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Heart Failure - Symptoms, Causes and Treatment

Listen as Dr. Jay Amin, a cardiologist specializing in the diagnosis, treatment and management of heart conditions, discusses the symptoms, causes and treatments of heart failure.
Heart Failure - Symptoms, Causes and Treatment
Featured Speaker:
Jay K. Amin, MD
Dr. Amin was born in Canada and spent his childhood growing up in rural Alberta. He holds a Bachelor of Science Degree from the University of Connecticut and a Master’s Degree in Physiology from Georgetown University.

Dr. Amin earned his medical degree from the University of Connecticut School of Medicine, and then pursued his internship and residency training at Boston University Medical Center. Following his clinical training, he worked as a post-doctoral research fellow at the Whitaker Cardiovascular Institute in Boston where his basic science research interest focused on the cellular mechanisms of myocardial remodeling in heart failure which lead to several papers that he co-authored. He completed his clinical cardiology fellowship at the University of Michigan in Ann Arbor, MI where he specialized in non-invasive cardiology and echocardiography.

Dr. Amin is board certified in cardiovascular disease. He is actively involved in PET perfusion imaging as well as CT imaging and is recognized by the Society of Cardiovascular Computed Tomography in Level 2 Cardiovascular CT and vascular imaging. He is a fellow of the American College of Cardiology.

Learn more about Dr. Jay Amin

Maggie McKay: Welcome to BayCare HealthChat. I'm Maggie McKay. Heart failure is nothing to fool around with or ignore. It's a serious condition that needs medical care and the more you know, the better. So today we'll talk about the symptoms, causes and treatments of heart failure with Dr. Jay Amin a cardiologist specializing in the diagnosis, treatment and management of heart conditions in patients at BayCare. Dr. Amin, thank you so much for joining us today to talk about this important topic that affects so many people.

Dr. Jay Amin: Yeah. Thanks for having me. I appreciate that.

Maggie McKay: Absolutely to begin with what is heart failure and are there different types of it?

Dr. Jay Amin: Yeah. So, congenital heart failure is a condition that's common in our population of patients that we see typically in the United States. And it's characterized by symptoms of shortness, of breath fluid retention, swelling in the legs. And typically, what it's related to is the fact that the heart muscle is a pump and is unable to pump the flow of the blood forward.

And as a result, it backs up and patients develop congestion in their lungs. They have difficulty breathing, and there's another type of heart failure where the heart muscle pumps normally it just doesn't relax properly. And as a result of that, patients can get congested with the backup of the fluid into the lungs causing symptoms of shortness of breath and fatigue, and difficulty doing their activities of daily living.

Maggie McKay: And you said it's common. Are there any statistics? how many people are we talking about that are affected by this?

Dr. Jay Amin: Yeah, it's a common condition. You know, we've been, overloaded with all the COVID-19 and the pandemic. But if you look at the United States of America, there's probably about 6 million people in the country that have a diagnosis of congestive heart failure. And every year, unfortunately there's probably 900,000 new cases. And so this will only continue to worsen as you see in our aging population. I mean, there's 10,000 individuals that are baby boomers every day. And so it is a condition associated with aging of our population. So it's only going to increase.

And unfortunately, if you look at the number of patients perhaps over the age of 40, there's a 20% likelihood that patients will develop it in that age group, that those over 40 will develop symptoms of heart failure during the course of their lifetime. And it's a huge economic impact and social impact within our society. And the cost is extraordinary. I mean, it's extraordinarily high and it's probably 30 to 40 billion dollars per year, but by maybe 2030, thereabouts, it'll be 60 or 70 billion dollars. So it is a huge economic impact within our society and a huge social impact. And it affects a lot of people.

Maggie McKay: You mentioned age. What other risk factors are there? Who is at greatest risk?

Dr. Jay Amin: Yeah. It's patients that tend to have a history of some other medical issues and the things you think about are ischemic heart disease or coronary artery disease. So those are the patients that have had blockages of their arteries to their heart or have had prior heart attacks where the heart muscle is diseased or damaged. It used to be several years ago or decades ago where hypertension was the main cause of congestive heart failure. And that tends to be also a predominant cause in the patient population that we see now.

But hypertension in itself is a huge risk factor. Loosely, heart failure in patients that are, for example, diabetics, patients that are obese with valvular heart disease and valves are within the heart itself are structures that they're like gates within the heart, they open and they close. And if they get diseased over time, that can lead to heart failure. With the COVID-19 pandemic, we've seen cases of what's defined as myocarditis which is inflammation of the heart muscle leading to heart failure.

