Advanced Heart Failure Diagnosis And Screening
Heart failure is diagnosed through careful medical evaluation, including a thorough physical exam, review of your medical history and cardiac tests and imaging. Some of the diagnostic tools used to detect heart disease include:
- Cardiac computerized tomography scan: A CT scan uses an X-ray to produce 3-dimensional images of your heart, chest and blood vessels.
- Chest X-ray: A chest X-ray allows your doctor to see a picture of your heart and lungs. This can be used to identify other conditions that may not be heart failure.
- Echocardiogram: An echocardiogram allows your doctor to see the size and shape of your heart, as well as anything unusual. Echocardiograms are also used to determine how well your heart is pumping, which is important for classifying heart failure.
- Electrocardiogram : An ECG can be used to detect heart rhythm problems or other heart abnormalities.
- Stethoscope: Your doctor may listen for abnormal sounds that may indicate heart failure.
Your doctor may order alternate or additional tests based on your unique circumstances.
Left Side Of The Heart
The job of the heart muscle is to transport oxygenated blood coming from the lungs to the left atrium and on through to the left ventricle. The left ventricle is the main pumping portion of the heart. It is larger than the other chambers and plays a fundamental role in normal heart function. When there is HF on the left side of the heart, the heart muscle has to work harder to squeeze out the same volume of blood. This is referred to as left ventricular heart failure. It is the most common type of HF.1
What Can I Do To Manage Swelling From Extra Fluid
- Elevate your legs above the level of your heart. This will help with fluid that builds up in your legs or ankles. Elevate your legs as often as possible during the day. Prop your legs on pillows or blankets to keep them elevated comfortably. Try not to stand for long periods of time during the day. Move around to keep your blood circulating.
- Limit sodium . Ask how much sodium you can have each day. Your healthcare provider may give you a limit, such as 2,300 milligrams a day. Your provider or a dietitian can teach you how to read food labels for the number of mg in a food. He or she can also help you find ways to have less salt. For example, if you add salt to food as you cook, do not add more at the table.
- Drink liquids as directed. You may need to limit the amount of liquid you drink within 24 hours. Your healthcare provider will tell you how much liquid to have and which liquids are best for you. He or she may tell you to limit liquid to 1.5 to 2 liters in a day. He or she will also tell you how often to drink liquid throughout the day.
- Weigh yourself every morning. Use the same scale, in the same spot. Do this after you use the bathroom, but before you eat or drink. Wear the same type of clothing each time. Write down your weight and call your healthcare provider if you have a sudden weight gain. Swelling and weight gain are signs of fluid buildup.
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What Are The Symptoms
Your feet, legs, and ankles will likely to swell because blood is backing up in your veins. This symptom is called edema.
- If it backs up into your stomach or liver, you may notice that your abdomen is distended, too.
- You might find that you have to go to the bathroom more, especially at night. This is caused by fluid buildup, too.
As your heart failure gets worse, you may also see some of these symptoms:
- Itâs hard to breathe.
- Your neck veins are swollen.
- Your pulse is fast or feels âoff.â
- Your chest hurts.
- Youâre gaining weight from excess fluid.
- You donât feel like eating.
- Your skin is cold and sweaty.
- Youâre very tired.
What Is An Ejection Fraction
An ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60% means that 60% of the total amount of blood in the left ventricle is pushed out with each heartbeat. A normal ejection fraction is between 50% and 70%.
Organs like the kidneys require a certain amount of pressure as blood flows through them to work properly. A weak pump can reduce this pressure and in turn decrease the ability of other organs, like the kidneys, to do their jobs. This is how heart failure can lead to multiple organ failure and even death.
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Advanced Heart Failure Care In Kansas City
Advanced heart failure is a serious medical condition that occurs when the heart weakens and doesn’t pump enough blood to your body. This chronic condition requires a high level of care and lifelong treatment.Symptoms of heart failure include:
- Fatigue or weakness
- Swelling in the legs, ankles or stomach
- Difficulty breathing while lying down
- Shortness of breath during daily activities
- Reduced appetite and nausea
How Common Is Heart Failure
In the United States alone, more than six million adults have been diagnosed with heart failure.
Heart failure is usually divided into two categories based on which side of the heart it mainly affects. The right side of the heart collects oxygen-depleted blood from the body and brings it to the lungs to be filled with fresh oxygen. The left side of the heart receives oxygen-rich blood from the lungs and sends it out to the rest of the body.
While the end result is the same, symptoms can vary based on whether the right or left side of the heart is affected.
