(Courtesy of Englewood Health) “Often when people hear the words ‘heart failure,’ they think it is a death sentence,” says cardiologist Andrew J. Weissman, MD, of Englewood Health. “The reality is that there are many degrees of heart failure. It is important to understand that all heart failure is not equal.”
What is congestive heart failure?
Congestive heart failure (CHF) occurs when the heart muscle is unable to pump enough blood to meet the body’s demands. It often causes the body to retain fluid.
Symptoms of CHF include:
- difficulty breathing
- fatigue
- decreased ability to exercise
- swelling in legs
- abdominal distention
- weight increase that occurs over a period of a few days
What are systolic and diastolic heart failure?
Heart failure caused by a weak heart muscle is called systolic heart failure. Almost all medications and devices shown to be effective for treating heart failure were developed through clinical studies on systolic heart failure.
When the heart muscle is stiff and unable to relax to fill with blood, it is called diastolic heart failure. Chronic hypertension (high blood pressure) is the most common cause of diastolic heart failure. Hypertension is a silent, or asymptomatic, disease; it is therefore important to have your blood pressure checked regularly. If you have high blood pressure, you should take your prescribed medications, which can prevent the long-term complications of high blood pressure.
What is an ejection fraction?
If you have systolic heart failure, the “ejection fraction” is the most important number to know. It indicates the percentage of the heart that empties with each beat (normal is 50–70 percent). If your ejection fraction is less than 40 percent, you are considered to have systolic heart failure. Your doctor may prescribe medications and devices to manage symptoms, extend life and improve the ejection fraction—or at least to prevent further deterioration.
What about medical devices to treat heart failure?
If the heart muscle remains weak despite optimal medication, we typically recommend certain devices to treat a patient’s heart condition and prevent sudden death.
These devices include:
Implantable defibrillator: For patients at risk for sudden ventricular arrhythmia, this device is inserted during a minimally invasive procedure. The device, which consistently monitors the heart, administers a shock to the heart in the event of a potentially fatal ventricular arrhythmia.
Biventricular pacemaker (also called cardiac resynchronization therapy): If, in addition to being weak, the right and left chambers are beating out of sync, a biventricular pacemaker may significantly improve the symptoms of heart failure.
Heart transplant: For severe, advanced heart failure, a heart transplant may be a possibility. Unfortunately, there are only limited donor organs available compared with the need, and not all patients are candidates for heart transplant.
Ventricular assist device: In patients who are candidates for a transplant, a surgically implanted pump called a left ventricular assist device (LVAD) can be used either as “bridge to transplant” or as “destination therapy,” to provide long-term support.
If you have symptoms, it is important that you be evaluated by a doctor. Heart failure is the most common cause for hospitalization in the United States and hospitalization for heart failure can often be prevented. If you do have heart failure, you need to be closely followed by your doctor.
Dr. Weissman’s other recommendations for patients with heart failure include:
- Pay attention to taking your medications and to your diet.
- Weigh yourself every morning. If you gain more than one or two pounds in a day, you may be retaining fluid and should call your doctor.
- Have a low threshold for calling your doctor. Reach out at the onset of symptoms—don’t wait a few days. Contacting your doctor early can help prevent hospitalization.
Dr. Weissman believes that patient and family education is the most important aspect of caring for heart disease patients, and he strives to ensure that his patients do not leave his office with unanswered questions. “Don’t hold onto those questions,” he says. “Ask! And if you have more questions after you leave the office, call.”
An avid exerciser, Dr. Weissman commits one hour every day to exercise, with the goal of keeping his own heart in shape. A former basketball enthusiast, he now plays tennis in local leagues in Rockland County, where he lives with his wife and family. “I love it,” he says. “I wish I had taken it up earlier.”
Andrew J. Weissman, MD, is a board-certified cardiologist with Cardiovascular Associates of North Jersey and a member of the Englewood Health Physician Network.
