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Heart Failure: What to Know, What to Do
Heart failure means your heart isn't pumping enough blood to your body. Dr. Stuart Russell, Director of Heart Failure at WakeMed Heart & Vascular; Regional Director of Heart Failure and Professor of Medicine at Duke University School of Medicine, explains what to know about heart failure and what to do.
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Learn more about Stuart Russell, MD
Stuart Russell, MD
Dr. Stuart Russell is board certified in cardiovascular disease and advanced heart failure/transplant cardiology and is dedicated to the care and treatment of advanced heart failure patients. He routinely performs right heart catheterizations and heart biopsies having performed more than 5,000 of each procedure.Learn more about Stuart Russell, MD
Transcription:
Heart Failure: What to Know, What to Do
Anne Hoffman (Host): Heart failure. What is it? Patients report feeling thrown off by the term. It doesn’t mean that your heart has stopped working. It just means it’s not pumping blood the way it should. So, if you have heart failure; what should you know and what should you do? Let’s talk with Dr. Stuart Russell. He’s a heart failure transplant cardiologist at WakeMed Health and Hospitals.
This is WakeMed Voices the podcast with WakeMed Health and Hospitals. I’m Anne Hoffman. So, Dr. Russell, let’s talk about the actual term heart failure. I think it’s really confusing. I think when you first hear it and you don’t know what it is; it’s easy to think how can someone have heart failure and still be alive. A lot of people get thrown off by this term. Talk to me about that.
Stuart Russell, MD (Guest): Yeah so, heart failure is really a clinical definition of when your heart doesn’t pump enough blood out to your body. For us, it is really defined as anytime somebody’s ejection fraction which is the percent of blood that’s ejected with each heart beat is less than normal. And so if you are not getting as much blood to your body as you should; then we define it as heart failure.
Heart failure does not mean that your heart has stopped working. Clearly if that was the case, you’d be dead. And so, it’s really kind of a bad phrase to define a heart that isn’t working normally. But the heart truly hasn’t completely failed.
Host: So, do you get patients who have that same kind of confusion that I did?
Dr. Russell: Right. No, I think that happens all the time. And I mean on a serious note, people have talked about should we change the name of the disease because it truly doesn’t define what we are doing. And we will at times, talk about cardiomyopathy which means weak heart which is probably a better definition than truly heart failure. But at the end of the day, heart failure is the way we were all brought up in medical school and the name has stuck.
Host: So, what do patients with heart failure need to know? What are the most important things for them to know?
Dr. Russell: So, I think number one, we have a lot of different medicines that have been shown to make patients feel better, stay out of the hospital, do more and most importantly, live longer. And so the important thing is to take the medicines that are prescribed because they truly are beneficial. And this common complaint that I hear of, I’m taking so many medicines; you are taking those medicines because they work in different ways to help you and help you kind of adapt to a heart that’s not working correctly.
Host: Right and it’s often a number of different medications that you have to take, like a beta blocker, and ACE inhibitor.
Dr. Russell: Right, so beta blocker, an ACE inhibitor, an aldosterone antagonist have all independently been shown to improve survival and then most people also are on a diuretic which really helps to deal with the symptoms of heart failure which are usually related to having too much fluid on board.
Host: So, a diuretic is like a water pill, right?
Dr. Russell: Correct.
Host: All right. Well what are some of the signs and symptoms of heart failure?
Dr. Russell: So, from a symptom standpoint, it’s all about this fluid and so people will get short of breath, they’ll get short of breath with exertion. As they put more fluid on, it will take less and less exertion to get short of breath so some people even get so short of breath that something like putting on their clothes will make them short of breath.
Other symptoms that come along with this are laying down, where normally we like to sleep flat in bed, patients who have more fluid on board, will start to sleep on two pillows, three pillows, four pillows or may even sleep in a Lazy Boy just because gravity will drive that fluid out of their lungs and so they can get a good night’s sleep.
From a sign standpoint, the big one that we see is swelling. The swelling for some people is always in the legs, for other people it can be in the belly and they can have very skinny legs. But either place, depending on the patient, that’s a sign of retained fluid. And most of these signs and symptoms are all really related to just too much fluid on board.
Host: So, I’m curious about patients who are experiencing heart failure and want to reverse their condition. Is that possible?
