Expert care for advanced heart failure in Fort Worth
The heart cannot pump as well as it should when someone is experiencing heart failure. Blood and fluid may back up into the lungs as a result, and some parts of the body won’t receive enough oxygen-rich blood to perform normally. These problems result in the symptoms patients experience.
Our team at the Advanced Heart and Lung Disease Center at Baylor Scott & White All Saints Medical Center – Fort Worth looks at the cause of heart failure to help guide a patient's treatment plan. If a valve disorder causes heart failure, then surgery may fix the valve. If the cause is an underlying disease (such as anemia), treating that underlying issue may be part of the plan. While there's no cure for heart failure due to damaged heart muscle, many treatments can effectively improve symptoms of the heart condition.
Cardiomyopathy describes any disorder that affects the heart muscle, causing the heart to lose its ability to pump blood effectively. In dilated cardiomyopathy, the heart muscle begins to stretch and becomes thinner. This can occur for a variety of reasons. Over time, the inside of the chamber enlarges or dilates. As the heart chambers dilate, the heart muscle doesn't contract normally and cannot pump blood very well. As the heart becomes weaker heart failure can occur. Common symptoms of heart failure include shortness of breath, fatigue and swelling of the ankles, feet, legs, abdomen and veins in the neck.
Including sarcoidosis, LV non-compaction
Hypertrophic cardiomyopathy is most often caused by abnormal genes in the heart muscle. These genes cause the walls of the heart chamber (left ventricle) to contract harder and become thicker than normal. The thickened walls become stiff. This reduces the amount of blood taken in and pumped out to the body with each heartbeat. Restrictive cardiomyopathy causes the heart's ventricles to become rigid because abnormal tissue, such as scar tissue, replaces the normal heart muscle. As a result, the ventricles can't relax normally and fill with blood, and the atria become enlarged. Blood flow in the heart is reduced over time. This can lead to problems such as heart failure or arrhythmias.
Including amyloidosis and hemochromatosis
Similar to restrictive cardiomyopathy, infiltrative cardiomyopathy causes the heart's ventricles to become rigid because abnormal tissue replaces the normal heart muscle. As a result, the ventricles can't relax normally and fill with blood, and the atria become enlarged. Blood flow in the heart is reduced over time. This can lead to problems such as heart failure or arrhythmias. Amyloidosis is a disease in which abnormal proteins build up in the body's organs, including the heart. These abnormal proteins infiltrate the heart muscle and cause cardiomyopathy to occur. Hemochromatosis is a disease in which too much iron builds up in your body. The extra iron is toxic to the body and can damage the organs, including the heart. The excess iron deposits in the heart muscle and causes infiltrative cardiomyopathy.
In ischemic cardiomyopathy, a lack of blood supply to the heart muscle caused by coronary artery disease and heart attacks has resulted in a weak heart muscle. This decreases the heart's ability to pump blood and over time the heart becomes weaker. Eventually, heart failure can occur. Common symptoms of heart failure include shortness of breath, fatigue and swelling of the ankles, feet, legs, abdomen and veins in the neck.
When the heart or blood vessels near the heart do not develop normally before birth, a condition called congenital heart defect occurs. Congenital heart defects occur in close to one percent of infants, and most young people with congenital heart defects are living into adulthood now. In order to maintain wellness, it is important that those born with a heart defect continue heart care into adulthood.
Coronary artery disease begins when damage leads to the development of plaque building up within the artery wall. This plaque buildup begins to narrow the arteries carrying blood to the heart. As more plaque builds up, your artery has trouble supplying blood to your heart muscle when it needs it most. Plaque may tear, completely blocking the artery, or a blood clot may plug the narrowed opening. The decreased blood supply to the heart causes the heart muscle to become weak. Sometimes, the blockages can be opened up by placing a stent or balloon into the artery. Sometimes, the blockages must be surgically "bypassed" where new pathways for blood flow to the heart muscle are created. Sometimes, neither of these procedures is an option, and medications are used for management.
