More than 5 million Americans have heart failure, and tens of thousands of Americans die from this condition each year.
However, treatment advances are providing new hope to patients.
Learn more about the treatment options – including heart transplants and implantable devices – available at UVA.
Selected Podcast
Options for Treating Heart Failure
Featured Speaker:
Organization: UVA Heart Failure and Transplant Center
Dr. Jamie Kennedy
Dr. Jamie Kennedy is a fellowship-trained specialist in heart failure who is board-certified in both internal medicine and cardiovascular disease.Organization: UVA Heart Failure and Transplant Center
Transcription:
Options for Treating Heart Failure
Melanie Cole (Host): More than 5 million Americans have heart failure. The treatment advances that are providing new hope to patients with this often serious condition are out there. My guest is Dr. Jamie Kennedy. She's a fellowship-trained specialist in heart failure who is board certified in both internal medicine and cardiovascular disease. Welcome to the show, Dr. Kennedy. Please explain for the listeners: what is heart failure? They hear heart failure, they think heart attack, stroke, but it's different. It's a condition and can be a chronic condition. Explain a little bit about heart failure for us.
Dr. Jaime Kennedy (Guest): Heart failure describes a whole host of different disease processes that all have similar symptoms. That's namely fluid retention, so swelling in the legs and in other body parts as well. The other key symptom is exercise intolerance. Patients may be comfortable sitting still, but when they do more strenuous activities as far as climbing stairs or walking up a hill, they develop shortness of breath and fatigue to the point where they're not able to do those activities anymore.
Melanie: Heart failure, Dr. Kennedy, can develop over time as the heart's pumping action grows a little bit weaker. So it's not pumping that fluid out of the lungs, around the lungs, and up from the legs, correct?
Dr. Kennedy: It's a combination of inability of the heart to pump efficient blood to the rest of the body and then the body's compensatory mechanism that cause fluid retention in the legs, in the lung, everywhere.
Melanie: If you notice this fluid retention, you notice this edema in your legs, in your ankles, around your abdomen, or you're coughing, you're having exercise intolerances, you say, which is not just normal exercise intolerance but a little bit more severe, and they come to see you, what can they expect? How is this diagnosed?
Dr. Kennedy: We use a lot of different tools. One of the most important is just talking with the patient to explore their symptoms and then examining the patient to look for signs that we see in patients with heart failure. As far as more specific testing, what's called an EKG is very helpful. It just looks at the electrical activity of the heart, and that helps us to know if abnormal heart rhythms are part of the problem. The other test we rely on a lot is that called an echocardiogram. That's basically an ultrasound of the heart. It's very much used to look at pregnant women, the babies that they're developing in the uterus. But we're using the same technology to look at the function of the heart that helps us to know if the heart muscle is weak, if there's heart valve problems, either leaking or not opening well, a whole host of problems in the heart that can lead to the heart failure syndrome.
Melanie: Now, how is this treated? If there are underlying causes such as coronary heart disease, blood pressure problems, diabetes, anything that might contribute to congestive heart failure, what do you do for treatment?
Dr. Kennedy: That goes back to the wide range of different disease processes that can lead to heart failure, and then we have to look into each one of those processes and treat it appropriately. Like you said, if a patient has high blood pressure, then we need to get that blood pressure under control. If a patient has coronary artery disease narrowing their blockages and heart arteries, then we consider whether bypass surgery or stents in those arteries would be helpful. If patients have valvular heart disease—one of their valves is too tight, it doesn't open enough or if it's open [wide too well] it leaks—then we consider whether repairing or replacing the valve in some way would be helpful. If the heart muscle itself it weak, unfortunately, there's no perfect fix for that, but we do have medications which can help the heart to recover in some cases, and in many, many cases can, help a heart to be as efficient as possible despite its weakened state. All of these things, the goal, of course, is to keep people feeling well, as active as they possibly can be, keep them out of the hospital, and obviously, keep them alive.
Melanie: When you're talking about treatments—and you mentioned medications, making sure to get the blood pressure down to reduce the strain on your heart—what about things like diuretics? If fluid does start to build up, is this something that you're on permanently now for the rest of your life?
Dr. Kennedy: It really depends. We use diuretics, of course, or medications to help people get rid of extra fluid. Some patients will need them forever. Some patients, as we treat the other processes involved, their need for diuretics can be reduced or even, at times, eliminated. Diuretics, we really use as we need to. It's not mandatory necessarily. The patient will need a diuretic only when fluid retention is a problem.
Melanie: What about lifestyle changes, Dr. Kennedy? Do you work with patients in lifestyle changes so that the workload of their heart is reduced? What are those lifestyle changes you might work with them about?