Dr. Russell: So, reversal of heart failure, a lot of it really gets down to what’s the cause of heart failure for a person. The vast majority of heart failure in America is related to coronary artery disease. In somebody who had a big heart attack and it left them with part of their heart muscle being dead and the rest of the heart adapts to that but not totally. Now if they’ve got areas of their heart that don’t get enough blood flow but aren’t dead; getting more blood flow to those areas will improve the heart function.
And so, while you may not totally reverse heart failure; you can make it a lot better if that’s the situation for you. So, something as crazy as you might need a bypass is something that we think about with every patient just because of that reversibility. There are some causes of heart failure that are very reversible. Some people develop hyperthyroidism and that can cause a heart to weaken. That’s a reversable cause and you treat the thyroid disorder and the heart gets better.
Other people will have other kind of unique things that are similar to that way. I would say for most patients, getting them on medications, if they just present with heart failure, getting them on medications about half the time we see improvement in heart function. We may not see it come all the way back to normal; but we definitely see an improvement from where they are just with the medications that we use.
Now one thing that a lot of people will ask me about is stem cells. What if I go and get stem cells? And stem cells in general right now, haven’t been proven to be efficacious for reversing heart failure. I think we are still studying it and there’s still a dream that stem cells can reverse it but today; it definitely is not ready for prime time.
Host: So, for someone who is caring for a family member with heart failure, maybe they themselves are at an increased risk for developing the same disease; what can they do for prevention?
Dr. Russell: So, probably the two biggest ways I think to prevent heart failure today is if you have high blood pressure or if you have diabetes; great control of blood pressure and diabetes are probably the two biggest ways that we can help to prevent that heart failure 10, 15, 20 years down the road. a lot of people get heart failure really from bad luck and it’s nothing that they did but common things being common, treating hypertension, treating diabetes can help to prevent heart failure down the road.
Host: Got it. So, get those chronic conditions under control.
Dr. Russell: Yup.
Host: Well thank you so much Dr. Russell. I’m Anne Hoffman with WakeMed Voices brought to you by WakeMed health and Hospitals in Raleigh, North Carolina. For more information on heart and vascular services at WakeMed visit www.hearts.wakemed.org. Thanks for checking out this episode of WakeMed Voices. Head to www.hearts.wakemed.org to get connected with Dr. Stuart Russell or another cardiologist and if you found this podcast helpful, please share it on your social channels. And be sure to check out the entire podcast library for topics of interest to you.
Heart Failure: What to Know, What to Do
Anne Hoffman (Host): Heart failure. What is it? Patients report feeling thrown off by the term. It doesn’t mean that your heart has stopped working. It just means it’s not pumping blood the way it should. So, if you have heart failure; what should you know and what should you do? Let’s talk with Dr. Stuart Russell. He’s a heart failure transplant cardiologist at WakeMed Health and Hospitals.
This is WakeMed Voices the podcast with WakeMed Health and Hospitals. I’m Anne Hoffman. So, Dr. Russell, let’s talk about the actual term heart failure. I think it’s really confusing. I think when you first hear it and you don’t know what it is; it’s easy to think how can someone have heart failure and still be alive. A lot of people get thrown off by this term. Talk to me about that.
Stuart Russell, MD (Guest): Yeah so, heart failure is really a clinical definition of when your heart doesn’t pump enough blood out to your body. For us, it is really defined as anytime somebody’s ejection fraction which is the percent of blood that’s ejected with each heart beat is less than normal. And so if you are not getting as much blood to your body as you should; then we define it as heart failure.
Heart failure does not mean that your heart has stopped working. Clearly if that was the case, you’d be dead. And so, it’s really kind of a bad phrase to define a heart that isn’t working normally. But the heart truly hasn’t completely failed.
Host: So, do you get patients who have that same kind of confusion that I did?
Dr. Russell: Right. No, I think that happens all the time. And I mean on a serious note, people have talked about should we change the name of the disease because it truly doesn’t define what we are doing. And we will at times, talk about cardiomyopathy which means weak heart which is probably a better definition than truly heart failure. But at the end of the day, heart failure is the way we were all brought up in medical school and the name has stuck.
Host: So, what do patients with heart failure need to know? What are the most important things for them to know?
