“A wise man sees trouble ahead and changes his path,” says James O. Smith, MD, interventional cardiologist at the AdventHealth Pepin Heart Institute. He is referring to the importance of getting help right away when someone has symptoms of congestive heart failure. Congestive heart failure, or CHF, is a condition that arises when the there is a problem with the left ventricle, one of the four chambers of the heart and the one that squeezes the blood to the rest of the body. “Congestive heart failure is clearly on the rise,” says Dr. Smith. It’s estimated that over the next decade, about 40 million Americans will experience CHF of one form or another.
Sometimes the left ventricle becomes stiff and doesn’t relax enough between heartbeats. This can lead to a situation where the heart pumps too much of its blood out with each beat. Other times, the left ventricle does not pump hard enough, causing too much blood to remain in the chamber. Either way, the inefficient heart begins to fail, which can cause a build-up of fluid in the lungs and other parts of the body.
While congestive heart failure is a serious condition, thankfully today there are treatments for it, including some that do not involve open heart surgery.
“In the 1970s, the average survival with CHF was two years,” says Dr. Smith. “Today, people with the condition can often live 20 years or more.”
The Causes and Symptoms of Congestive Heart Failure
High blood pressure, diabetes, underlying heart disease, being obese, smoking and sleep apnea are all some of the risk factors for congestive heart failure. Some of these can be managed by lifestyle changes and medical care. “Every step improves survival,” Dr. Smith says. While he says that some people show no signs of CHD until they find the need to go to the emergency room “in deep trouble,” there are three big symptoms:
• Swelling in the ankles, especially in both legs and after cutting back on salt
• Shortness of breath, for example, after walking up one flight of stairs
• Inability to lie flat without being short of breath
People who have any of these symptoms – and especially all three – should see their doctors as soon as possible. While people might expect to feel winded as they age, windedness should not appear suddenly or without much physical activity.
Medical Treatments for Early Congestive Heart Failure
“Early prevention helps,” says Dr. Smith. He explains that there are inexpensive medications such as beta blockers and diuretics that patients with milder CHF can take. These medicines help the heart beat slower and more regularly (beta blockers) and also remove some of the body’s excess fluid so the heart doesn’t have to pump as hard (diuretics). These prescription drugs have the added benefit of lowering blood pressure, sparing the heart from more damage. ACE inhibitors, which open up blood vessels to treat high blood pressure, are also commonly prescribed for CHF. Some patients are better helped by angiotensin receptor blockers (ARBs), although sometimes a combination of ACE inhibitor and ARB is appropriate.
If the simple medications don’t work well enough, there are other, more sophisticated options available. Dr. Smith mentions that a combo medication – sacubitril/valsartan – has been a “game-changer,” improving survival and reducing hospitalizations for patients with a specific form of CHF. Another promising treatment is dapagliflozin, which works in the kidneys to lower blood sugar and sodium, which in turn lower blood pressure and strain on the heart.
Interventional Cardiology Treatments for Congestive Heart Failure
When CHF is or becomes too serious to be managed by pills alone, a heart procedure may be in order. A common solution is installing a device called an implantable cardioverter defibrillator, or ICD. An ICD detects dangerously abnormal heart rhythms and shocks the heartbeat back into order when they occur. Dr. Smith can install ICDs through a minimally invasive procedure that involves a small nick in the skin. A thin tube called a catheter is then threaded through the arteries to reach the heart. Then, the ICD is inserted through the catheter and placed into position.
“About 3 or 4 in every 10 patients with congestive heart failure can benefit from an ICD,” says Dr. Smith. Some patients receive both an ICD and a pacemaker when two or three chambers in the heart need to be put back into synchronicity to work together.
If a blockage in one or more of the coronary (heart) arteries is causing CHD, Dr. Smith uses percutaneous intervention (PCI), one of the most common procedures in interventional cardiology. It involves a minimally invasive, catheter-based approach to opening the blocked arteries in the heart. A common way to do this is with balloon angioplasty. A balloon is inserted inside a blocked artery and then filled up with air. The balloon’s increased size compacts the plaque buildup against the artery walls, widening the artery. After the artery is widened, Dr. Smith usually inserts a stent – a tube made of metal mesh that supports the artery, holding it open.
By using PCI, “we can recover some heart function in half or more people with congestive heart failure,” says Dr. Smith.
“There’s something to do for almost everybody,” he continues. He and his colleagues at the Pepin Heart Institute are part of a larger, more comprehensive AdventHealth heart and vascular care team that does what it needs to save lives and improve quality of life.
If you or a loved one is experiencing possible symptoms of congestive heart failure, call your doctor. If you need a cardiologist or a heart surgeon, call
Call813-971-6000 for an appointment at the AdventHealth Pepin Heart Institute.