Verywell / Jessica Olah
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Right Sided Vs Left Sided Heart Failure
When the heart fails to pump blood adequately to the body tissues owing to the decrease in the pumping capacity of the right heart chambers, this condition is identified as the right heart failure. When the heart failure is due to the faltering of the pumping capacity of the left heart chambers, this is known as left sided heart failure. Pumping Capacity In right sided heart failure, pumping capacity of the right heart chambers is decreased. It is the pumping capacity of the left heart chambers that is decreased in the left sided heart failure. Causes
· Aortic and mitral valve diseases
· Other myocardial diseases such as myocarditis
What Are The Symptoms Of Right
The main sign of right-sided heart failure is fluid buildup. This buildup leads to swelling in your:
- Feet, ankles and legs.
- Gastrointestinal tract and liver .
Other signs include:
Where you accumulate fluid depends on how much extra fluid and your position. If youre standing, fluid typically builds up in your legs and feet. If youre lying down, it may build up in your lower back. And if you have a lot of excess fluid, it may even build up in your belly.
Fluid build up in your liver or stomach may cause:
Once right-sided heart failure becomes advanced, you can also lose weight and muscle mass. Healthcare providers call these effects cardiac cachexia.
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How Do I Take Care Of Myself If I Have Right
The most important thing is to make healthy lifestyle habits part of your daily routine. The more you make healthy living part of your new lifestyle, the better youll feel. Try to:
- Work with a nutritionist or dietitian to create a nutritious, filling meal plan you can stick with long-term.
- Find an exercise routine you enjoy so youll be motivated to get moving every day.
- Track and manage your symptoms. Report any changes to your healthcare provider.
- Take medications as instructed.
What Are The Different Types Of Chf
Heart failure can occur on the left side of the heart, the right side, or both. Most commonly, it begins in the heart’s primary pumping chamber – the left ventricle. Each specific type of CHF is accompanied by its own distinct characteristics:
- Right-sided CHF – Right-sided CHF develops when the right ventricle struggles to deliver blood to the lungs. As blood backs up into the blood vessels, the body begins to retain fluid in the abdomen and lower body.
- Left-sided CHF – Left-sided CHF is the most common form of CHF and begins when the left ventricle cannot effectively deliver blood throughout the body. Eventually, this can lead to fluid retention throughout the body, particularly around the lungs.
Cases of left-sided CHF can be further classified into one of two sub-types, characterized by the manner in which the ventricle is affected:
- Systolic CHF – Systolic CHF occurs when the left ventricle is unable to contract with enough force to circulate blood properly.
- Diastolic CHF – Diastolic CHF occurs when the heart muscle becomes stiff. Because the chamber must relax in order to fill with blood between contractions, this stiffness means that an inadequate amount of blood is available to pump out to the rest of the body.
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Your Heart Failure Care Team
You will be cared for by a team of heart failure experts. Our team brings together an experienced staff that is solely dedicated to heart failure.
- Cardiologists: At The University of Kansas Health System, we have 6 dedicated, board-certified cardiologists who specialize in heart failure. Our cardiologists are some of the best and brightest in the nation and come from the most esteemed cardiology programs in the country. The culmination of their interests, expertise and many years of experience ensures you receive reliable, yet innovative care.
- Nurses: Our nurse practitioners have achieved national certification in heart failure. We also have nurses who specialize in heart failure care.
- Others: Dietitians, pharmacists, case managers, social workers and palliative care providers offer much-needed support services before, during and after your treatment.
A cardiologist and nurse specializing in cardiology will lead the team. Depending on your needs, your team may also include interventional cardiologists, heart rhythm specialists or heart surgeons. Because we are an academic medical center, we have access to the latest treatments and clinical trials.
Your cardiologist and nurse will work closely with you to ensure your treatment plan is effective. They will also offer guidance and resources to help you establish and maintain the healthy changes to your diet and lifestyle. They will keep in touch with you and respond to your questions and concerns quickly.
About Heart And Vascular Institute
The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.
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Why Choose Us For Advanced Heart Failure
Academic health systems like The University of Kansas Health System are able to care for the sickest patients with the most complex heart issues. Our patients come from all walks of life throughout the Kansas City region and beyond.
As the only hospital offering heart transplant surgery in Kansas, our hospital has become a destination for those seeking advanced heart failure treatment. Our heart failure and transplant services have been recognized for maintaining the highest standards of care.
- Our advanced heart failure program earned a perfect score from The American Heart Association/American Stroke Association’s Get With The Guidelines program.
- Our participation in Get With The Guidelines demonstrates our commitment to quality care.
- The American Heart Association/American Stroke Association awarded us with the Gold Plus Achievement Award for heart failure as part of the Get With The Guidelines program.