And initially there is a condition called a stress induced cardiomyopathy, believe it or not where patients are under tremendous amounts of emotional stress, which can lead to a diseased heart where the heart muscle is not pumping as well as it should, which can lead to symptoms of congestion - seeing water retention, fluid backing up with the lungs. So there's a multitude of, causes. Fortunately, we've come a long way in terms of advancements in treatments.

Maggie McKay: What signs or symptoms should we be aware of?

Dr. Jay Amin: So the bread and butter symptoms there's several, but we always focus on breathing - are you short of breath with activity? Are you able to do the activities during the day with no symptoms at all of shortness of breath? Are you noticing you're becoming more winded going from a flight of stairs, doing the laundry or going for your daily walk, then we zoom in on more specific symptoms. Are you noticing that your legs are getting a little more swollen. They retain maybe a little bit water.

There's what we call edema. Are you short of breath at night? Are you able to lay flat in bed or are you wheezy, more fatigued? A lot of patients present very subtly with symptoms of heart failure. And a lot of these patients are elderly. Until we really zoom in with some questions and asking about these specific symptoms. It's sometimes difficult to tease out.

Maggie McKay: And you mentioned a couple of causes of heart failure. What would you say are the top few?

Dr. Jay Amin: In the United States of America, I think for a long period of time hypertensive heart disease. So these are patients that have a history of hypertension, maybe not well controlled, perhaps they're not watching their salt intake and they're not watching their diet, they’re obese, but now we're also seeing a lot more patients that are younger what's called ischemic heart disease. So these are patients that have had with high cholesterol, that are diabetic, that are smokers. They may have had a heart attack in the past, their heart muscle, which is, the heart is a pump and if you damage that pump, the pump doesn't work as well.

And so ischemic heart disease is playing more into the patients that we're seeing now with development of congestive symptoms with volume retention, fluid retention. We see it in a lot of our elderly patients that are, females that are over the age of 80 with hypertensive heart disease. Never had a heart attack or a stroke or otherwise they're doing okay, but they're just not watching their salt intake. They're eating a lot of frozen foods and processed foods and they develop heart failure on the basis of the fact that they're retaining just a little bit extra fluid and it backs up in the lungs and they can't breathe. And that's a component of a heart failure that we see a lot of commonly with the United States.

Maggie McKay: Dr. Amin, what does diagnostic testing involve for heart failure? How do you test for it?

Dr. Jay Amin: Yeah, there's a number of tests that we do a lot of diagnosis for heart failures, just based on clinical examination and symptoms, but there are some additional tests that we can do to try to sort some of this out. We do chest x-rays looking for evidence of passive congestion or fluid in the lung. We'll examine them. Do they have signs of the fact that there's a lot of fluid or extra water on board, that's swelling in the legs? Do they seem that they're gaining some weight unexpectedly for no reason? And then we delve deeper with doing what are called ultrasounds with heart or, echocardiograms looking at heart function.

And sometimes on those ultrasounds we can determine is the heart function normal or is it abnormal? Are the valves that are in the heart that are responsible for kind of regulating the blood flow within the heart. Are those normal? There's a lot of diagnostics we can do. But fortunately, with this testing, we've made a lot of improvements in terms of not just diagnosis, but treatment.

Maggie McKay: And when it comes to treatment of heart failure, what else is involved? What can a patient expect?

Dr. Jay Amin: Yeah. So, unfortunately there, heart failure is treatable. There are a lot of medications that we have in our toolbox. So it's not uncommon when patients that have had their first episode of heart failure, they wind up within the hospital. We treat them, we give them medications whether through intravenous medications, through an IV or medications, whether it be a pill form. We try to get rid of that extra fluid. Those are medicines called diuretics. And then based upon what the other tests show, there are medicines that we use to treat their blood pressure, there are medicines that we use to treat their heart failure, that affect their volume status.

And then we also look for, again, the cause of the heart failure and we try to look to what can we do to prevent this from happening again. In some patients it's just not watching their salt intake and not watching their diet. And we can attack that. In other patients, they have more severe conditions, whether it be valves leaking, or if their heart muscle's weak. Could they have underlying coronary artery disease with lack of blood flow to the heart? And there's what's called cardiac catheterizations, which we can do to look at the arteries to make sure the blood flow to the heart is normal.

