Heart Failure: What You Need to Know

By Tamekia Reece

The number of people diagnosed with heart failure continues growing, but new medications and treatments can help improve cardiac function.

In 2014, Andrew Dittrich, then 29, found himself going to the doctor at least once a month for several months. He had been feeling slightly ill, with occasional ankle swelling, fatigue, moments of mental cloudiness and weight loss. Despite the frequent doctor’s visits, the Chicago resident didn’t know what was wrong. Then his symptoms got worse.

“My heart would beat fast, my feet and ankles started swelling more, my stomach was distended, and I felt gross all the time,” he says. Finally, in February 2015, a specialist gave him a diagnosis: bacterial endocarditis, an infection that occurs when bacteria enter the bloodstream and settle in a heart valve, blood vessel or lining of the heart.

The good news: Bacterial endocarditis is treatable with antibiotics. The bad, for Dittrich, was the infection had damaged his aortic and mitral valves. He had heart failure.

Now 34, Dittrich recalls thinking his life would soon be over. “I thought this was either going to kill me very quickly or we’re going to treat it so that it stretches me out for a handful of years.”

Fortunately, Dittrich was wrong. Although heart failure (HF) is serious and can be deadly if untreated, with proper management, people can live long and healthy lives.

An Umbrella Term

An estimated 6.2 million Americans age 20 and older are living with heart failure. By 2030, experts predict that more than 8 million adults will have HF. Contrary to popular belief, HF doesn’t mean the heart has stopped or is about to stop working.

“Heart failure is a condition in which the heart is unable to pump enough blood to meet the needs of the body, or it can do so only at very high pressures,” says Lee R. Goldberg, M.D., MPH, section chief of Advanced Heart Failure and Cardiac Transplant at the University of Pennsylvania. Essentially, the heart still works — just not as effectively.

There are two main types of HF: systolic and diastolic. In systolic, the heart muscle is too weak to contract as it should; diastolic means the muscle becomes so stiff that it can’t relax, Dr. Goldberg says.

HF can occur on the left, right or both sides of the heart. Left-sided tends to be more common, while right-sided usually occurs because of left-sided HF. “Even if heart failure starts on the left side, if it’s not well treated, eventually the right side of the heart can fail as well because it’s doing so much extra work,” Dr. Goldberg explains.

Why a Heart Fails

The most common cause of HF is coronary artery disease (a buildup of plaque in the arteries) and heart attack. Another major cause is hypertension, or high blood pressure. “Longstanding high blood pressure can cause the heart to thicken and become stiff, or cause the heart muscle to stretch and weaken,” Dr. Goldberg says.

Other conditions that may lead to HF include congenital heart disease, faulty valves, cardiomyopathy (damage to the heart muscle), cardiac arrhythmias, some infections that can weaken the heart muscle and other health problems such as thyroid disease, severe anemia, excessive iron in the body, sarcoidosis and emphysema.

Also, people who are age 65 or older, overweight or obese, African American, have type 2 diabetes, smoke tobacco or consume excess alcohol are at risk for developing HF.

People with HF often experience symptoms such as fatigue, weakness, coughing, fast or irregular heartbeat, shortness of breath (when active or lying down), swelling in the feet, ankles or stomach, loss of appetite and weight gain.

Mending a Failing Heart

Medications can control the symptoms of HF, help strengthen the heart over time and prevent progression of the condition, Dr. Goldberg says. The most commonly used medications include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), angiotensin-receptor neprilysin inhibitors (ARNIs), beta-blockers, diuretics and aldosterone antagonists. Together, the medications help the heart relax, protect it from stress hormones, control blood pressure and eliminate excess fluids and sodium.

“More than half the people that are treated with these medications will see improvement in their cardiac function over time,” Dr. Goldberg says.

For others, medical devices or procedures may be helpful. Device options include a pacemaker, which helps coordinate the heart so both sides contract at the same time, and an implantable cardioverter defibrillator (ICD), a device that monitors the heart rhythm and then shocks the heart if it detects an abnormal heart rhythm.

