Beating heart failure
Treating the early signs of heart failure can prevent damaging heart attacks
December 01, 2012
To many people, the term heart failure conjures up an image of an out-of-the-blue emergency, a heart that has suddenly stopped beating.
In reality, heart failure is a process in which the heart muscle becomes so weakened over time that it no longer pumps enough blood to meet the body's needs.
"Heart failure is generally the result of another disease such as high blood pressure, a heart-valve problem, coronary artery disease, disorders of the heart's electrical system and other chronic conditions," says cardiologist Dr. Dawn Lombardo, director of UC Irvine Medical Center's Heart Failure Program, the only one of its kind in Orange County and the first in Southern California to be certified for disease-specific care by The Joint Commission in 2008.
In the early stages of heart failure, patients may not experience any symptoms. But as the condition progresses, warning signs may include fatigue and shortness of breath. "Many individuals also suffer from swelling of the legs, ankles and feet due to the heart's decreased pumping action," says Lombardo.
Eventually, heart failure can become so debilitating that patients become exhausted walking across a room or climbing a few stairs. But with the right treatment and lifestyle choices, people with heart failure can live full and active lives.
At UC Irvine's Cardiovascular Center, nationally and internationally acclaimed cardiologists, cardiothoracic surgeons and vascular surgeons treat thousands of patients each year. The Heart Failure Program is an integral part of this effort, making use of the center's arsenal of services and emerging technologies to offer leading-edge diagnostics, including three-dimensional transthoracic echocardiography.
"This imaging modality produces detailed information about the heart's structure, size and function," says Lombardo, whose program won recertification in March 2010, earning a Gold Seal of Approval for quality.
Other tests range from cardiac catheterization to multi-detector CT imaging and nuclear scans. Once the diagnosis of heart failure is confirmed, treatment focuses on correcting the underlying disorders that contribute to the condition.
If high blood pressure, thyroid disorders or elevated cholesterol levels are involved, medication is prescribed to control these problems. If the heart failure was precipitated by an arrhythmia, a procedure known as ablation can restore normal cardiac rhythm.
When clogged coronary arteries are the cause, blood flow is restored with coronary balloon angioplasty and stent placement. These procedures are performed in the cardiac catheterization laboratories in UC Irvine Douglas Hospital. This is also the site for cardiac bypass surgery, which takes place in the hospital's state-of-the-art operating rooms.
Medication is the primary therapy for heart failure. "A combination of drugs is used to improve heart function, relieve symptoms and slow the progression of the disease," says
ACE inhibitors lower blood pressure and reduce the heart's workload. Beta blockers decrease the failing heart's tendency to beat faster, thus reducing stress on it. Digoxin can help boost the heart's weakened pumping action. Diuretics also can eliminate excess body fluids. "In severe heart failure, a potassium-sparing diuretic called spironolactone works synergistically with ACE inhibitors and beta blockers to prolong survival," says Lombardo. "Since medications are individually tailored and frequently adjusted, treatment for heart failure must be carefully and constantly managed."
In addition to drug therapy, other treatments may be needed. "A biventricular pacemaker can improve the heart's ability to pump blood by coordinating heart-muscle contractions," says Lombardo. In some cases, an implantable cardioverter defibrillator may also be necessary to stop rapid, abnormal heart rhythms that may develop.
Patients with advanced heart failure also may benefit from a small pump implanted in the left ventricle that assists in circulating blood throughout the body. "When drugs and other approaches are combined with lifestyle changes, many patients experience a dramatic improvement in their condition," says Lombardo.