About Heart Failure: Causes, Patient Assessments and Treatment Options

Heart Failure is on the Rise

An estimated 400,000 to 700,000 new cases are diagnosed each year. And death from heart failure has more than doubled in the last three decades, averaging 250,000 annually.

As a leader in heart and vascular care in Central Texas, Scott & White established the Advanced Heart Failure Clinic to diagnose and treat patients with this complex disease. Find out more »

Causes of Heart Failure

The causes of heart failure can be numerous and varied.

Diseases of the blood vessels:

  • Coronary artery disease
  • Past heart attack (myocardial infarction)
  • High blood pressure (hypertension)
  • Abnormal heart valves (narrowing of the valves [mitral stenosis, aortic stenosis] or leaking [mitral regurgitation, tricuspid regurgitation])
  • Diseases of the heart muscle itself, including enlargement of the heart and thinning of the walls (dilated cardiomyopathy); an enlargement of the heart secondary to wall thickening (hypertrophic cardiomyopathy); or inflammation (myocarditis)
  • Heart defects present at birth (congenital heart disease)
  • Severe lung disease
  • Diabetes

Other conditions that can cause heart failure include:

  • Low red blood cell count (severe anemia). When there aren't enough red blood cells to carry oxygen, the heart tries to move the small number of cells at a faster heart rate. It can become overworked from the effort.
  • An overactive thyroid gland (hyperthyroidism). This condition causes the body to work at a faster pace, and the heart can be overworked trying to keep up.
  • Abnormal heart rhythm (arrhythmia or dysrhythmia). When the heart beats too fast, too slow or irregularly, it may not be able to pump enough blood to meet all the body's needs.
  • Sudden emotional Shock (Broken Heart Syndrome or Taka-tsubo cardiomyopathy). Seen more frequently in women it is a transient type of heart failure that usually resolves with medical treatment in a few weeks.

How Heart Failure Patients are Assessed for Treatment

Step 1

A thorough history is taken of the patient, followed by a physical examination, extensive blood tests and an ultrasound of the heart (echocardiogram).

Step 2

If the medical staff cannot get good images with an EKG (electrocardiogram), then they proceed to other imaging methods such as a cardiac MRI scan or a cardiac CT scan.

Step 3

If a reversible cause is detected, then the team will go ahead and fix the problem and allow the heart to regain normal functioning.

Step 4

If the problem is not easily reversed, then medical treatments for heart failure are started.

If the patient does not make adequate progress, then the team will proceed to advanced heart failure therapies, such as a mechanical circulatory pump replacement or heart transplant.

Advanced Heart Failure Therapies

  • Electrophysiological options
    • Heart pacemaker (cardiac resynchronization therapy) which improves the synchrony of contraction of the left and right chambers of the heart.
    • Implantable cardioverter-defibrillator (ICD) to prevent a sudden cardiac death. The device will stop any irregular/abnormal beating of the heart that can cause it to stop suddenly, causing instant death
  • Home Inotropes — using continuous intravenous medications to boost the pumping function of the heart.
  • Surgical options
    • Mechanical assist devices — mechanical pumps placed in the left or right side to take over the pumping function of the heart.
    • Heart transplantation

Both home inotropes and mechanical pumps can be used as a bridge while the patient is waiting for a heart or as a permanent option to improve symptoms and have a better quality of life.

The Role of the Advanced Heart Failure Team in Managing Heart Failure Patients

A three-tiered system helps physicians and other medical staff members decide if transplantation should be recommended for a particular patient.

Tier 1 – Medical Management

Medical staff makes sure the patient is knowledgeable about their medications and that they are doing what they need to do to manage their heart failure.

Tier 2 – Invasive Procedures

The patient may undergo bypass surgery to replace a valve or have a pacemaker or defibrillator implanted to improve the synchronization of the heart.

Tier 3 – Replacement of the Pump

Replacement of the pump can be done in two ways: heart transplantation or implanting a mechanical device to support the failing heart.

  • When is heart transplantation or mechanical support an option? Patients that are not responding to optimal medical management, or have frequent hospitalization and patients requiring IV medications to improve the contractivity of their heart will most likely need some sort of replacement therapy.
  • Who is eligible for a heart transplant?

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