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Online Chat - Learning to Live with Heart Failure

Online Chat - Learning to Live with Heart Failure

Monday May 14, 2012

Dr. Dickinson:
Hi, I’m Dr. Dickinson. Thank you for joining me today to learn more about understanding heart failure. While the questions start coming in, I’ll start with a few facts you may not know.

Dr. Dickinson:
If you have heart failure, it means your heart can't properly pump blood through your body.

Dr. Dickinson:
Many conditions can lead to advanced heart failure (AHF) or congestive heart failure (CHF).

Dr. Dickinson:
Other heart problems that may cause heart failure are coronary artery disease, congenital heart disease, heart attack, heart valve disease and some types of abnormal heart rhythms (arrhythmias).

Dr. Dickinson:
Other diseases that can cause or contribute to heart failure include emphysema, overactive or overactive thyroid as well as severe anemia.

Comment From Susan:
How do you get heart failure?

Dr. Dickinson:
Heart failure comes from any number of conditions that cause the heart to not pump the blood as efficiently as it should. The most common cause is longstanding high blood pressure, but prior heart attacks, valve disease, viral infections and a number of other problems can cause it.

Comment From Susan:
What's the difference between having heart failure and having a heart attack?

Dr. Dickinson:
A heart attack is when the heart is damaged from a blocked coronary artery. This is treated with angioplasty, stents or bypass surgery. Heart failure is a syndrome of symptoms that occurs when the heart does not pump the blood as well as it should. Heart attacks can cause heart failure, but a lot of other things can cause heart failure.

Comment From Linda:
My father gets very tired with his heart failure. Are we better to push him to be active or let him rest all the time?

Dr. Dickinson:
That is a challenging and good question. Studies of cardiac rehab for heart failure have shown benefits in terms of stamina and sense of well being from a coordinated exercise program.

Dr. Dickinson:
On the other hand, fatigue is one of the hallmark symptoms of heart failure and rebound fatigue (excessive fatigue after pushing oneself too hard) is a real phenomena. I often teach my patients to use energy conservation techniques so that they can achieve what is most important to them without pushing themselves too hard.

Dr. Dickinson:
So to answer your question - it all depends. Getting some daily activity is valuable and may help to maintain muscular fitness and stamina. Understanding the fatigue and not pushing too hard is also important.

Spectrum Health:
FACT: There are approximately 5 million adults in the United States diagnosed with heart failure.

Comment From Toni:
Good afternoon my question is I am 32 living with chf are my child bearing days over

Dr. Dickinson:
It depends. Heart failure can become unstable and significantly worsen with the stress of pregnancy (blood volumes increase during pregnancy). It can be very dangerous to become pregnant if you have a significant cardiomyopathy. Some women have a condition called peripartum cardiomyopathy that is heart failure that resulted from pregnancy. For these women to become pregnant again can be very risky.

Dr. Dickinson:
If someone had self limited heart failure and has a normal ejection fraction it might be possible to have more children. Discussion one on one with your physician is the best thing to do.

Comment From Carol:
How long is one expected to live once they have heart failure?

Dr. Dickinson:
That is a hard but important question. Heart failure is serious and many people die each year of heart failure with an average survival of about 5 years after diagnosis. That being said, those are statistics that take in all patients (including the very elderly or those with many medical problems) and are not an individual prognosis for a given patient. With proper treatment with medications, salt restriction, attention to all of your health problems, etc... most of my patients live many years.

Spectrum Health:
FACT: Heart failure is the most common heart-related reason that people are admitted to the hospital. About 550,000 new cases are diagnosed each year.

Comment From Eric:
I had acute heart failure but right now it seems okay.. I'm still feel from time to time heart pains. but I didn't have any severe respiratory distress like it was in my acute heart failure..what do you think?

Dr. Dickinson:
It is hard to fully answer you without knowing all of the details of your medical history. As one of the causes of heart failure is coronary artery disease it is important that you have testing done (a stress test or heart catheterization) at some point to make sure that you don't have a coronary blockage that should be corrected. These blockages can of course cause chest pain.