Dr. Kennedy: Yes. Absolutely. Lifestyle modifications are a huge component as well. We do encourage patients to exercise, though I ask them to try to be smart about it. I ask them not to push themselves to the point of gasping for breath. I also ask them to avoid any really heavy lifting type activities to where they're straining. Then, obviously, if they are feeling profoundly short of breath, chest pain, lightheaded or dizzy, or passing out, they need to stop whatever exercise they're doing and rest and recover. Dietary changes are also a big part of heart failure care. Especially in patients who tend to retain fluid, keeping the amount of sodium in your diet to a reasonable level can help with that problem because sodium, where sodium goes, water tends to follow. In general, Americans eat a colossal amount of sodium every day, at least 4 to 5 grams in the average American diet. We ask patients with heart failure to try to keep that closer to 2 grams of sodium a day. Obviously, sodium is necessary for your body's processes and you cannot eliminate it completely because that is equally harmful. But trying to keep it to a moderate level can be helpful. Also in patients who tend to retain fluid, we ask them to limit the amount of fluid that they take in to minimize the fluid retention problem. Again, you do need some fluid. You can't eliminate that completely. But we ask folks to keep it to about two liters of fluid a day.
Melanie: What about alcohol?
Dr. Kennedy: Alcohol actually can cause heart failure in itself in patients who drink to excess. There are some people who have a very difficult time controlling their alcohol intake. And those individuals, I tell them that they need to eliminate it completely. In patients who enjoy a drink once a week, I think that's a reasonable thing to continue. There's a little bit of data that red wine can be somewhat helpful for heart function. If you're going to drink something, red wine might be something to drink.
Melanie: Okay. You've talked about fluid intake. You've talked about alcohol and lifestyle changes and exercise, and I do want to just bring out that you mentioned about heavy lifting, that Valsalva maneuver, that holding your breath and pushing really hard, that can actually worsen congestive heart failure, correct? It can aggravate it.
Dr. Kennedy: Patients just tend to not tolerate that sort of activity very well. They tend to get profoundly short of breath and also extremely lightheaded and can pass out.
Melanie: If you would just sort of wrap it up for us, heart failure patients coming to UVA for care, what can they expect, and what are the most recent advances that you can tell them about?
Dr. Kennedy: I think it's a very tailored treatment plan because it does depend so much on the individual's characteristics as far as our disease process as well as the rest of their life. But we can promise it's a very individualized treatment plan depending on what the individual needs.
Melanie: It's an individualized treatment plan, and there's lifestyle changes, medication, and it's symptom management and getting that heart failure under control, and all of the things that might go along with it. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
Options for Treating Heart Failure
Melanie Cole (Host): More than 5 million Americans have heart failure. The treatment advances that are providing new hope to patients with this often serious condition are out there. My guest is Dr. Jamie Kennedy. She's a fellowship-trained specialist in heart failure who is board certified in both internal medicine and cardiovascular disease. Welcome to the show, Dr. Kennedy. Please explain for the listeners: what is heart failure? They hear heart failure, they think heart attack, stroke, but it's different. It's a condition and can be a chronic condition. Explain a little bit about heart failure for us.
Dr. Jaime Kennedy (Guest): Heart failure describes a whole host of different disease processes that all have similar symptoms. That's namely fluid retention, so swelling in the legs and in other body parts as well. The other key symptom is exercise intolerance. Patients may be comfortable sitting still, but when they do more strenuous activities as far as climbing stairs or walking up a hill, they develop shortness of breath and fatigue to the point where they're not able to do those activities anymore.
Melanie: Heart failure, Dr. Kennedy, can develop over time as the heart's pumping action grows a little bit weaker. So it's not pumping that fluid out of the lungs, around the lungs, and up from the legs, correct?
Dr. Kennedy: It's a combination of inability of the heart to pump efficient blood to the rest of the body and then the body's compensatory mechanism that cause fluid retention in the legs, in the lung, everywhere.
Melanie: If you notice this fluid retention, you notice this edema in your legs, in your ankles, around your abdomen, or you're coughing, you're having exercise intolerances, you say, which is not just normal exercise intolerance but a little bit more severe, and they come to see you, what can they expect? How is this diagnosed?
Dr. Kennedy: We use a lot of different tools. One of the most important is just talking with the patient to explore their symptoms and then examining the patient to look for signs that we see in patients with heart failure. As far as more specific testing, what's called an EKG is very helpful. It just looks at the electrical activity of the heart, and that helps us to know if abnormal heart rhythms are part of the problem. The other test we rely on a lot is that called an echocardiogram. That's basically an ultrasound of the heart. It's very much used to look at pregnant women, the babies that they're developing in the uterus. But we're using the same technology to look at the function of the heart that helps us to know if the heart muscle is weak, if there's heart valve problems, either leaking or not opening well, a whole host of problems in the heart that can lead to the heart failure syndrome.