Surgical procedures may include coronary bypass surgery or angioplasty to restore blood supply to the damaged or weakened heart muscle, or heart valve repair or replacement. Dittrich, a member of Mended Hearts Chapter 129 in Joliet, Illinois, had valve replacement surgery in February 2015 and underwent a six-week  course of antibiotics to treat the bacterial endocarditis. Now he takes a couple of heart medications but doesn’t have any HF symptoms, and his ejection fraction (how much blood the heart pushes out when it beats) is normal.

Some people with HF need a transplant. If a donor heart isn’t available (or the person chooses not to get one), a ventricular assist device (VAD) is an option. “The device acts as a mechanical pump and takes over the pumping function of the left side of the heart and circulates the blood around the body,” Dr. Goldberg says.

Piper Dankworth Sutton, 62, of Shepherdstown, West Virginia, went the transplant route. In 2005, she was diagnosed with hypertrophic cardiomyopathy, a disease in which the heart muscle becomes abnormally thick. She had a defibrillator placed and was put on arrhythmia medications. “As the years passed, my doctors kept increasing the medication dosages because I was having episodes where my ICD would fire, but I would sometimes black out and fall and hurt myself before it fired,” she says.

By 2016, Sutton, a member of Mended Hearts Chapter 200 in Northern Virginia, was wiped out. “I’d been feeling progressively worse and was having more frequent firings with my ICD,” she says. She even had to quit her job and couldn’t drive because of the blackouts. Her heart failure specialist told her a transplant was her only remaining option. Sutton got a heart transplant in October 2016.

Another important component of managing HF, regardless of treatment approach, is lifestyle changes. The goal is to prevent any further damage to the heart, so people with HF should consume a heart-healthy diet that is low in sodium, saturated fat and cholesterol, exercise regularly and get adequate sleep, Dr. Goldberg says. It’s also important to quit smoking, manage stress and limit alcohol and caffeine.

For Sutton, the lifestyle changes are a big deal. “I go to the gym three to four times a week, and when I’m not there, I’m walking with my dog.” She also eats healthfully and has lost 60 pounds since her heart transplant. “I want to give this heart every chance to keep me around for a long time, so I’m doing everything I need to do to honor it and the donor that gave it to me,” she says.

On the Horizon

Over the last two decades, huge strides have been made in managing HF, and further improvements may occur soon. “Recent data shows some diabetes medications have benefit in terms of the heart’s metabolism and helping to remove excess fluid,” Dr. Goldberg says. “We’ve begun to notice that patients taking these medicines have less heart failure and fewer heart attacks and strokes.” Researchers are now studying the medications in people who are at risk of or already have HF.

In addition, Dr. Goldberg says there are two other classes of experimental drugs that work to strengthen the heart by acting on the proteins of the heart muscle. Those drugs are showing promise in clinical trials.

Surgical procedures are also improving. Better devices mean people are less likely to have clots or get an infection. “And we’re making advances in transplant in terms of manipulating the immune system to prevent rejection of the transplanted heart and also to reduce the risk of infection,” Dr. Goldberg says.

Things should get better soon on the care side, too. Mended Hearts has joined other advocates — professional societies and patient and caregiver groups — to launch the Heart Failure Charter. The goal is to reduce the number of hospitalizations and preventable hospital readmissions of patients with HF experience. The charter aims to:

• Provide patients with personalized education

• Empower and support caregivers

• Help patients be better able to self-monitor and recognize symptom changes

• Promote better coordination of care among healthcare providers

Dr. Goldberg, for one, is excited about HF management today and what’s to come. “Although it sounds like a horrible disease because it has the word ‘failure’ in it, there’s actually a tremendous amount of success in managing heart failure,” he says. “We’re extending patients’ lives and giving them a much better quality of life.”

If you have symptoms of heart failure that are not responding to treatment, talk to your doctor.