So there's a multitude of tests that we can use and the number of medications that we can use to help optimize their status and improve their functional capacity and prevent recurrent episodes of heart failure.

Maggie McKay: That's encouraging. What's the overall prognosis based on -severity, age, type of heart failure?

Dr. Jay Amin:Very good question. And so when we look at patients with heart failure, unfortunately, if you get admitted with heart failure within the United States of America, your mortality rate can be as high as 25% for readmissions within the next 30 days. We've made great advancements with following up with the patients in the office within a seven day or 10-day horizon adjusting their medications and kind of instructing them, educating them, and optimizing their medical therapy. The fact that we're doing better than that now.

And so I think a lot of heart failure, both treatment as well as prognosis has improved over time. The important thing is, I think education with patients and finding out what the cause of the heart failure is and trying to treat the underlying heart condition such as hypertension, obesity things like weight loss, monitoring your weight on a daily basis is important. Watching your salt intake. If you're a smoker, getting off the cigarettes. If you're a diabetic focusing on diabetes management. If you've got a history of valvular heart disease, trying to assess the valvular heart disease with testing and determining whether or not we need to do additional imaging or testing to fix the issues with the valve.

So there's a lot of things that we can do in 2022 that we couldn't have done perhaps 20 years ago. Still it's a very common condition. I think we've made a lot of advancements in, not just treatment, but also, helping out with prognosis.

Maggie McKay: Dr. Amin, what's your advice on prevention of heart failure and once you have it, why BayCare is so outstanding in treating it?

Dr. Jay Amin: Yeah. Another excellent question. I mean, I think prevention is so important within our health care system, not just at BayCare, but nationwide. Congestive heart failure is a chronic condition. So what I mean by chronic is that once you get diagnosed with it, it goes with you for the rest of your life. Just like diabetes, just like hypertension, just like high cholesterol or hyperlipidemia. So we need to focus in on is what can a patient do to help with their long term outcomes, their long term prognosis. And what I tell patients is focus on things that you can control, you know, control things such – as are we exercising?

Are we watching what we’re eating? Are we watching our salt or intake of foods that perhaps aren’t really helpful? So foods that have a lot of salt in them is just not helpful. Watching our intake of saturated fats. At home, cardiologists have been blessed because we can monitor patients remotely from the standpoint of blood pressure monitoring. What's your blood pressure running? What's your heart rate running? What is your weight? That's a really important marker for decompensation of heart failure. So I, think having patients involved in their care gives them more control in the process, because you want to get them involved as well.

And these things are important as they go forward. Because though this is a chronic illness, we can still treat this long term, but you've got to have patient engagement, they need to know what they need to do at home watching for any symptoms. And sometimes when you have patients weighing themselves every day, think that's kind of a mindless thing to do, but it's really important from a standpoint, as a cardiologist and a patient with heart failure. If their weight goes up by three or four pounds within the 24-hour period or a 36-hour period, that tells me that they're retaining some fluid, that's water weight, and that may be the first sign of their heart failure.

Even though they may not be short of breath. And so if they call us with that reported abnormality, we can make some adjustments on the telephone. Hopefully prevent them from getting more symptomatic where they are so short of breath that they need to go to the emergency room. They get admitted for heart failure and they get sent home. Hopefully you prevent that admission process.

Maggie McKay: Is heart failure, hereditary?

Dr. Jay Amin: There are some conditions, where if you look at the family, something called a dilated cardiomyopathy where various family members have inextricably this weak heart muscle, and the heart is a pump. And there are genetic abnormalities where patients are more predisposed to weaknesses in their heart muscle and that's through genetic testing. So if you had a family member that was relatively young and diagnosed with symptoms of heart failure, based upon, just history, physical examination, diagnostic testing, and you found out well, their sibling had heart failure. Their parents had heart failure.

Maybe even their children, believe it or not, have a diagnosis of heart failure. Then that really points you in a direction of a genetic abnormality. And within BayCare, we have the ability to refer patients to perhaps centers that have more advanced heart failure expertise, to give those patients a better opportunity for treatment and long-term success.

Maggie McKay: Dr. Amin, thank you so much for your time and expertise in talking to us about heart failure and all that it involves it's been a pleasure.

Dr. Jay Amin: I appreciate the opportunity. Thanks so much.

Maggie McKay: And that wraps up this episode of BayCare HealthChat, head on over to our website at for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other bay care podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social channels and be sure to check out all of the other interesting podcasts in our library. I'm Maggie McKay, be well.