Treating Cardiovascular Diseases in Wisconsin and Northern Illinois
The term “heart failure” often generates confusion. Although it is a very serious condition, heart failure (HF) doesn’t mean the heart has “failed” or stopped working. Rather, it means the heart is no longer pumping enough blood to meet the body’s needs.
When the heart weakens, one or more of the following changes may occur:
- One or more heart chambers may enlarge, allowing them to hold more blood and contract more forcefully.
- The heart may speed up to help increase its output of blood.
- The heart muscle may develop more mass, helping it to beat more forcefully.
These changes typically work for a while, but eventually the heart muscle becomes weaker and less effective. Over time, the weakened heart becomes unable to pump blood effectively to the body’s organs. As a result, blood that should be pumped out of the heart backs up in the lungs and other parts of the body, causing common heart failure symptoms, such as shortness of breath or swelling in the abdomen (belly), hands, legs and feet.
Heart failure is very common. It affects about 5.8 million people in the United States and is the leading cause for hospitalization among Medicare patients, according to the National Heart Lung and Blood Institute. As the population continues to age, the condition will become even more widespread.
Heart Failure Symptoms
Signs of heart failure vary dramatically from person to person. Symptoms may appear gradually or intermittently and range from mild to severe. The following heart failure symptoms result from fluid accumulating in the body’s tissues:
- Fatigue (feeling tired)
- Feelings of fullness or bloating in the stomach
- Heart palpitations
- Loss of appetite or nausea
- Reduced ability to exercise
- Shortness of breath during everyday activities
- Swelling in the ankles, feet, legs, abdomen and veins in the neck
Symptoms get worse as heart failure progresses. Some people may experience shortness of breath or coughing when resting, especially when lying flat. Others may gain weight as excess fluid accumulates in the feet, ankles, legs and abdomen. They may also experience a need to urinate more frequently, especially at night.
Other symptoms may include a cough, loss of appetite and irregular heartbeats. And because the heart doesn’t pump enough blood to the brain, some people experience dizziness, an inability to concentrate or fainting.
Who Is at Risk for Heart Failure?
Certain groups of people are more at risk for heart failure, according to the National Heart Lung Blood Institute. These groups include:
- African Americans
- People ages 65 and older
- People who are overweight or obese
- People who have diabetes
- People who have various types of heart disease, including congenital heart disease
In general, men are more likely to have heart failure than women.
What Causes Heart Failure?
There are many causes of heart failure and most of them stem from diseases that affect the heart. Common causes include:
- Arrhythmia (irregular heart beat)
- Cardiomyopathy (enlarged heart)
- Congenital heart disease
- Coronary artery disease (clogged arteries)
- Heart attack
- Heart valve disease
- Hypertension (high blood pressure)
Other conditions that can impact the heart and lead to heart failure include:
- Alcohol abuse
- Certain chemotherapy medications and radiation
- Street drugs, especially cocaine
- Thyroid conditions
- Sleep apnea
Diagnosing Heart Failure
A diagnosis of heart failure is based on a physical exam and the appearance of signs and symptoms. A determination is also based on your medical and family histories, your risk factors, results from various tests and ruling out other conditions.
Some of the tests used when diagnosing heart failure include:
- Cardiac catheterization
- Cardiac magnetic resonance imaging (MRI)
- Chest X-ray
- Coronary angiography
- Electrocardiography testing or EKG, including a Holter monitor
- Lab testing to check for a certain hormone in the blood that can indicate heart failure
- Nuclear imaging including a nuclear stress test or a positron emission tomography (PET) scan
- Thyroid function tests
- Ultrasound testing, including echocardiography, Doppler ultrasound or a stress echo
Treating Heart Failure
Generally, the earlier heart failure is diagnosed and treatment begins, the better. The goals of treatment are to treat the underlying causes, reduce symptoms, slow the progression of the disease and help people live long, active lives.
To treat the underlying causes and symptoms of heart failure, your doctor may recommend certain lifestyle changes, such as eating a heart healthy diet, limiting salt (sodium) and excess fluids and avoiding alcohol. Other recommendations may include losing weight, getting more exercise, quitting smoking and getting enough rest. Annual flu and pneumonia shots are also recommended.
