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Advanced Heart Failure

Expert managements of advanced heart failure

When you have heart failure, the heart is not able to pump as well as it should. Blood and fluid may back up into the lungs, and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms you feel.​

The cause of the heart failure will guide the treatment plan. If the heart failure is caused by a valve disorder, then surgery may be done to fix the valve. If the heart failure is caused by a disease, such as anemia, then the underlying disease will be treated. Although there is no cure for heart failure due to damaged heart muscle, many forms of treatment have been used to treat symptoms very effectively.

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Conditions treated

 
  • Complex congenital heart disease
  • Coronary artery disease: inoperable
  • Cardiomyopathy: dilated
  • Cardiomyopathy: hypertrophic or restrictive (including sarcoidosis, LV non-compaction)​
  • Cardiomyopathy: infiltrative (including amyloidosis and hemochromatosis) 
  • Cardiomyopathy: ischemic
  • Hypoplastic left-heart syndrome
  • Interstitial lung disease
  • Inoperable valvular heart disease
  • Pulmonary artery hypertension​​
  • Refractory life-threatening arrhythmias

Advanced heart failure treatment options

Treatment plans for patients will be determined by their care team based on age, medical history, type and stage of heart failure and personal preferences.

Options may include:

  • Controlling risk factors
  • Medications
  • Cardiac resynchronization therapy
  • Biventricular pacing
  • Heart transplant​​​
  • Implantable cardioverter defibrillator​ 
  • Ventricular assist devices (VADs)​
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Frequently asked questions

 

The evaluation is used to determine two primary areas:

  • Evaluation for cause – This includes assessment for presence of coronary artery disease, usually via cardiac catheterization, stress testing, echocardiogram, basic laboratory tests and/or ECG. Further testing could be needed based on what is found on these screening exams.
  • Evaluation for factors that affect heart failure – This includes smoking, drug/alcohol use, high blood pressure, high cholesterol, abnormal heart rhythms, diabetes control, weight management, exercise, thyroid disease, anemia and sleep apnea.
  • ACE Inhibitors and ARBs – These meds are the cornerstone of heart failure treatments. While ACE Inhibitors are the mainstay, ARBs may be utilized if you cannot tolerate ACE inhibitors. Both of these classes of drugs are used to reduce dilation and restore the heart to its normal shape.
  • Beta blockers – Provides the greatest potential benefit of all possible medications; some beta blockers have been proven to help the heart return to its normal shape/function. These are started at low dose and gradually adjusted as tolerated.
  • Aldosterone antagonists – The third line of medical therapy, used in low doses in combination with the above. This medication is used to prevent your body from losing potassium and it is a mild diuretic.
  • Digoxin – The last line of medical therapy in addition to the three above it has been shown to decrease the risk of hospitalizations.
  • Diuretics – Used to managed swelling and fluid retention
  • ICD (Implantable Cardioverter Defibrillator) - Small device placed under the skin of the chest. An ICD is designed to prevent a person from dying suddenly from a dangerous heart rhythm.
  • Low Sodium Diet – Restrict sodium (salt) to 2,000 mg per day. Dietitians are available to assist you with your dietary plan.
  • Exercise is very important. Please discuss this with your provider.
  • No medication has been shown to help a stiff heart relax and thus most therapies are aimed at controlling factors that worsen the condition such as hypertension, diabetes and sleep apnea.
  • Diuretics can be used to help manage swelling and fluid retention.

The better you can control your heart failure and the aggravating factors, the greater the possibility that you could postpone or prevent the need for transplant or LVAD.

  • Dilated cardiomyopathy
  • Ischemic cardiomyopathy
  • Restrictive cardiomyopathy (including amyloidosis, sarcoidosis, hypertrophic cardiomyopathy, LV non-compaction)
  • Pulmonary artery hypertension
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