An estimated 6.5 million adults in the United States have heart failure. More than 670,000 Americans over the age of 45 get a heart failure diagnosis for the first time each year.
Overall, heart disease remains the leading cause of death among Americans.
Heart failure is a serious, chronic condition. Though older people are more likely to develop heart failure, it can happen at any age for a variety of reasons.
Dr. Gavin Hickey, MD, medical director, Ventricular Assist Device Program, UPMC Heart and Vascular Institute, answers some questions about heart failure symptoms and treatment.
As always, if you think you’re having a heart attack, call 911 or visit your closest emergency room.
What Are the Risk Factors for Heart Failure?
Poor diet and a sedentary lifestyle can lead to coronary artery disease, the No. 1 cause of heart failure.
Toxins like alcohol and smoking.
Stimulants like methamphetamines, long-standing high blood pressure or diabetes that aren’t well controlled, and sleep apnea can potentially increase the risk for heart failure.
Additionally, people over 65 years old are more likely to experience heart failure.
What Are the Symptoms of Heart Failure?
Shortness of breath and fatigue are two of the most common reasons patients go to see their doctor.
You may start to feel tired and unable to complete daily tasks without needing to stop and rest. This can occur when you’re resting, sitting still, or more commonly, exerting yourself. This can include going for a walk, hiking up a hill, or climbing a flight of stairs.
Chest pain or discomfort is also very common. Though leg swelling can occur for a lot of reasons, it might be an indication that you have too much fluid in your heart. This can be a sign of heart failure.
As a heart failure specialist, there are two key symptoms I always look for.
One is noticing that when you’re eating, you’re getting full very quickly. That can be a sign of ascites, which is a buildup of fluid in your belly. Also, if you get nauseous after eating, that could be an indication that you are not getting enough blood flow.
For older patients, we also look for signs of confusion, trouble remembering things, or difficulty concentrating.
A dry cough, or shortness of breath when lying flat, are two other warning signs. When patients with heart failure lay flat, they may feel short of breath. They have to prop themselves up to breathe normally. PND, or paroxysmal nocturnal dyspnea, is a symptom that occurs when patients try to lie down to go to sleep at night but wake up short of breath, gasping for air, in the middle of the night.
What Are Treatment Options for Heart Failure?
The No. 1 treatment would be preventing heart failure by treating risk factors.
We have two distinct types of heart failure. One is diastolic heart failure, which is a stiff heart where pumping is normal but relaxation is not. This can be caused by hypertension or diabetes. In that case, the treatment is to address the underlying cause. So, treating high blood pressure, diabetes, increasing activity, or targeting weight loss.
There are a couple of medications that we can use to treat this type of heart failure.
For people who have low ejection fraction, systolic fracture, or a pumping problem, there are very specific treatments for that.
We have guideline-directed medical therapy clinics in which we try to get the person on four medications to help the heart heal. Those four medications can increase the survival rate to 72%.
If their condition does not improve, then we discuss heart pumps and heart transplants.
How Does Heart Failure Differ in Men and Women?
Men tend to experience heart failure earlier than women.
Men are more likely to have coronary artery disease, ischemic heart failure, and lower ejection fractions, also referred to as systolic heart failure.
Women are more likely to experience diastolic heart failure when they’re older. Diastolic failure happens when the left ventricle loses its ability to relax because the muscle has become stiff, leading to impaired function.
Heart attack symptoms can differ among men and women, too.
Women may have less chest discomfort or may experience discomfort in a different place like the neck, jaw, or back. Women may also experience shortness of breath without chest discomfort.
So, if you’re having any of those symptoms, it’s appropriate to talk to your primary care doctor and cardiologist to get further testing done.
When Should I Begin to See a Cardiologist to Discuss Heart Failure Prevention?
Typically, most patients see a primary care doctor first. If they identify a cardiology abnormality, they will refer you to a cardiologist for specialized care.
Your cardiologist can then determine how frequently you need to be seen.
How Do You Diagnose Heart Failure?
Often, we use an echocardiogram. This is an ultrasound of the heart and is one of our main tools to see exactly what the ejection fraction is. Ejection fraction is essentially a measurement of how much blood the heart is pumping.
If you have symptoms of heart failure and we find on an echocardiogram that the ejection fraction is greater than 50%, you may have diastolic heart failure or heart failure with preserved ejection fraction.
If the ejection fraction is less than 50%, and this is specifically the left ventricle, this could be a pumping problem with the heart, or systolic dysfunction. So, we call this heart failure with reduced ejection fraction.
Other things we look at on in an echocardiogram include the right side of the heart, where diseases such as cardiomyopathies and pulmonary embolism can take hold. The right side of the heart can fail if it’s struggling to pump blood to the lungs and rest of the body. This can also result in a buildup of fluid and swelling.
We also look at pressure in the lungs. As fluid builds up on the left side of the heart, it can back up into the lungs, creating shortness of breath — and pulmonary hypertension, which is a buildup of pressure in the lungs.
We can also look for valvular disease or valvular conditions that may be causing heart failure symptoms.
Sometimes, we use a cardiac MRI. This provides pictures of the heart’s structure and function while it’s beating.
After we have done the necessary testing and a thorough evaluation, we can determine if you have or are at risk for heart failure.
Our goal in treating patients with heart failure is to improve their quality of life. We want you to breathe better. We want you to do more. We want you to be able to stay out of the hospital.
The UPMC Heart and Vascular Institute is one of the world’s premier centers for comprehensive cardiovascular care. For more information, visit our website.