About Heart Failure

Heart failure is a condition in which the heart is unable to pump enough blood to meet the needs of the body. Heart failure can be caused by a number of conditions, such as heart attacks, hypertension, diabetes and coronary artery disease, all of which can result in structural or functional changes to the heart and impair the ability of the heart to adequately pump blood. These changes result in an enlarged heart. The reduced blood flow to the body causes patients to feel tired, weak, short of breath or unable to do many daily activities.

 

Heart failure is the leading cause of death in the developed world and is estimated to affect approximately five million Americans, with 550,000 new cases diagnosed in the U.S. each year. Worldwide numbers are estimated to be double those for the U.S. Heart failure is predominately seen in patients over the age of 50 and the American Heart Association estimates that it affects 10 out of every 1,000 people over the age of 65. The diagnosis of heart failure is made by the physician after a comprehensive review of the patient’s medical history, physical examination and diagnostic tests.

Current Treatment Options

In a majority of patients, there is no cure for heart failure. Heart transplantation, replacing the damaged heart with a normal heart from a recently deceased donor, is available on a limited basis to 2,500 patients per year in the U.S. Therefore, heart failure is most often managed with a combination of therapies, including life style changes such as improved diet and exercise, medications, devices and/or surgeries.

Medications

Medicines that are used to improve the pumping function of the heart include beta blockers, diuretics, angiotensin-converting enzymes (ACE inhibitors) and angiotensin II receptor blockers (ARB). The goal of these medications is to improve blood flow to the body and slow the progression of heart failure. Many patients do well on these medications and are able to control the progression of their disease. However, other patients do not respond to these medicines, resulting in a return or worsening of heart failure.

Devices and Surgery

There are several interventional and surgical procedures commonly recommended for the treatment of heart failure. Some of the common treatment approaches are described below.  Only a physician can advise which approach might be right in individual cases.

 

• Angioplasty and Stents
  Heart failure can be caused by coronary artery disease (blocked arteries in the heart). Angioplasty and stent devices are designed to open blocked arteries. Re-establishing the blood flow to the heart may improve or resolve the symptoms associated with heart failure.
• Pacemakers and Defibrillators
  Heart failure can be worsened by irregular heartbeats and result in a poorly functioning heart or even sudden death. Pacemakers and defibrillators can be used (together or separately) to regulate the electrical conduction of the heart and may improve or resolve the symptoms associated with heart failure.
• Coronary Artery Bypass
  When coronary artery disease cannot be treated with angioplasty, coronary artery bypass surgery can be performed to re-establish blood flow around the blocked artery and may improve or resolve the symptoms associated with heart failure.
• Heart Valve Surgery
  Heart failure can be caused by functional (diseased valve) or structural abnormalities in the heart and result in a malfunctioning valve. Heart valves can be repaired or replaced to re-establish the normal blood flow in the heart and may improve or resolve the symptoms associated with heart failure.
• Ventricular Assist Devices
  Ventricular Assist Devices (VADs) are implanted devices used as a bridge-to-transplant or as destination therapy for the treatment of failure patients. Many of these devices that are currently available require highly invasive implantation surgery that requires opening the chest cavity and placing the patient on cardiac bypass. Less-invasive circulatory support systems are being designed to reduce the invasiveness of the procedure while also potentially reducing the symptoms associated with heart failure in a broad range of patients.
• Heart Transplantation
  Heart transplantation is an option for some end-stage heart failure patients who are not responsive to conventional medical therapy (medications, devices and surgery). Heart transplants are a cure for heart failure. Unfortunately, there is a severely limited number of donor hearts available, and heart failure patients often may have developed other underlying conditions, potentially excluding them from becoming a heart transplant candidate.