Dr. Dickinson:
Sometimes patients will have a feeling of chest fullness when they get fluid overloaded even if they have normal coronary arteries. If you are feeling a recurrence of symptoms I would suggest that you see your doctor for an examination and labs that could help to ensure that your fluid status is optimal for you.

Comment From Eric:
Is it possible my diabetes type 1 caused my heart failure? My diabetes is brittle,, swings from low to high and high to low.. if yes, could you explain me how my diabetes affect my heart? I eat healthy and I don’t have any cholesterol.

Dr. Dickinson:
Diabetes can cause heart failure in a variety of ways. Having longstanding diabetes (especially type 1 DM) can increase your risk for coronary artery disease and making sure that you don't is very important. Second diabetes can occasionally cause a direct cardiomyopathy, plus it is commonly associated with high blood pressure which is the most common cause of heart failure.

Dr. Dickinson:
If you don't have coronary disease, then close attention to your blood sugar control but especially your blood pressure is very important. Also if your ejection fraction (EF) is reduced then you should be treated with an ace inhibitor (or angiotensin receptor blocker) and a beta blocker.

Spectrum Health:
FACT: Heart failure is on the rise, but due to new and better treatment, survival is increasing.

Comment From Linda:
What would be some energy conservation techniques?

Dr. Dickinson:
Most of these are common sense. There are things in life that you do but don't have to do. These are things that you can get help with (mowing the lawn, cleaning, etc...) I tell my patients to look at what they think they need to achieve in the day and then prioritize which they really need to or want to do.

Dr. Dickinson:
Some people need more help as they age. Sometimes it means moving into an assisted living or senior apartment setting where the burden of cooking and cleaning can be removed from them. I would much prefer them to enjoy the quality of their life, and get in a little bit of exercise, then being exhausted from trying to keep up with a large home.

Comment From Susan:
Does the amount of sodium a person consumes really matter to a healthy person?

Dr. Dickinson:
To a patient with heart failure or high blood pressure the amount of sodium they take in is critical to their management and symptoms. They should "throw away" their salt shaker and get in the habit of counting the number of grams of sodium that are present in the foods that they eat. The American diet is far too high in sodium content and it can be challenging to try to reduce your sodium intake. The recommendation has been that heart failure patients restrict their diet to less than 2000 mg per day but recently those recommendations are being revised to less than 1500 mg per day.

Dr. Dickinson:
For a person without heart disease the importance is less clear. We clearly know that in societies with a very low sodium intake, heart and vascular disease is MUCH lower (at times nearly nonexistent) than in our society. From this standpoint we would suggest that all of us should reduce the sodium we take in. The recent ADA recommendations for 1500 mg/day of sodium were based on a desire to push manufacturers (and the American public) toward a societal norm of less sodium intake.

Dr. Dickinson:
That being said, it is challenging when you first start to try to keep to a low sodium diet. Patients who succeed do so by being creative and making good use of the whole wealth of available herbs and spices to flavor their foods. Those who just try to not use salt continue to struggle.

Spectrum Health:
FACT: After heart failure is diagnosed, heart failure survival is poorer in women than in men.

Comment From Eric:
My doctor noticed heart failure mitral on echo. Is it common in diabetes type 1 heart failure mitral?

Dr. Dickinson:
I assume you are referring to mitral insufficiency. The mitral valve is the valve the is supposed to prevent the blood from going backwards towards the lungs when the heart contracts. If this leaks a LOT (severe mitral insufficiency) then it can cause heart failure and can weaken the heart over time.

Dr. Dickinson:
Often it is present because of heart failure rather than being the cause of heart failure. As the heart enlarges or gets weaker, the mitral valve can get "tethered" open or distorted causing it to leak. It is fairly common to see mild or moderate mitral insufficiency in the setting of a cardiomyopathy. The treatment for this is to treat the heart itself - with diuretics, ace inhibitors or beta blockers - rather than to repair or replace the valve.

Dr. Dickinson:
Sometimes the valve itself is the problem or the leakage is severe. In these cases a mitral valve repair or replacement can be helpful. Our surgeons at the Meijer Heart Center have extensive experience in doing this surgery with good outcomes via both a traditional approach and via a robotic surgery approach.