- We have also made the honor roll for heart failure as part of Get With The Guidelines.
Treatment Of Heart Failure
Lifestyle modifications play a key role in preventing further deterioration of the heart muscles while reducing the risk of complications such as cardiac arrhythmias. Every patient after being diagnosed with heart failure, are advised to minimize the consumption of alcohol and to control their body weight. A small, low sodium and low salt diet is ideal for a heart patient. Bed rest is usually recommended since it minimizes the stress on the cardiac muscles.
The drugs given in the management of heart failure include
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Diagnosis Of Heart Failure
A clinical suspicion of heart failure is confirmed through the following investigations.
This includes FBC, liver biochemistry, cardiac enzymes released in acute cardiac failure and BNP.
- Electrocardiogram
- Cardiac MRI. This is also called CMR
- Cardiac biopsy. This is carried out only when a cardiac myopathy is suspected
- Cardiopulmonary exercise testing
What Are The Signs And Symptoms Of Heart Failure
The signs and symptoms depend on how severe your heart failure is. The signs and symptoms you have may be due to the backup of fluid and blood in your tissues. It may also be due to decreased oxygen in your blood. You may have any of the following:
- Trouble breathing with activity that worsens to trouble breathing at rest
- Shortness of breath while lying flat
- Severe shortness of breath and coughing at night that usually wakes you
- Feeling lightheaded when you stand up
- Purple color around your mouth and nails
- Confusion or anxiety
- Periods of no breathing, then breathing fast
- Lack of energy , or trouble sleeping
- Swelling in your ankles, legs, or abdomen
- Heartbeat that is fast or not regular
- Fingers and toes feel cool to the touch
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What Are The Stages Of Heart Failure
Each type of heart failure is classified into stages. There are four stagesA, B, C, and Dand once you progress from one stage to another, there is no going back. The key to managing heart failure is to make changes and adhere to treatment strategies that stop or slow the progression of your heart failure from one level to the next.
A number of medications may be used to increase the function of your heart. For right-sided heart failure, the following may be prescribed:
- Medications for correcting problems that caused the heart failure, like hypertension
- Diuretics like furosemide to reduce fluid buildup and swelling
- Anticoagulants like warfarin to reduce clotting in stagnant blood that backs up in the right atrium
- Medications to increase the pumping ability or elasticity of the heart
- Implanted devices that help the heart pump more effectively
Left-sided heart failure requires slightly different treatments, including:
- Diuretics to reduce swelling
- Medications to control high blood pressure
- Inotropic medications that can help your heart pump more effectively
- Medications that reduce the strain on the heart and help it pump better like digoxin
- Implanted devices or a pump to help supplement the work of the heart
As your heart failure progresses, you may need additional treatments to manage the complications of heart failure, including medications to help support your kidney function or lifestyle changes to cope with the fatigue and weakness that heart failure can cause.
Left Sided Heart Failure
primary cause of right sided heart failure.
When the left ventricle is not working as effectively, fluid pressure increases and ends up moving back through the lungs. This can cause an overload to the heartâs right side.
Consequently, when the right side is unable to pump blood, fluid accumulates in the veins, resulting in swelling.
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What Do I Need To Know About Heart Failure
Heart failure is a condition that does not allow your heart to fill or pump properly. Heart failure may begin on the left or right side of the heart. If one side does not work properly, the other side has to work harder to function. Over time, heart failure affects both sides of the heart. Heart failure is a long-term condition that tends to get worse over time. It is important to manage your health to improve your quality of life.
Classification Based On Course Of The Disease
Heart failure can develop suddenly, for instance after a heart attack or due to certain heart rhythm problems. This is known as acute heart failure.
But it usually develops gradually over time as a result of a different medical problem, such as permanently high blood pressure. This is known as chronic heart failure.
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Types Of Heart Failure
In heart failure, the heart can no longer pump enough blood around the body. The heart muscle is either too weak or not elastic enough. Different parts of the heart may be affected too. The type of medication people use for the treatment of heart failure will depend on the type of heart failure they have.
Heart failure often only affects the left or right side of the heart, but can affect both. Doctors differentiate between three types of heart failure, accordingly:
- Left-sided heart failure: The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins . This causes shortness of breath, trouble breathing or coughing especially during physical activity. Left-sided heart failure is the most common type.
- Right-sided heart failure: Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins . The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen .
- Biventricular heart failure: In biventricular heart failure, both sides of the heart are affected. This can cause the same symptoms as both left-sided and right-sided heart failure, such as shortness of breath and a build-up of fluid.