The management of heart failure includes medication and Cardiac Resynchronization Therapy (CRT). Patients may also have the option to participate in a clinical trial related to their heart failure medical management.
Aurora has dedicated Cardiologists that specialize in the treatment of heart failure. These cardiologists first evaluate the medications that a patient is on and attempt to maximize the dose and frequency. They may also add medications to their regimen that will decrease their mortality and improve their quality of life.
Medications may include:
- ACE inhibitors to relax your blood vessels and lower blood pressure to decrease the heart’s workload
- Aldosterone antagonists to block hormones that prevent the kidneys from getting rid of salt and water through urine
- Angiotensin Receptor Blockers (ARBs) to relax your blood vessels and lower blood pressure to decrease the heart’s workload
- Digoxin to make the heart beat stronger
- Diuretics to reduce fluid buildup in your lungs, abdomen, legs and feet
To help make your heart beat more effectively as the condition progresses, your doctor may recommend device therapy for patients with heart failure. These devices may include:
- A cardiac resynchronization therapy device (CRT), which is a type of pacemaker that helps both sides of your heart contract at the same time
- A left ventricular assist device (VAD), to help your heart pump blood to the rest of your body
An implantable cardioverter defibrillator (ICD), which uses electrical pulses to correct irregular heart rhythms
A ventricular assist device (VAD) is an artificial pump that is surgically implanted through an open heart procedure. The pump drains blood from the ventricle of the heart and pumps it up to the aorta, which is the major artery that supplies blood to the rest of the body.
Ventricular assist devices are often used to keep a patient alive or improve circulation to major organs during the wait for a heart transplant. We call this a ‘bridge’ to transplant.
Sometimes VADs are used in patients who are not candidates for heart transplant. There are multiple reasons that a patient may not be a candidate. A VAD used for this reason is considered ‘destination’ therapy and will be used permanently to treat a patient’s heart failure and improve their quality of life.
The average hospital stay after a VAD is implanted is two weeks, one week to take care of the medical concerns and another week to educate regarding the VAD. A patient and their family will be trained to take care of the VAD, understanding its alarms, function, dressing change, power supply, and expectations at discharge.
In some cases, surgery is necessary. A heart transplant may be performed as a life-saving measure when medications and medical devices are ineffective. A patient is considered for heart transplant when all other management of heart failure has been attempted and optimized through the clinic here at Aurora. A patient will then go through an extensive evaluation to be deemed elibigle for transplant and ensure success. A comprehensive look at each candidate is done through a multidisciplinary approac. A patient's severity of illness, co-morbidities, and socila supports are all key components of the evaluation.
Another type of heart failure ssurgery involves a total artificial heart, which is a mechanical pump that supports both sides of the heart, is implanted in a very limited number of patients. A total artificial heart is a surgically implanted pump that supports both sides of the heart as yet another option for patients who have complicated end stage heart failure. The indications and use for the artificial heart are limited, but have been used successfully at Aurora St. Luke’s as a bridge to transplantation.
A Leader in Treating Heart Failure
Aurora’s Heart Failure Program provides the whole spectrum of services for patients and their families. We provide continuity of care with dedicated heart failure caregivers who manage patients throughout their lifetime. Aurora patients often have the same nurse coordinator and physician for many, many years.
In addition to our nurses and physicians, many other dedicated professionals care for our patients with heart failure, including:
- Cardiac and pulmonary rehabilitation therapists
- Financial counselors
- Heart failure pharmacists
- Home care nurses and therapists
- Social workers
These professionals work as a team in the Tendick Heart Failure Center(link tbd), located at Aurora St. Luke’s Medical Center in Milwaukee, Wisconsin. We manage and coordinate outpatient services at this location, which makes it easier for patients to see a variety of dedicated heart failure professionals at one location, during one visit. If patients require hospitalization, this same team also oversees their inpatient care, which makes for a seamless transition.
The Aurora Health Care Mechanical Circulatory Support Program (VAD Program) is the largest in the nation. Our survival rate exceeds 90 percent. In 2010, we implanted more than 95 ventricular assist devices and expect to implant our 500th this year.
Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.