Dr. Russell: So, I think number one, we have a lot of different medicines that have been shown to make patients feel better, stay out of the hospital, do more and most importantly, live longer. And so the important thing is to take the medicines that are prescribed because they truly are beneficial. And this common complaint that I hear of, I’m taking so many medicines; you are taking those medicines because they work in different ways to help you and help you kind of adapt to a heart that’s not working correctly.
Host: Right and it’s often a number of different medications that you have to take, like a beta blocker, and ACE inhibitor.
Dr. Russell: Right, so beta blocker, an ACE inhibitor, an aldosterone antagonist have all independently been shown to improve survival and then most people also are on a diuretic which really helps to deal with the symptoms of heart failure which are usually related to having too much fluid on board.
Host: So, a diuretic is like a water pill, right?
Dr. Russell: Correct.
Host: All right. Well what are some of the signs and symptoms of heart failure?
Dr. Russell: So, from a symptom standpoint, it’s all about this fluid and so people will get short of breath, they’ll get short of breath with exertion. As they put more fluid on, it will take less and less exertion to get short of breath so some people even get so short of breath that something like putting on their clothes will make them short of breath.
Other symptoms that come along with this are laying down, where normally we like to sleep flat in bed, patients who have more fluid on board, will start to sleep on two pillows, three pillows, four pillows or may even sleep in a Lazy Boy just because gravity will drive that fluid out of their lungs and so they can get a good night’s sleep.
From a sign standpoint, the big one that we see is swelling. The swelling for some people is always in the legs, for other people it can be in the belly and they can have very skinny legs. But either place, depending on the patient, that’s a sign of retained fluid. And most of these signs and symptoms are all really related to just too much fluid on board.
Host: So, I’m curious about patients who are experiencing heart failure and want to reverse their condition. Is that possible?
Dr. Russell: So, reversal of heart failure, a lot of it really gets down to what’s the cause of heart failure for a person. The vast majority of heart failure in America is related to coronary artery disease. In somebody who had a big heart attack and it left them with part of their heart muscle being dead and the rest of the heart adapts to that but not totally. Now if they’ve got areas of their heart that don’t get enough blood flow but aren’t dead; getting more blood flow to those areas will improve the heart function.
And so, while you may not totally reverse heart failure; you can make it a lot better if that’s the situation for you. So, something as crazy as you might need a bypass is something that we think about with every patient just because of that reversibility. There are some causes of heart failure that are very reversible. Some people develop hyperthyroidism and that can cause a heart to weaken. That’s a reversable cause and you treat the thyroid disorder and the heart gets better.
Other people will have other kind of unique things that are similar to that way. I would say for most patients, getting them on medications, if they just present with heart failure, getting them on medications about half the time we see improvement in heart function. We may not see it come all the way back to normal; but we definitely see an improvement from where they are just with the medications that we use.
Now one thing that a lot of people will ask me about is stem cells. What if I go and get stem cells? And stem cells in general right now, haven’t been proven to be efficacious for reversing heart failure. I think we are still studying it and there’s still a dream that stem cells can reverse it but today; it definitely is not ready for prime time.
Host: So, for someone who is caring for a family member with heart failure, maybe they themselves are at an increased risk for developing the same disease; what can they do for prevention?
Dr. Russell: So, probably the two biggest ways I think to prevent heart failure today is if you have high blood pressure or if you have diabetes; great control of blood pressure and diabetes are probably the two biggest ways that we can help to prevent that heart failure 10, 15, 20 years down the road. a lot of people get heart failure really from bad luck and it’s nothing that they did but common things being common, treating hypertension, treating diabetes can help to prevent heart failure down the road.
Host: Got it. So, get those chronic conditions under control.
Dr. Russell: Yup.
Host: Well thank you so much Dr. Russell. I’m Anne Hoffman with WakeMed Voices brought to you by WakeMed health and Hospitals in Raleigh, North Carolina. For more information on heart and vascular services at WakeMed visit www.hearts.wakemed.org. Thanks for checking out this episode of WakeMed Voices. Head to www.hearts.wakemed.org to get connected with Dr. Stuart Russell or another cardiologist and if you found this podcast helpful, please share it on your social channels. And be sure to check out the entire podcast library for topics of interest to you.