Spectrum Health:
FACT: The estimated cost of heart failure in the United States for 2010 is $39.2 billion.

Comment From Susan:
What is an ejection fracture?

Dr. Dickinson:
We refer to the ejection fraction (EF). That is the percent of the blood that the heart pumps out with each beat. As you can understand the heart's job is to fill with blood and then to squeeze and push the blood out. On average a normal heart will push between 55-70% of the blood that it has when it is full out with each beat.

Dr. Dickinson:
Some patients have a normal ejection fraction but still have heart failure. For these patients the problem is that the heart is stiff and doesn't fill with enough blood. Even if it is able to push out a high percent of the blood it filled with, if it doesn't fill with enough blood it can't pump enough blood.

Dr. Dickinson:
Other patients have a cardiomyopathy (or weakening of the heart muscle). This causes the ejection fraction to be low.

Dr. Dickinson:
We teach our patients to "know their EF" because if the EF is 35% or lower, this suggests that they have a risk of sudden cardiac arrest and an implantable defibrillator is indicated.

Spectrum Health:
FACT: Although the majority of people with heart failure are elderly, heart failure is NOT a natural consequence of old age and there are many young people living with heart failure, as well.

Comment From Eric:
Hi I had several extreme low pulse pressure during my acute heart failure. Pulse pressure 10 .. ex: 205/195 Is it common thing? Or it's pretty rare very low pulse pressure of 10 or less and heart failure? Thank you

Dr. Dickinson:
To have a low pulse pressure like you describe would be uncommon. What you are noting is very high blood pressure occurring during the acute heart failure episode. The 205 systolic BP is concerning. This is often observed however in patients with acute heart failure. The thought is that the episode is a "snowball effect" cascade of heart failure causing increased adrenaline levels which cause higher blood pressure which impairs the hearts function which causes more heart failure which causes more adrenaline, etc...

Dr. Dickinson:
I think the real issue you describe is trying to make sure that your blood pressure is tightly controlled as well as close attention to your fluid status so that these "spells" don't occur, more than a concern about the pulse pressure itself.

Spectrum Health:
FACT: When your heart is functioning normally, it beats with enough force to shoot blood a distance of 30 feet.

Comment From Mark:
Can people live with undiagnosed heart failure for a long time? How do you diagnose HF?

Dr. Dickinson:
Studies of young people who die unexpectedly in the military have shown that many of them have evidence of cardiomyopathy on autopsy. This suggests that if you are physically fit it is possible to have heart failure and not know it. We see this in the very young and the very fit.

Dr. Dickinson:
What we also see in the young and healthy (e.g. <50 yrs of age, active) is that they think they have the flu or bronchitis or pneumonia. It is not uncommon that patients with a cardiomyopathy go weeks to months before the fact that they have heart failure is recognized. Many times they have had a few courses of antibiotics to treat the "pneumonia" that was really heart failure.

Dr. Dickinson:
The most common symptoms of heart failure are shortness of breath, edema (or ankle swelling) and fatigue. All of us have had some of these symptoms when we have a cold or the flu and didn't have heart failure, but if you do have edema or persistent symptoms it might be worth raising the question of if you have heart failure.

Dr. Dickinson:
The tests to diagnose heart failure are three: (1) physical examination to look for distended neck veins, crackles in the lungs, or edema (2) BNP - a blood test, and (3) an echocardiogram to look at the heart's function.

Dr. Dickinson:
We all know the unfortunate story of Wes Leonard that generated so much attention. From what I know of the case it sounded like Wes was an incredibly fit athlete that was able to function at a high level in spite of having a severe cardiomyopathy. It can be hard for excellent physicians to recognize heart failure in this setting. It is for that reason that the physicians at the Frederik Meijer Heart & Vascular Institute have been strong advocates for placing defibrillators in public places to be able to rapidly respond if a "Wes" type situation occurs again.

Dr. Dickinson:
And - common sense prevails. If you don't feel well - and you continue to not feel well - especially if it is shortness of breath, etc... perhaps getting a b-type natriuretic peptide (BNP) level checked isn't a bad idea - along with an exam by your physician.