Melanie: Now, how is this treated? If there are underlying causes such as coronary heart disease, blood pressure problems, diabetes, anything that might contribute to congestive heart failure, what do you do for treatment?
Dr. Kennedy: That goes back to the wide range of different disease processes that can lead to heart failure, and then we have to look into each one of those processes and treat it appropriately. Like you said, if a patient has high blood pressure, then we need to get that blood pressure under control. If a patient has coronary artery disease narrowing their blockages and heart arteries, then we consider whether bypass surgery or stents in those arteries would be helpful. If patients have valvular heart disease—one of their valves is too tight, it doesn't open enough or if it's open [wide too well] it leaks—then we consider whether repairing or replacing the valve in some way would be helpful. If the heart muscle itself it weak, unfortunately, there's no perfect fix for that, but we do have medications which can help the heart to recover in some cases, and in many, many cases can, help a heart to be as efficient as possible despite its weakened state. All of these things, the goal, of course, is to keep people feeling well, as active as they possibly can be, keep them out of the hospital, and obviously, keep them alive.
Melanie: When you're talking about treatments—and you mentioned medications, making sure to get the blood pressure down to reduce the strain on your heart—what about things like diuretics? If fluid does start to build up, is this something that you're on permanently now for the rest of your life?
Dr. Kennedy: It really depends. We use diuretics, of course, or medications to help people get rid of extra fluid. Some patients will need them forever. Some patients, as we treat the other processes involved, their need for diuretics can be reduced or even, at times, eliminated. Diuretics, we really use as we need to. It's not mandatory necessarily. The patient will need a diuretic only when fluid retention is a problem.
Melanie: What about lifestyle changes, Dr. Kennedy? Do you work with patients in lifestyle changes so that the workload of their heart is reduced? What are those lifestyle changes you might work with them about?
Dr. Kennedy: Yes. Absolutely. Lifestyle modifications are a huge component as well. We do encourage patients to exercise, though I ask them to try to be smart about it. I ask them not to push themselves to the point of gasping for breath. I also ask them to avoid any really heavy lifting type activities to where they're straining. Then, obviously, if they are feeling profoundly short of breath, chest pain, lightheaded or dizzy, or passing out, they need to stop whatever exercise they're doing and rest and recover. Dietary changes are also a big part of heart failure care. Especially in patients who tend to retain fluid, keeping the amount of sodium in your diet to a reasonable level can help with that problem because sodium, where sodium goes, water tends to follow. In general, Americans eat a colossal amount of sodium every day, at least 4 to 5 grams in the average American diet. We ask patients with heart failure to try to keep that closer to 2 grams of sodium a day. Obviously, sodium is necessary for your body's processes and you cannot eliminate it completely because that is equally harmful. But trying to keep it to a moderate level can be helpful. Also in patients who tend to retain fluid, we ask them to limit the amount of fluid that they take in to minimize the fluid retention problem. Again, you do need some fluid. You can't eliminate that completely. But we ask folks to keep it to about two liters of fluid a day.
Melanie: What about alcohol?
Dr. Kennedy: Alcohol actually can cause heart failure in itself in patients who drink to excess. There are some people who have a very difficult time controlling their alcohol intake. And those individuals, I tell them that they need to eliminate it completely. In patients who enjoy a drink once a week, I think that's a reasonable thing to continue. There's a little bit of data that red wine can be somewhat helpful for heart function. If you're going to drink something, red wine might be something to drink.
Melanie: Okay. You've talked about fluid intake. You've talked about alcohol and lifestyle changes and exercise, and I do want to just bring out that you mentioned about heavy lifting, that Valsalva maneuver, that holding your breath and pushing really hard, that can actually worsen congestive heart failure, correct? It can aggravate it.
Dr. Kennedy: Patients just tend to not tolerate that sort of activity very well. They tend to get profoundly short of breath and also extremely lightheaded and can pass out.
Melanie: If you would just sort of wrap it up for us, heart failure patients coming to UVA for care, what can they expect, and what are the most recent advances that you can tell them about?
Dr. Kennedy: I think it's a very tailored treatment plan because it does depend so much on the individual's characteristics as far as our disease process as well as the rest of their life. But we can promise it's a very individualized treatment plan depending on what the individual needs.
Melanie: It's an individualized treatment plan, and there's lifestyle changes, medication, and it's symptom management and getting that heart failure under control, and all of the things that might go along with it. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.