for people to watch for and when should they contact their doctor should these arise?

Gregory Macaluso, MD: Yeah, that's a great question. We often have patients experiencing what's called dyspnea, that's shortness of breath with activity. So most of the time, when you've normally been able to do your activities of daily living, going up and down a flight of stairs, walking from room to room, you're going to start noticing that you're feeling that shortness of breath.

Other things may be shortness of breath lying flat, so you're able to feel fine and okay in the upright position, but you lay down at night, you're short of breath. And then, some patients experience just swelling of the lower extremities, and even total body swelling. So, any of those signs and symptoms that start to develop, can be heart failure from any number of causes. And, we would certainly want to see your physician to help investigate what those causes might be.

Host: So we touched on some of the causes. Is congestive heart failure on balance, would you say, mostly genetic? Or does diet and lifestyle play more of a part in being diagnosed? Which is the more common cause, would you say?

Gregory Macaluso, MD: Well, I still think in this country, the effects of diet and what we call the Western diet, which can lead to coronary artery disease and high blood pressure, diabetes, obesity is a huge proportion of what results in ultimately heart failure. The smaller portion is certainly genetic where you can trace through a family, my father and my father's father had a heart muscle problem, and in those cases, we now have the ability to identify certain genes through genetic testing, and we can actually determine if those genes have been passed on to your children before they have symptoms.

 This is why, you know, I think you should want to see a heart failure specialist to help determine that. But genetic forms of cardiomyopathy are the rare, but we now know that it's probably up to 30 percent of cases are genetic.

Host: Interesting. And it seems like the genetic testing that you allude to there, that it's really popping up in more forms of conditions and in more areas of the medical world all the time. Yes?

Gregory Macaluso, MD: Absolutely. In fact, you know, a decade ago, which I started older than it, longer than a decade ago, we didn't have commercially available testing for genetic testing. We now have commercially available genetic testing kits, which is a saliva test, and can test for 92 of the known genetic variations that cause cardiomyopathy.

It's a little bit of a Pandora's box. There's still a lot we're learning. If you trace it in a family per se, that has genealogy of a father's father and a father and a brother that have a heart condition, but a genetic test is negative; we maybe haven't completely understood exactly all those different genes, but the Human Genome Project has actually opened up a lot of doors for us to be able to identify, you know, the true genetic abnormalities that we know are associated with certain forms of cardiomyopathy.That's a heart muscle problem. Cardiomyopathy is just a heart muscle disorder.

Host: Pretty amazing stuff. So switching gears, if you are diagnosed with CHF, what are some of the more common treatment options available?

Gregory Macaluso, MD: Well, first of all when you're diagnosed, it's directed at figuring out what's causing the heart muscle disorder. And if in fact it's because of blocked arteries, sometimes treating those blockages in the arteries with things like bypass surgery or balloons and stent placement will also assist with the combination of what we call guideline directed medical therapy, and I say guideline directed medical therapy four words, for really four drugs that are different classes of agents that we use four different medications, in combination to help improve heart muscle function.

And your cardiologist, or certainly a heart failure cardiologist, would be someone that could help you understand those treatment options.

Host: So after treatment, can people with CHF live full and high quality lives from that point on?

Gregory Macaluso, MD: Yeah, absolutely. And we like to talk about things like, and which is kind of sexy for lack of a better word; things like cardiac transplant or left ventricular assist devices, things that help a failing heart. But we are much more excited about watching people recover and getting them to recover and go into remission from their heart failure.

And so many more patients that need those last end stage possible therapies can actually get better with proper treatment. And it just as an aside to that, having heart failure is like as bad as being diagnosed with many of the common cancers we talk about. It is a deadly diagnosis. And if we can put people into remission or improve them, that is really our goal.

And so, by and large, we see many more people that we can improve with proper treatment than those that go down the road of ongoing failure and need things like end stage therapies.

Host: So there are answers indeed. So what's a common myth that people believe about living with CHF? You just touched on how scary this can be. It's serious business to say the least. How about a common myth?

Gregory Macaluso, MD: Well, I think we just touched on one, but to add to that, that people can't live really long, healthier lives. With proper treatment, many of our patients get back to doing a lot of the things that they want to do. So that shortness of breath, them being in clinical congestion, full of fluid, can go away with proper treatment.

And really, much like if you were diagnosed with a cancer, there is a, you would want to see an oncologist. These heart failure specialists, of which I'm a part of that community, can help tease out the proper treatment to either reverse the disease process, in rare cases, cure it completely, and in other cases, really manage it, for many, many years and even decades.

Host: So how do you and yours go about walking your patients through dispelling some of these myths and calming their concerns or fears?

Gregory Macaluso, MD: Well, I think it starts with telling patients that you're going to be there for them and it's a journey together. So nobody cares how much, you know, until they know how much you care. So you tell them, that we're going to get through this together. We're first going to figure out and put you through some tests as to finding out what is the ultimate cause of this? And then get you on that quadruple therapy, that four drug regimen. And then we're going to figure out if you're not doing well with that, we're going to be there for you to determine what your heart's performance is. And if in fact you have, you know, a cause that's not responding to treatment, we're going to go that next step to things like surgically placed heart pumps and even transplant that are going to help you live longer.

To give you some context, you know, a patient who has end stage heart failure and isn't responding to treatment, 60 to 80 percent of those people may be dead at six months. We now have really good evidence that with a surgically placed heart pump, 50 to 60 percent of people are alive at five years and with a transplant, 60 percent of people are alive at 10 years.

That is a huge change in prognosis for people who have really a limited lifespan facing them and to change that with those treatments. So it's just a spectrum. We're going to take you from point A, you know, and we're going to get you there, whether it's meds and help you recover or if you need end stage therapy, we're going to be there too.

Host: And so in summary here, Doctor, what's your message to those with CHF about the hope going forward?

Gregory Macaluso, MD: Well, I think that there are treatments available and cardiologists are experts in this field. And if you have heart failure, you can get to your cardiologist. It's also okay because we work hand in hand with the general cardiologist to ask to see a heart failure specialist who can help work with your cardiologist to get you triaged to the right treatment strategy.

We really work hand in hand with different subspecialties of cardiology, general cardiologists, interventional cardiologists, and electrophysiologists to figure out the right medical and device therapy that can help you live longer, better lives.

Host: That's awesome. Obviously, it's great life saving and life enhancing work that you and your people do every day. Folks, we trust you're now more familiar with congestive heart failure and its treatment options. Dr. Gregory Macaluso, interesting information. Thanks so much again.

Gregory Macaluso, MD: Thanks so much for having me.

Host: And for more information, please visit silvercross.org/heart, again, that's silvercross.org/heart. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of this edition of Silver Cross Hospital's I Matter Health Podcast.