Spectrum Health:
FACT: The best way to prevent heart failure is to keep your heart healthy. Do not smoke, eat a healthy diet, exercise regularly, lose weight if needed, do not use illegal drugs, drink alcohol moderately and take prescribed medications as directed.

Comment From Linda:
Are there any natural supplements that you have seen success with in heart failure?

Dr. Dickinson:
That is a great question. We would all love to have a "natural" solution to heart failure. That being said, most of the great advances in medicine have been discovered from naturally occurring substances. In terms of the health supplements that are suggested for heart failure (nutraceuticals, Hawthorne, Coenzyme q-10, fish oil) most of them have not been well studied enough for us to say whether they or of benefit or not.

Dr. Dickinson:
The GISSI-HF trial did look at a super purified version of fish oil and that seemed to provide benefit. The others have not been shown to cause harm, but unfortunately there is no hard scientific evidence to suggest benefit either. I generally say this: (1) There are treatments that have profound benefit (ACEI, Beta blockers, etc...) Make sure that you do these first. (2) I don't know about the supplements. If you want to try them - fine. The primary risk is your money and some patients have felt that they have provided them benefit.

Spectrum Health:
FACT: Heart failure may affect the left side, the right side or both sides of the heart.

Comment From Guest:
Do daily aspirins help with heart failure?

Dr. Dickinson:
Daily aspirin "can" help to prevent heart attacks and strokes in patients with risk factors for vascular disease. This means that we sometimes recommend this to reduce the risks of those events. In patients without vascular disease (coronary disease, blocked arteries, etc...) there is no evidence of benefit. In one of the research trials there was a suggestion that aspirin can slightly increase the risk of heart failure hospitalization and another suggested that it might interfere with the benefit of the ace-inhibitor medications.

Here is what we tell patients: We use aspirin to prevent heart attack and vascular events. It is worthwhile in heart failure patients with known coronary disease or significant risk factors. If there are not these risks, then there is no benefit.

Comment From Mark:
What would cause someone so young to have heart failure?

Dr. Dickinson:
There are a few causes. The most common one is "idiopathic" meaning that we don't know for sure. We do know that viruses an attack the heart and we presume that most of these are "viral cardiomyopathies." Some patients have a familial cardiomyopathy - meaning an inherited condition which can cause their heart to weaken over time. It is for this reason that whenever we identify someone with a reduced ejection fraction and they do not have coronary disease that we recommend that all of their first degree family members get echocardiograms to make sure that they also don't have asymptomatic weakness of their heart muscle.

Comment From Eric:
In the cases like Wes Leonard, what would be the best things to prevent this to happen again? do you know? Maybe some preventive tests to diagnose risk at early stage?

Dr. Dickinson:
This is of course an area of debate. Some countries (such as Italy) and some organizations do extensive testing of athletes to try to screen for such conditions. That has never been proven to be of benefit and even in these areas the rates of sudden cardiac death have not been shown to be lower.

Dr. Dickinson:
We do not recommend routine cardiac testing for athletes because any tests that might be suggested don't necessarily predict who might have problems. We do recommend that they have a good examination with their physician and adhere to good preventive health strategies. This seems helpful.

Dr. Dickinson:
To do EKGs or echocardiograms on every athlete would be very costly, would have higher false positive tests than real abnormal tests (suggesting normal people to real risks of follow up tests) and should not be recommended.

Dr. Dickinson:
What we do recommend is this:

- If you have symptoms - see your doctor.

- All of us should learn CPR to potentially be a "hero" for our school or community.

- All of our schools and public places should have automated external defibrillators (AEDS) available and we should all make sure that we know where they are and how to get them quickly.

Dr. Dickinson:
Thank you for taking the time to learn more about heart failure. It’s important to recognize the warning signs of heart failure and call your doctor right away if you notice any of them:

Cough

Fatigue, weakness, faintness

Loss of appetite

Need to urinate at night

Pulse that feels fast or irregular or a sensation of feeling the heart beat (palpitations)

Shortness of breath when you are active or after you lies down

Swollen (enlarged) liver or abdomen

Swollen feet and ankles

Waking up from sleep after a couple of hours due to shortness of breath

Weight gain

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