Heart Failure

Heart failure is a serious, life-threatening condition that develops gradually over time as the heart’s pumping action grows weaker. Eventually, the heart can’t pump enough blood to meet the body’s needs. Heart failure can involve the right side of the heart only, or it can affect both sides of the heart.

Early diagnosis and heart failure treatment can help people who have heart failure live longer, more productive lives. Treatment for early stages of heart failure revolves around lifestyle changes that include a heart-healthy diet, control of fluid intake, weight loss, smoking cessation and exercise. Your doctor will prescribe medications based on the type of heart failure you have and its severity, and will watch closely for signs that heart failure is worsening.

Of the 5.7 million Americans living with heart failure, about 10% have advanced heart failure. When heart failure progresses to an advanced stage – stage D according to the American Heart Association and American College of Cardiology’s A-to-D staging system – treatment becomes more complex.

A collaboration between Memorial Hermann and McGovern Medical School at UTHealth, the Center for Advanced Heart Failure at Larry D. Johnson Heart & Vascular Institute brings together affiliated, board-certified and fellowship-trained physicians who coordinate the best possible heart failure treatment plans for individual patients. They are experts at using revolutionary technology for successful treatment of advanced heart failure.

The most common causes of heart failure are coronary heart disease, high blood pressure and diabetes. Other heart failure causes include cardiomyopathy or heart muscle disease, heart valve disease, arrhythmias and congenital heart defects. Treatments for cancer, such as radiation and chemotherapy, thyroid disorders, drug or alcohol abuse, HIV/AIDS or too much vitamin E may also injure the heart muscle and lead to heart failure.

The most common signs and symptoms of heart failure are:

• Shortness of breath or trouble breathing
• Fatigue (tiredness)
• Swelling in the ankles, feet, legs, abdomen and veins in the neck

These symptoms are caused by fluid buildup in the body, which also causes weight gain, frequent urination and a cough that’s worse at night or when you’re lying down.

As your heart grows weaker, symptoms worsen. You may begin to feel tired and short of breath after walking across the room. As heart failure advances, you may find that you are short of breath while lying in bed.

Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Specialists diagnose heart failure based on your medical and family history, a physical exam and test results. They will examine you for the conditions that can cause heart failure – coronary heart disease, high blood pressure or diabetes – and rule out other causes of your symptoms.

No single test can diagnose heart failure. If you have signs and symptoms of heart failure, the affiliated specialists at Memorial Hermann will recommend one or more tests:

• An electrocardiogram (EKG) records the heart’s electrical activity, shows how fast your heart is beating and may show whether the walls in your heart’s pumping chambers are thicker than normal, making it harder for your heart to pump blood.
• A chest X-ray can show whether your heart is enlarged, you have fluid in your lungs or have lung disease.
• A BNP blood test checks the level of brain natriuretic peptide in your blood; BNP is a hormone that increases during heart failure.
• An echocardiogram uses sound waves to create a moving picture of your heart, showing how well the chambers of your heart and valves work.
• Doppler ultrasound uses sound waves to measure the speed and direction of blood flow.
• A Holter monitor records your heart’s electrical activity for a 24- or 48-hour period as you continue your normal routine.
• A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.
• Cardiac catheterization allows your specialist to check the pressure and blood flow in your heart.
• Coronary angiography is done during catheterization and uses a dye that allows your heart specialist to see the flow of blood to the heart muscle.
• A stress test, during which you walk or run on a treadmill or pedal a bicycle, allows your doctor to see how your heart functions when it’s beating fast.
• Cardiac MRI (magnetic resonance imaging) can show if parts of your heart are damaged.

When symptoms of heart failure worsen despite lifestyle changes and medication, you may be diagnosed with advanced heart failure. About 10% of the 5.7 million Americans living with heart failure have advanced heart failure – stage D according to the American Heart Association and American College of Cardiology’s A-to-D staging system. Advanced heart failure treatment is more complex, involving the implantation of devices or, when all other treatments are no longer effective, heart transplantation.

Ventricular Assist Devices

Life-saving and therapeutic, ventricular assist devices (VADs) are implantable mechanical circulatory devices that help pump blood from the left ventricle of the heart to the body. VADs are designed to partially or completely replace the functions of a failing heart in patients with severe heart failure, either as a bridge to heart transplantation or as a long-term destination treatment for those who cannot receive a transplant. Most often, VADs are designed to assist the left ventricle of the heart (LVAD), but devices may also be used to assist the right ventricle (RVAD) or both ventricles (BiVAD). VADs significantly ease the burden on the heart and other organs, providing a higher survival rate and better quality of life. You can learn more about advanced heart failure treatments here.

Total Artificial Heart

Despite growing demand, only approximately 2,200 donor hearts become available each year in the United States. When a donor heart is unavailable and both cardiac ventricles fail, a temporary SynCardia Total Artificial Heart is used as a bridge to transplantation and can eliminate the symptoms and source of end-stage biventricular failure. As soon as patients are stabilized following surgery, they are returned to the active transplant list. You can learn more about advanced heart failure treatments here.

Heart Transplantation

When all other treatments for heart failure have been unsuccessful, physicians may refer a patient for heart transplant. Advanced heart failure is staged on a four-point scale; as severity increases, patients enter stage four or end-stage heart failure, making them eligible for transplantation. Once transplant candidates have undergone a thorough screening process, they are placed on the national transplant list and monitored while awaiting a donor heart. If the transplant candidate’s condition begins to decline, intravenous medications, total artificial heart or ventricle assist device implantation may be recommended until a donor heart is available.

The heart specialists practicing at the Center for Advanced Heart Failure at Larry D. Johnson Heart & Vascular Institute are leaders in the management and diagnosis of heart failure, especially in the case of more complex disease. With appropriate medical and surgical intervention and healthy lifestyle habits, patients with heart failure can continue to live full and productive lives.

Specialists at the Center for Advanced Heart Failure at the Memorial Hermann Heart & Vascular Institute provide treatment for more complex cases, including medical management, percutaneous interventions and surgery.