Heart Failure Clinic

The goal of the heart failure clinic at Heart First is to provide exceptional evidence-based care for patients diagnosed with heart failure with the objectives of improving quality of life, prolonging survival, and decreasing hospitalizations.

This will be accomplished through optimization of drug therapy, patient and family education with emphasis on self-care, vigilant follow-up, early treatment of signs and symptoms of fluid overload, coordination with other providers and increased access to the health care provider. These are all elements of the Heart First heart failure disease management program.

What is heart failure?

Heart failure occurs when the heart muscle becomes weak and cannot pump blood through the body efficiently. The body does not get the oxygen-rich blood it needs. The diagnosis of heart failure can be quite intimidating. Although it is a serious, ongoing condition, our goal at Heart First is to assist you in managing this condition. According to the American Heart Association, there are approximately 5 million Americans living with heart failure.

What causes heart failure? What type of heart failure do I have?

• Coronary artery disease- This is the most common cause of heart failure. Over time, plaque deposits in the arteries of the heart, narrowing the blood supply to the heart muscle, damaging the muscle. If a heart attack has occurred, muscle tissue has died. The remaining healthy heart tissue has to work harder over time, thus weakening the heart.
• High blood pressure- Uncontrolled, elevated blood pressure can double or triple the risk of developing heart failure. The heart has to pump harder than normal to keep blood circulating through the body. Over time, the chambers of the heart get larger and weaker.
• Abnormal heart rhythm- If the heart beats too fast, too slow or irregularly; it may not be able to effectively meet the needs of the body leading to heart failure.
• Heart muscle disease (referred to as cardiomyopathy) – Damage to the heart muscle caused by drug or alcohol use, viral infections or other unknown reasons can increase the risk of heart failure.
• Congenital heart defects- When the heart and its chambers are not formed correctly, the healthy parts have to work harder to compensate.
• Abnormal heart valves- If heart valves do not open or close properly, the heart has to work harder to circulate blood. When the workload becomes too great, heart failure can result.
• Severe lung disease- With improperly functioning lungs, the heart has to work harder to get oxygen to the rest of the body.
• Diabetes- This condition increases the risk of developing heart failure. Individuals with diabetes tend to develop high blood pressure and coronary artery disease; these have been linked to heart failure.
• Sleep apnea- Low blood oxygen content, altered carbon dioxide level, and changes in pressure in the chest cavity all occur in sleep apnea. These all have harmful effects on the cardiovascular system which can lead to heart failure.
• Other conditions- At times, an otherwise healthy heart may not be able to keep up with the needs of the body. This can occur in severe anemia when there are not enough red blood cells to carry oxygen and in hyperthyroidism when the body works at a fast pace. Both conditions cause the heart to be overworked trying to keep up. Chemotherapy can damage the heart leading to heart failure.

What exactly happens when heart failure occurs?

• The heart does not pump enough blood to meet the needs of the body.
• There is not enough forward blood flow from the heart to the body.
• When a weak heart cannot pump blood as well as it should, it begins to back up in your veins causing swelling of the legs, hands, abdomen, and other parts of the body.
• Fluid is often visible when it settles in the lowest part of the body such as the ankles and feet.
• When too much fluid is in the lungs, this is called pulmonary edema.

What types of testing might be done when I come to the office? What will be scheduled at my next office visit?

• EKG- evaluates heart rhythm. Is it too fast or too slow, or is it irregular.
• Echocardiogram- Evaluate the structure of the heart muscle and valves, evaluate ejection fraction which is a key number to know in heart failure. Normal is 50-70%.
• Stress testing- Nuclear stress testing or stress echo to evaluate for coronary artery disease.
• Coronary CT angiography- A test using a CT scanner and dye to evaluate for coronary artery disease.
• Heart catheterization- Done in the hospital to evaluate for coronary artery disease.
• Microvolt T-wave- A test done to evaluate for potential cardiac arrhythmias which could lead to sudden cardiac death which is a risk with a low ejection fraction.
• Bio-Z testing- Done in the clinic with multiple chest electrodes which evaluates key measurements including fluid in the lungs.
• Lab work- There are some key markers we will look for in heart disease. Multiple medications can impact electrolytes in the body; we may look at some of these indices. We will obtain records from your primary care physician to review most recent lab work including lipid status. We may initially test for rare causes of heart failure such as lupus, hemochromatosis, leptospirosis, and Chagas disease.
• Sleep study- If indicated, we will evaluate for sleep apnea which can worsen heart failure.
• Pulmonary function testing- This will be ordered if on certain medications impacting rhythm which can impact functioning of the lungs.
• Chest X-Ray- May be done to further evaluate shortness of breath.

How can I take control of my condition?

• Reduce your salt intake to no more than 2000 mg a day. Avoid table salt. Use other spices like lemon and salt-free seasoning or spices. Buy fresh vegetables when possible. Buy canned or frozen vegetables without salt. Rinse canned or frozen vegetables with fresh water before eating.
• Lower the fat and cholesterol in your diet.
• Limit the amount of alcohol you drink. If your heart failure was caused by alcohol use do not use alcohol in any amount. Women should only have one drink per day and men two drinks per day.
• Avoid all tobacco products. We will refer you to a pulmonologist for smoking cessation if needed.
• Exercise daily within your capacity. No heavy weight lifting.
• Plan time throughout the day to rest if needed.
• Weigh daily in the morning after urination and record your weight. Bring this record to your office visit.
• Take all your medication as directed. This is vital. Call our office before taking over the counter medications.

What types of medications are used to treat heart failure? What am I on?

• Beta-blockers block adrenalin and lower the heart rate and blood pressures.
• ACE inhibitors strengthen the heart to lowering the blood pressure and relaxing blood vessels.
• Angiotensin II receptor blocker (ARB) block a chemical that can potentially lead to unhealthy changes in the heart. They also lower blood pressure.
• Diuretics help the body get rid of fluid.
• Potassium supplements depending on the type of diuretics used due to depletion of potassium with certain diuretics.
• Vasodilators dilate and plump of blood vessels to improve circulation through them.
• Digoxin helps the heart pump better, strengthening and slowing the heart beat.
• Calcium channel blockers lower blood pressure and pulse and prevents coronary artery spasm.
• Anticoagulants prevent clots.
• Antiarrhythmics prevent abnormal heart rhythm.
• Statins prevent the build up of plaque in the coronary arteries.

When do I call the heart failure clinic?

• Increased fatigue and weakness.
• Weight gain of 3 pounds in 1-2 days or 5 pounds in 1 week.
• Shortness of breath or wheezing at rest or during exercise.
• Waking up short of breath or gasping for air.
• Frequent dry cough, especially with laying down.
• Swelling of your legs, ankles, fingers, hands or abdomen.
• Dizziness or fainting. Remember to change position slowly.
• Confusion or inability to think clearly.
• Any medication problems.
• Inability to keep food or liquid down.
• Chest discomfort that is more frequent. If severe, call 911.
  * If chest discomfort is not promptly relieved by rest take nitroglycerin every 5 minutes for three doses.
  * If chest discomfort is not relieved with nitroglycerin call 911.