There are four valves that regulate the flow of blood within the heart: two on the left side (the aortic and mitral valves) and two on the right side (the pulmonary and tricuspid valves). Heart valve disorders can be caused by leaking (insufficiently or regurgitation) of the valves or narrowing (stenosis) of the valves. When heart valves fail to open and close properly, the effects on the heart can be serious, possibly impairing the heart's ability to pump blood efficiently through the body. Heart valve problems are one cause of heart failure. Typically, valves can either be repaired or replaced through intervention or surgery. However, sometimes neither of these procedures are an option, and an evaluation for advanced heart failure therapies is warranted.
An irregular heartbeat is an arrhythmia. Some arrhythmias are life-threatening, and having heart failure increases the risk of developing these life-threatening arrhythmias. There are some medications and procedures that can be used to stop abnormal heartbeats from occurring, but sometimes the arrhythmia does not respond to the treatment. In these cases, advanced heart failure therapies may be necessary.
Heart failure treatment options
Heart failure treatment is determined by a care team based on patients' personal preferences, age, medical history and type or stage of heart failure
The Advanced Heart and Lung Disease Center at Baylor Scott & White All Saints Medical Center – Fort Worth offers several treatment options, including:
- Controlling risk factors
- Cardiac resynchronization therapy
- Biventricular pacing
- Transplante de corazón
- Implantable cardioverter defibrillator
- Ventricular assist devices (VADs)
What happens during a heart failure evaluation at the Advanced Heart and Lung Disease Center?
The evaluation is used to determine two primary areas:
- Evaluation for cause—This includes assessment for presence of coronary artery disease, usually via cardiac catheterization, stress testing, echocardiogram, basic laboratory tests and/or ECG. Further testing could be needed based on what is found on these screening exams.
- Evaluation for factors that affect heart failure—This includes smoking, drug/alcohol use, high blood pressure, high cholesterol, abnormal heart rhythms, diabetes control, weight management, exercise, thyroid disease, anemia and sleep apnea.
What kinds of treatment may be used for heart failure?
- ACE inhibitors and ARBs—These medications are the cornerstone of heart failure treatments. While ACE Inhibitors are the mainstay, ARBs may be utilized if you cannot tolerate ACE inhibitors. Both of these classes of drugs are used to reduce dilation and restore the heart to its normal shape.
- Beta blockers—Provides the greatest potential benefit of all possible medications; some beta blockers have been proven to help the heart return to its normal shape/function. These are started at low dose and gradually adjusted as tolerated.
- Aldosterone antagonists—The third line of medical therapy, used in low doses in combination with the above. This medication is used to prevent your body from losing potassium and it is a mild diuretic.
- Digoxin—The last line of medical therapy, in addition to the three above, it has been shown to decrease the risk of hospitalizations.
- Diuretics—Used to managed swelling and fluid retention
- ICD (Implantable Cardioverter Defibrillator)—Small device placed under the skin of the chest. An ICD is designed to prevent a person from dying suddenly from a dangerous heart rhythm.
- Low-sodium diet—Restrict sodium (salt) to 2,000 mg per day. Dietitians are available to assist you with your dietary plan.
- Exercise is very important. Please discuss this with your provider.
What treatment might be used for stiff heart or diastolic heart failure?
- No medication has been shown to help a stiff heart relax. Most therapies aim to control the factors that worsen conditions such as hypertension, diabetes and sleep apnea
- Diuretics can be used to help manage swelling and fluid retention
What can I do to avoid needing a heart transplant?
The better you control your heart failure and its aggravating factors, the more likely you are to postpone or prevent the need for a transplant or LVAD.
What conditions do the Advanced Heart and Lung Disease Center treat?
- Dilated cardiomyopathy
- Ischemic cardiomyopathy
- Restrictive cardiomyopathy (including amyloidosis, sarcoidosis, hypertrophic cardiomyopathy, LV non-compaction)
- Pulmonary artery hypertension
If you find yourself asking, "How do I know if I need a heart failure specialist?" our experienced care teams are here to help guide you through your healthcare journey. Tell us a little about where you are in your journey and get the answers you need.