Melanie Cole (Host): Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. The term heart failure doesn’t mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care. My guest today is Dr. Jason Guichard, he’s a cardiology with Greenville Health System. Welcome to the show Dr. Guichard. So please explain to the listeners what congestive heart failure is and what the difference they hear heart failure, they think heart attack. So explain the difference a little.
Dr. Jason Guichard (Guest): Yes, thank you very much Melanie. So heart failure as you’ve accurately described already is when the heart is unable to keep up with the body’s demand due to heart pump dysfunctions. Your heart is a muscle and just like any other muscle in your body it contracts through squeezes but it also relaxes and your heart is the same. You can have an issue with the contraction or squeezing function of your heart or you can have an issue with the relaxing portion of your heart. Either issue with those components of your heart can cause heart failure.
Heart failure in itself is a constellation of symptoms that we diagnose clinically. Some of those common symptoms are tiredness or fatigue, being short winded with activity, leg or abdominal swelling or bloating, unable to lay flat without getting short of breath, these are some of the common symptoms that we encounter when we think about heart failure and sometimes the initial symptoms that patients have when we see them in clinic or in the hospital. Any sort of clinical diagnosis when you have those symptoms requires confirmation testing to give the diagnosis of heart failure.
One of the most important and most common confirmatory testing is an echocardiogram or transthoracic echocardiogram. That actually measures if your heart is squeezing enough or if it’s relaxing well enough. Sometimes it requires a right heart catheterization which measure the pressures in your heart and lungs. Sometimes we do that with or without exercise. Those confirm the diagnosis of heart failure.
Now heart failure is a muscle issue like I said with either squeezing or relaxing, whereas heart attack is a blockage in one of the arteries which causes the muscle to die. It is one cause of heart failure that we can talk about now. Heart failure itself can actually affect the two ventricles of the heart. We have two ventricles, the left side which pumps blood to the body and the right side which pumps blood to the lungs. And you can have an issue with either side of the heart and that can cause heart failure.
Now on the left side there’s two types of heart failure. One like we talked about with squeezing which is a heart failure with reduced ejection fracture, the other one is with relaxing which is preserved ejection fracture. And the heart failure with reduced ejection fraction can be caused due to the blockages like we talked about already with heart attacks. But also it can be due to not having blockages and there be something intrinsically wrong with the muscle of your heart, either something you were born with or something you inherited from your parents or it could be something you were exposed to either as a child or adult such as substances like alcohol or some chemotherapies as well. These are things that we all look out for. Lifestyle also plays a roll, as you could imagine. Smoking, high blood pressure, high cholesterol, these are all components of left sided heart failure.
Now on the right side there can be right-sided cardiomyopathies that can be very rare but very important to diagnosis. In addition, the most common cause of right-sided heart failure is pulmonary hypertension. Pulmonary hypertension can be caused by a number of things. We group them into classifications. The first one is pulmonary arterial hypertension which can be due again to something that you were born with or inherited from your mother or your dad, also something to do with connective tissue diseases, another cause if left sided heart failure. One of the most common causes of right-sided heart failure is left-sided heart failure. The next one would be due to lung disease. Any sort of lung disease that causes a lack of or a low oxygen level in your blood can cause right-sided heart failure. There’s a number of things that we work up whenever you have pulmonary hypertension. That’s kind of a long explanation of what heart failure is and where the issues are within the heart and what causes it. But hopefully that can help clear up some things for your listeners.
Melanie: So who is at risk for heart failure?
Dr. Guichard: Heart failure, like I said, it is a lot of times a lifestyle disease, so diet, lack of exercise, smoking, high blood pressure these can all cause heart failure. They can be due to blockages or not necessarily due to blockages. All of those kind of lifestyle changes can play a role and tax the heart. But there’s also a very large component of this which is actually genetic. It is genetic that happens spontaneously, not really due to anything that you did, or genetic being something that you inherited so if your mother or father had heart failure or if their grandparents or if you have other first degree relatives that had heart failure, you may inherit that predisposition or that genetic abnormality that may cause you to have heart failure as well. So those are kind of the two main categories of that causes of heart failure.
Melanie: So if somebody has some of the symptoms that you described, fatigue and swelling and some of these others, and they do diagnose it via echo or however you’re going to diagnose it, what is the first line of defense? Are you looking to try and regulate what’s going on and liquid building up in the system? What’s your first line of defense doctor?
Dr. Guichard: Yes, that’s an excellent question. So the first line of defense that we have to treat heart failure is medications. We’ve been very lucky in the heart failure community that we have a number of medications to help people feel better and improve their heart function and improve their longevity or their survival. Some of these medications as you suggested already are called diuretics. They allow you to lose fluid through the urinary tract by increasing your urinary output. This reduces the swelling and reduces the fluid symptoms that are inside your body.
