Understanding Advanced Heart Failure

Each February, physicians and specialists recognize Heart Month and take the opportunity to share important heart health information with patients and the community. According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million adults in the United States have heart failure, which is a serious and sometimes fatal condition. Dr. Biswajit Kar and Dr. Igor D. Gregoric explain the differences between a heart attack and heart failure, the causes and symptoms of advanced heart failure and the best treatment options available, including mechanical circulatory support and heart transplantation.

Q: What is heart failure? Is it different from having a heart attack?
Dr. Kar: Heart failure occurs when the heart can no longer pump enough blood to the body to meet its demands for oxygen. This can happen due to damage to the structure of the heart or the mechanical function, such as the pumping or relaxation mechanisms. A heart attack occurs when a main blood vessel supplying blood to and from the heart is blocked, thus inhibiting blood supply to the heart muscle. The difference between the two is that heart failure occurs when the heart muscle itself is damaged or weak, and a heart attack occurs when blood flow to and from the heart muscle is blocked.

Q: What can cause heart failure?
Dr. Gregoric: Often, heart failure is a result of previous heart attacks. This kind of heart failure is defined as ischemic cardiomyopathy, which literally means that the heart muscle is weakened due to a deprivation of blood flow. Heart failure can also be defined as non-ischemic cardiomyopathy, which is typically caused by inflammation to the heart, heart disease, arrhythmias (irregular heartbeat), congenital abnormalities and environmental toxins including drug and alcohol use. People who have had previous heart attacks, a strong family history of heart failure, or certain cardiac risk factors-including high blood pressure, type 2 diabetes, and obesity caused by poor diet and lifestyle choices-are at a higher risk of developing heart failure.

Q: What are the symptoms of heart failure?
Dr. Kar: There is a wide range of symptoms including shortness of breath, the tendency to be easily fatigued, loss of appetite, and swelling of the feet, ankles, or legs. Often, patients who have heart failure may not show symptoms for years. We typically diagnose heart failure through a full examination of the heart muscle and its function. Tests might include an echocardiogram, which is an ultrasound of the heart muscle, imaging such as a cardiac MRI or an angiogram, a heart catheterization, or stress test.

Q: What treatment options are available for heart failure?
Dr. Gregoric: There are four main stages of heart failure, and each indicates a different type of treatment. Stage A is the earliest stage, with only risk factors for heart failure present, such as hypertension or previous heart attacks. Stages B and C are characterized by changes to the heart muscle visible on an echocardiogram; typically, in these stages, a patient is experiencing symptoms. Stage D is the most advanced stage, meaning that standard medical therapy is ineffective, and the patient is in need of more advanced therapies, including mechanical circulatory support such as the implantation of a heart pump, or a heart transplant.

At the Center for Advanced Heart Failure at Memorial Hermann Heart & Vascular Institute, we have the clinical expertise to treat all stages of heart failure with the latest cutting-edge research and evidence-based practices. We are unique in that we can offer the full spectrum of treatment options and can individualize our therapies to each patient and their individual heart conditions. In addition, in collaboration with McGovern Medical School at UTHealth Houston, we enroll patients in clinical trials focused on new medication and technologies to help slow or prevent the progression of heart failure, as there is currently no cure for the condition.

Q: How can I prevent heart failure? Is there a link between heart failure and COVID-19?
Dr. Kar: To reduce the risk of developing advanced heart failure, people should first focus on a healthy lifestyle, which includes quitting smoking, avoiding excessive alcohol use, eating a healthy and balanced diet, maintaining an ideal weight and remaining active. Risk factors should also be addressed, and a treatment plan should be developed with your cardiologist to manage diabetes, hypertension, sleep apnea and obesity. The heart can be affected during an active COVID-19 infection, including heart attack, blood clots and inflammation of the heart muscle. We still do not know if there is a direct correlation between COVID-19 infection and long-term heart failure. We are finding that patients with heart failure are at an increased risk for severe disease and complications after COVID-19. We highly recommend getting vaccinated against COVID-19 to reduce the risk of severe disease and its potential effects on the heart.

Are you in a high-risk category or concerned about symptoms for heart failure? Learn more about Memorial Hermann's comprehensive services at Center for Advanced Heart Failure | Memorial Hermann.