Living with heart failure: When to consider advanced care

Heart Health

by Cesar Guerrero-Miranda, MD, FACC

Jun 6, 2022

Your home has many systems that keep it running smoothly, such as electrical, mechanical, structural, chemical and plumbing—and the same holds true for your heart. When all your heart’s systems are running as they should, it functions normally.

But when one or more of these systems isn’t working correctly, it can lead to many different heart conditions, including heart failure. More than 6 million Americans are living with heart failure today. This common condition happens when your heart is unable to pump blood to meet the demands of your body.

There are many steps you can take to live with heart failure and manage your symptoms, including lifestyle changes and medications. However, some people eventually need advanced care. A cardiologist who specializes in advanced heart failure can help you understand your condition and give you options when other heart failure treatments aren’t enough.

What causes my heart failure symptoms?

Initially, heart failure may be caused by numerous health conditions or factors. Some of these are preventable, but others are not. They include:

  • High blood pressure
  • Coronary artery disease/myocardial infarction (i.e., heart attack)
  • Diabetes mellitus
  • Tobacco
  • Alcohol
  • Obesity
  • Arrhythmias
  • Valve problems
  • Familial factors
  • Congenital heart defects
  • Some medications
  • Viruses
  • Sleep apnea

When heart failure develops, it creates two problems. First, your blood is pushed backward, and that causes a buildup of fluid in your lungs and other parts of the body, producing cough/wheeze, fatigue and swelling. Second, your blood can’t deliver enough oxygen and nourishment to your body to allow it to work normally, reflecting tiredness, sleepiness and sometimes dizziness.  

These problems cause a wide range of symptoms that affect your quality of life. Other symptoms include shortness of breath, weight gain, getting full quickly, fast heart rate and loss of appetite.

Heart failure treatment options

If you’ve been diagnosed with heart failure, the first step is to talk to your doctor. With ongoing medical care, education and lifestyle changes, your doctor can help you create a plan to manage symptoms and monitor you for signs that additional care is needed.

Along with regular visits with your doctor, a comprehensive plan to live with heart failure includes:

  • Medications: There are several different medications for heart failure. Your doctor can help you balance the benefits and risks of each.
  • Dietary changes: When it comes to heart failure, sodium is your enemy. Avoid high-sodium foods, remove the saltshaker from your table, and always check food labels for salt content.
  • Exercise: Ask your doctor if you may benefit from cardiac rehab.
  • Daily weight checks: Weigh yourself every day and contact your doctor if you gain more than 3 pounds in three days.
  • Weight loss: If you are overweight or obese, the lower your body mass index, the less work for your heart to do.
  • Immunizations: When you get vaccinated, you help minimize the risk of getting respiratory infections like COVID-19, flu or pneumonia.
  • Know your symptoms: Let your doctor know if you have new or worsening symptoms.
  • Control other medical conditions: Manage conditions like diabetes mellitus, COPD, sleep apnea, high blood pressure, high cholesterol and obesity.
  • Reduce your risk factors: Quit tobacco, alcohol and illegal drug use (including marijuana).

Some people living with heart failure may also get a small, battery-powered pacemaker or implantable cardioverter-defibrillator (ICD). A pacemaker helps keep your heart in rhythm, while an ICD can provide a strong electrical shock that may help prevent sudden cardiac arrest.

What if these treatments don’t work?

Sometimes, despite these treatments, people with heart failure progress into what is known as end-stage heart failure. People with advanced heart failure may have signs that include:

  • Symptoms that do not respond to treatment
  • Fluid that doesn’t respond to diuretics
  • Inability to tolerate previously tolerated medications
  • Symptoms at rest due to heart failure
  • Progressive unintentional weight loss

End-stage heart failure mortality can be worse than most end-stage cancers, and end-stage heart failure patients have a poor quality of life. If you or a loved one has heart failure that’s progressing or if you’ve been told you have end-stage heart failure, you still have options. People with end-stage heart failure may qualify for one of two cardiac replacement therapies: a left ventricular assist device (LVAD) or a heart transplant.

LVAD are mechanical pumps that are implanted in your heart to help the heart pump blood. LVADs are used either as the final treatment for heart failure, known as destination therapy, or for a time until a heart transplant is performed, called a bridge to transplant.

If you have end-stage heart disease, the advanced heart failure teams at Baylor Scott & White Health have experience in complex LVAD and heart transplant cases and helping patients who didn’t qualify for either of those two therapies at another center.

How advanced heart failure specialists help

Specialists in advanced heart failure, which is a board certification beyond the typical cardiologist, have special training to evaluate and treat patients who need additional care for heart failure. When you have signs of advanced heart failure, it’s important to have an evaluation from a specialist before your condition progresses.

Your advanced heart failure specialist can provide you with access to extensive knowledge about heart failure, additional non-surgical care, clinical research studies, cardiac replacement therapies and more. These specialists usually work as part of a team to choose the best treatment plan for you.

If heart failure treatments are no longer managing your condition, seek out a center that provides specialized care to help you navigate your options and pursue innovative treatments.

Find an advanced heart failure clinic near you today.

About the Author

Cesar Guerrero-Miranda, MD, FACC, is an advanced heart failure and transplant cardiologist and medical director of mechanical circulatory support at Baylor University Medical Center.

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