Now these medicines, although they make you feel much better, they don’t necessarily improve your longevity or improve your pumping or relaxing function of you heart. So we have other classes of medications that do that and the three main classes of medications are beta blockers, ace inhibitors, or ARBs, and mineralocorticoid receptor antagonists. Those three classes of medications, we attempt to get every patient on at least a little bit of all those classes, and then really try to increase the dosages of the medications. Those three classes of medications have all been shown to be very powerful in improving your heart function and improving the survival rate of patients with heart failure.
So medications are always a first line of defense. Now sometimes medications are not enough, and we do have devices that have been shown to improve not only symptoms but longevity as well. A couple of these devices, one of these is called cardiac resynchronization therapy or CRT. There are a special class of heart failure patients based on their electrocardiogram that may benefit from this therapy. It is a good therapy and has been shown to improve survival in this particular set of heart failure patients. There are also other devices that we do and implant in patient’s lungs, in their lung arteries, to actually continuously measure the pressures in your body and allow us to very accurately regulate the fluid pressures in your body in order to improve symptoms and keep you out of the hospital. And then as everyone might imagine keeping you out of the hospital improves your longevity and also improves your quality of life. So in addition to medications there are devices that can also aid in the treatment of heart failure.
Melanie: So depending on what their treatments may be doctor, are there certain other kinds of lifestyle, even nutrition to make sure their getting enough potassium and that they’re getting enough of these nutrients to keep up with maybe they’re on a diuretic or whatever. So what do you tell them about lifestyle management and living with congestive heart failure, which now can be looked at as a chronic disease, yes?
Dr. Guichard: Yes. Absolutely. There’s a lot a patient can do. There’s always kind of a partnership with heart failure. There’s things that as a physician we’re obliged to do and offer patients and kind of do my part. And you’re absolutely correct there’s another side for the patient to do their part to improve their heart symptoms and longevity. And some of the biggest issues with those, if you have heart disease or blockages in your arteries, improving your diet is incredibly important.
The western diet is full of kind of bad things that we eat and cause high blood pressure and high cholesterol and blockages. So one of the main diets out there, the Mediterranean diet, is a good one. Another very good diet is a whole foods plant based diet, which has been championed here recently and actually has some data that shows that it may even reverse heart disease completely which is truly amazing.
But one of the cornerstone treatments that patients can do for themselves with regards to heart failure is what we call fluid and salt restriction. So keeping that daily salt intake to a 2 grams per day or less will really lessen the fluid overload symptoms in their body and then again reduce the amount of fluid that you take on a daily basis as you might imagine would reduce the fluid that gets accumulated in your body. A lot of these recommendations are made for people who have fairly advances heart failure but even in the lesser degrees of heart failure this has been shown to be helpful and improve the symptoms of heart failure.
Melanie: So wrap it up for us, this was such an excellent segment with such good information. What do you want patients to know if them or a loved one is suffering from congestive heart failure and they are living with this condition, what would you like them to know about it and also speak about what heart failures services Greenville Health System offers?
Dr. Guichard: Yes, there’s a lot of opportunity for heart failure patients out there. You know, heart failure is a very prevalent disease and there’s been a lot of advances here in the recent past that can improve the quality of life and survival for heart failure patients. One thing that I would suggest would be to see a heart failure specialist within cardiology. We are highly specialized but even within that specialization there are specialty trained heart failure cardiologists which myself, I have been trained specially in that area. We kind of know the ins and outs and kind of the tricks of the trade, if you will, of managing heart failure, especially as your heart failure progresses. So I would recommend seeing a cardiologist or in particular a heart failure cardiologist that knows the medications and devices available to keep people feeling better and living longer.
At GHS, we have the advanced heart failure and pulmonary hypertension and mechanical circulatory support programs, and we offer a whole spectrum of services available to the heart failure population in the Greenville County. We specialize in optimal medical therapy including the cardiac resynchronization therapy to help people live better and live longer. We also do the cardiomems implantation to manage fluids and pressures in your heart to make sure that we keep your volume status optimum.
We also have advanced devices in the hospital for when advanced heart failure patients come in and need a little extra support including mechanical devices like intra-aortic balloon pump and impella and other sorts of devices that can bridge people as they get really sit in the hospital. Then hopefully coming soon left ventricular assisted devices which is a mechanical pump that gets implanted to kind of take the place if you will of your left ventricle as it really begins to fail and allows patients to live a little bit longer and a little bit better even with this severe stage of heart failure.
Melanie: Thank you so much for being with us today. You’re listening to Inside Health with Greenville Health System. And for more information you can go to GHS.org. This is Melanie Cole, thanks so much for listening.