What is Heart Failure?

While congestive heart failure is a serious condition, nearly 6.5 million Americans are living with this chronic syndrome. Each year, 670,000 new patients are diagnosed. Heart failure occurs when the heart cannot pump enough blood to maintain normal circulation throughout the body. The heart keeps pumping blood, but not as efficiently as a healthy heart. So, blood can get backed up into the lungs, abdomen, and feet.

Ongoing problems with heart failure can also cause problems with other organ systems, such as the nervous system and the adrenal glands (hormonal system). The syndrome also interferes with the normal functioning of the kidneys. As a result, the body retains more fluid, which can cause swelling of the ankles and legs (edema) and fluid on the lungs (which leads to shortness of breath).

Our advanced heart failure program brings together experts in cardiac electrophysiology, acute cardiac care, interventional cardiology, cardiac surgery, hypertension, and heart failure technology to help you manage your symptoms and experience a higher quality of life.

The symptoms of heart failure and associated risks can be managed or reversed with appropriate medications and medical devices.

Symptoms of Heart Failure

• Shortness of breath
• Coughing and/or wheezing, especially when lying down
• Swelling in the legs
• Abdominal bloating
• Fatigue, lack of energy
• Problems with concentration or confusion

Causes of Heart Failure

Typically, the heart’s loss of pumping action stems from an underlying heart problem. Heart failure can be caused by any conditions or chemicals that injure the heart muscle.

Are You at Risk for Heart Failure?

You may develop heart failure if you have risk factors including chronic conditions such as coronary artery disease, high blood pressure, lung disease, diabetes mellitus, and obesity; lifestyle factors such as alcohol consumption, drug abuse, diet medications, and anabolic steroids; and medications, including certain types of chemotherapy and radiation to the chest.

How Do you Diagnose Heart Failure?

If you are living with risk factors associated with developing heart failure, your primary care physician or cardiologist may recommend a diagnostic test during a physical exam. Your medical history will help determine if you are at increased risk. The test results will help your doctors better understand the status of your heart health and function and may lead to a diagnosis.

Chest X-Ray
This diagnostic test uses electromagnetic energy to produce images of internal tissues, bones, and organs.

Electrocardiogram (ECG or EKG)
With electrodes taped to the chest, an EKG records the electrical activity of the heart, shows abnormal rhythms, and detects heart muscle damage.

Echocardiogram
This noninvasive test uses sound waves to produce a study of the motion of the heart’s chambers and valves.

Stress Testing
A cardiac stress test measures the heart’s ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by drug stimulation.

BNP Testing
B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension that occurs with heart failure. BNP levels are useful in the rapid evaluation of heart failure. The higher the BNP levels, the worse the heart failure.

Cardiac Catheterization
This procedure uses a catheter threaded through veins into the heart to see inside the heart, measure blood pressure, look at blood vessels, and help determine therapy options.

Treatments for Heart Failure

With the use of today’s treatment options — including prescription medications, medical devices, surgical measures, and lifestyle modifications — the majority of heart failure patients do not progress to the most severe (and life-threatening) stage of the syndrome. With an appropriate disease management program, many patients can recover heart function, and some are able to enter remission with normal heart function.

Medications
Most of the medications prescribed for heart failure work to re-establish the normal function of your body’s hormones and neurologic systems that contribute to worsening heart failure. There are several different types of medication that may be helpful in controlling high blood pressure. Often more than one type is needed to get effective control and promote recovery. All of these medications can improve cardiac, neurological, and hormonal functions, which contribute to the quality of life. Many of them can improve survival rates for those living with heart failure.

• Angiotensin-converting enzyme (ACE) inhibitors, like Lisinopril, decrease the pressure inside the blood vessels and reduce the resistance against which the heart pumps. 
• If ACE inhibitors are not tolerated, an angiotensin receptor blocker (ARB) can help reduce the workload on the heart.
• ARNI, sacubitril valsartan, is a medicine that combines two drugs and has been shown to reduce hospitalizations due to heart failure and improve survival rates.
• Beta-blockers help to control blood pressure by blocking the effects of stress hormones. 
• Mineralocorticoid receptor antagonists, such as Spironolactone, block the effects of the hormone aldosterone, which causes sodium and water retention.
• SGLT2 antagonist is a new class of medications for diabetes that can benefit heart failure patients with or without diabetes mellitus.
• Vasodilators, like Hydralazine and nitrates, can reduce the workload on the heart by dilating the blood vessels.
• Diuretics, including Furosemide, reduce the amount of fluid in the body.
• Digitalis increases heart strength and helps control rhythm problems.

Devices
In some cases, the following medical devices are just as effective as heart transplant surgery in promoting healthy heart function and recovery. The technology that supports such devices continues to advance, prompting smaller, more reliable, and more effective models to become available to patients.

• Biventricular Pacing/Cardiac Resynchronization Therapy (CRT)
  This type of pacemaker paces both ventricles simultaneously to coordinate contractions and improve pumping ability. Some heart failure patients are candidates for this therapy.
• Implantable Cardioverter Defibrillator
  This device is similar to a pacemaker, but it senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.
• Ventricular Assist Devices (VADs)
  This mechanical device takes over the pumping function for one or both of the heart’s ventricles. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.
• Barostim®
• Optimizer®
• Mitraclip® procedure also known as Transcatheter Edge-to-Edge Repair (TEER)

Surgery
Whether you qualify for a heart transplant will depend on a medical evaluation, your response to standard care, and other medical conditions you may have.

Clinical Trials
In addition to standard therapy, some patients qualify for clinical trials of emerging treatment options. Researchers and doctors are currently exploring the use of stem cell therapies to restore heart muscle function in some patients.

Can I Recover From Heart Failure?

With the right treatment program and access to medications, heart failure patients can aim for the following markers of recovery:

• Improved heart function
• Prolonged survival
• Improved quality of life
• Disease remission

Why Choose UHealth?

Advanced heart failure therapies. At UHealth, you have access to dedicated experts who specialize in treating heart failure and in advanced heart therapies. UHealth physicians offer heart transplant surgery at the Miami Transplant Institute at Jackson Memorial Hospital. Our Heart Failure Innovation and Treatment Program provides access to leading-edge therapies to treat heart failure, including remote monitoring and electrophysiologic devices. UHealth also hosts a variety of clinical trials exploring new medications, stem cell therapy, and medical devices.

We are home to the Elaine and Sydney Sussman Cardiac Catheterization Lab, which provides advanced interventional capabilities and complex procedures for patients with chronic heart disease. As a leading academic center, UHealth’s experts in cardiovascular disease offer novel treatments and investigational therapies go beyond what is generally available.

Multidisciplinary care by recognized specialists in their field. In many cases, the care of patients with chronic heart failure requires the expertise of various specialties, such as cardiothoracic surgery, interventional cardiology, electrophysiology, cardiac rehabilitation, and medical genetics. UHealth doctors and specialists from diverse departments communicate and collaborate to ensure your provider team is on board with a unified treatment plan. Our providers work together on disease control to improve and prolong the lives of patients living with the disease.

What we are working on – ground-breaking and life-saving research. We are investigating innovative devices, such as a papillary muscle sling, the V-wave interatrial shunt, Carillon right heart transcatheter mitral valve repair (TMVR) device, and the Cordella pulmonary artery pressure sensor system.