Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Amanda Wilde (Host): This is Be Well with Skagit Regional Health. We're talking about congestive heart failure with cardiology nurse practitioner, Graham Meeks. I'm Amanda Wilde, your host. Graham, thank you for joining me.

Graham Meeks: You're very welcome. Thank you so much for having me.

Host: Congestive heart failure, or CHF, is on the rise in the US. What exactly is congestive heart failure, and how does it affect the heart's ability to function?

Graham Meeks: Heart failure can happen a couple of different ways, but primarily it means that the heart cannot meet the body's needs, so it cannot circulate blood adequately. That can result in reduced cardiac output, which people can certainly have symptoms of, or can allow fluid overload to build up in different parts of the body, which also can be symptomatic.

Host: And what are the most common causes of CHF in adults?

Graham Meeks: A wide variety. We used to talk about a reduced ejection fraction in heart failure, the reduced pumping function of the heart and that is most often caused by a heart attack, by coronary artery disease or by hypertension. Kidneys can be involved, certain viruses can attack the heart. But we also think more about heart failure with preserved ejection fraction, a heart that pumps strongly but still becomes inefficient for a variety of reasons, especially heart rhythm changes. Kidneys can be involved there as well too, as can coronary disease. So multiple causes. It's important for us to pin down what the causes are so we can treat it properly.

Host: Well, what are some early warning signs people should pay attention to?

Graham Meeks: The tricky ones are things like shortness of breath, which can have so many different causes. But if you are short of breath with activity or when lying down and find that you breathe better when you sit up, or if you notice abdominal bloating, loss of appetite, nausea. Swelling in the legs can be a symptom of heart failure, though it isn't always. Those are primary ones that we look for.

Host: And that's when people should seek medical care, if they have noticed any of those warning signs.

Graham Meeks: Absolutely, yeah. Worsening shortness of breath, you always want to figure out what's causing that. Rapid weight gain, certainly can be associated with heart failure, and there are multiple causes there too. And of course, the usual cardiac symptoms that we think about, things like chest pain, left arm, jaw pain.

Host: Certainly not normal. How does CHF progress over time typically? And what do stages of heart failure mean?

Graham Meeks: It does tend to be progressive. If we don't intervene, the heart overworks, becoming less efficient. The causes that made it inefficient in the first place become more pronounced. And so, it does cause ongoing deterioration, which we can, with the right treatments and medications, often stabilize or even reverse to some extent.

The stages are a pretty, you know, medical academic way of thinking about risk factors to symptoms to structural changes of the heart. I more often think about symptoms of heart failure and how we can alleviate and improve those symptoms, but there are multiple ways for categorizing and classifying. And I tend to talk about those with patients one-on-one.

Host: So, there are ways for you to alleviate CHF, and how do you typically monitor CHF over time?

Graham Meeks: We are absolutely focused on alleviating heart failure. I think that's an important place to start. Heart failure is not the term that any of us would choose. It's a heart inefficiency. It usually does not mean that the heart is going to stop working entirely. But we try to get people to the point where they are not symptomatic. They have the condition, they're being treated for it, it's being managed and stabilized. But the goal is that somebody does not have to live as if they do have heart failure. If we cannot improve it that much, we get to where somebody is feeling better, is able to do more of the things that they want to do.

Host: So, have treatments progressed significantly in the last few decades, would you say?

Graham Meeks: Absolutely. Both in terms of interventions, devices that we have, medications. One of our biggest medications recently became generic this year. And so, it is less costly than it used to be. So, we have many more options than we used to.

Host: And how does CHF impact mental and emotional health for patients and for caregivers?

Graham Meeks: I think it's a really important question. I think throughout medicine, we're talking about how when somebody receives a big diagnosis that is first surprising, shocking, then life-altering, it really does bring depression and anxiety and worry. And I do believe that knowledge helps people to cope better and make their plan and realize what they can do to take control of their own health. And we do try to work with people to realize both how serious their condition is, but also how much we can improve it. And that does tend to bring more holistic wellbeing to people.

Host: What are the major risk factors for developing CHF?

Graham Meeks: A wide range. I would say, for one, it's people who really have not kept up with medical care, who don't go to see a primary care provider and have things like their blood pressure and blood sugar monitored.

There, lifestyle is really important. If you're getting consistent exercise and eating healthier foods, getting your fruits and vegetables and fiber, that certainly reduces risk. Certain substances are certainly part of the heart failure picture: alcohol, certain illicit drugs. So, many, many possible variables. And I think for the most part, people know if they have been living a healthy, careful lifestyle or if they have not been. We can always talk about changes to be made there as well.

Host: So, it's good to know each person has some agency in prevention.

Graham Meeks: Yes, absolutely.

Host: Well, Graham, thank you so much for this important information and a deeper understanding of congestive heart failure.

Graham Meeks: Thank you so much for your time. I appreciate it.

Host: That was Graham Meeks, cardiology nurse practitioner at Skagit Regional Health. For more information, visit skagitregionalhealth.org. If you enjoyed this podcast, please share it on your social channels, and check out the entire podcast library for topics of interest to you. Thanks for listening to Be Well with Skagit Regional Health.