Heart failure diagnosis and treatment

0 comments

diagnosis

To diagnose heart failure, your doctor will take a detailed medical history, review your symptoms, and perform a physical exam. Your doctor will also check to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease, or diabetes.

Your doctor can listen to your lungs for signs of fluid buildup (pulmonary congestion) and your heart for a hissing sound (murmur) that may indicate heart failure. Your doctor may check the veins in your neck and check your abdomen and legs for fluid buildup.

After the physical exam, your doctor may also order some of the following tests:

blood test. Blood tests are done to look for signs of disease that may affect the heart.
Chest X-ray. X-ray images can show the condition of the lungs and heart.
Electrocardiogram (ECG). This quick and painless test records electrical signals in the heart. It shows the time and length of the heartbeat.
Echocardiography. Sound waves are used to create images of the heart in motion. This test shows the size and structure of the heart and heart valves and the flow of blood through the heart. An echocardiogram can be used to measure ejection fraction, which shows how well the heart pumps blood and helps classify heart failure and guide treatment.
pressure test. A stress test measures the health of your heart during activity. You may be asked to walk on a treadmill while connected to an electrocardiogram machine, or you may receive intravenous medication to stimulate the effects of exercise on your heart.

Sometimes a mask is worn for a stress test to measure how well the heart and lungs are getting oxygen and exhaling carbon dioxide.
Cardiac computed tomography (CT) scan. During a cardiac CT scan, you lie on a table inside a donut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. Sometimes, contrasts are given. Because contrast media can affect kidney function, talk to your doctor if you have kidney problems.
Magnetic resonance imaging (MRI). In a cardiac MRI , you lie on a table inside a long tube-shaped machine. Radio waves produce images of the heart.

A cardiac MRI can be done with a dye (contrast agent). Before you have a cardiac MRI or other MRI , it's important to tell your doctor about any problems you have with your kidneys because contrast media can cause rare and serious complications in people with kidney disease.
Coronary angiography. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel, usually in the groin, and guided to an artery in the heart. A dye (contrast agent) is injected through the catheter to make the arteries appear more clearly on X-rays, helping doctors find blockages.
Myocardial biopsy. In this test, doctors insert a soft string into a vein in the neck or groin and remove very small pieces of heart muscle for examination. This test can be used to diagnose certain types of heart muscle disease that lead to heart failure.

Test results that diagnose heart failure can help doctors determine the cause of any signs and symptoms and decide on a treatment plan. To determine the best treatment for heart failure, doctors can classify heart failure using two systems:

New York Heart Association classification

This scale divides heart failure into four categories.

Class I heart failure. There are no symptoms of heart failure.
Class II heart failure. Daily activities can be performed without difficulty, but exertion can cause shortness of breath or fatigue.
Class III heart failure. Difficulty completing daily activities.
Class IV heart failure. Shortness of breath may occur even at rest. This category includes the most severe forms of heart failure.

American College of Cardiology/American Heart Association classification

This stage-based classification system uses the letters A through D and includes a category for people who are at risk of developing heart failure. Doctors use this classification system to identify risk factors and start more aggressive treatment earlier to help prevent or delay heart failure.

Stage A: There are several risk factors for heart failure but no signs or symptoms.
Period B. Have heart disease but no signs or symptoms of heart failure.
Period C. Have signs or symptoms of heart disease and heart failure.
Period D. Advanced heart failure requires specialized treatment.

treat

Heart failure is a chronic disease that requires lifelong management. However, with treatment, the signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.

Doctors can sometimes correct heart failure by treating the underlying cause. For example, repairing heart valves or controlling rapid heart rhythms can reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and sometimes devices that help the heart beat and contract normally.

drug

Doctors often treat heart failure with a combination of medications. Depending on your symptoms, you may be prescribed one or more medications, including:

Angiotensin-converting enzyme (ACE) inhibitors. These drugs relax blood vessels to lower blood pressure, improve blood flow, and reduce stress on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis, Prinivil), and captopril.
Angiotensin II receptor blockers. These drugs, including losartan (Cozaar), valsartan (Diovan), and candesartan (Atacand), have many of the same benefits as ACE inhibitors. They may be an option for people who cannot tolerate ACE inhibitors.
Beta blockers. These drugs slow your heart rate and lower your blood pressure. Beta blockers can reduce the signs and symptoms of heart failure, improve heart function, and help you live longer. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle), and bisoprolol.
Diuretics. Diuretics, often called water pills, allow you to urinate more frequently and prevent fluid from accumulating in your body. Diuretics, such as furosemide (Lasix), also reduce fluid in the lungs, allowing you to breathe easier.

Because diuretics cause your body to lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you are taking diuretics, your doctor may monitor the levels of potassium and magnesium in your blood with regular blood tests.
Aldosterone antagonist. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). These are potassium-sparing diuretics that have additional properties that may help people with severe systolic heart failure live longer.

Unlike some other diuretics, spironolactone and eplerenone can raise the potassium levels in your blood to dangerous levels, so if you're concerned about elevated potassium levels, talk to your doctor and find out if you need to adjust your high-potassium foods intake.
Inotropes. These drugs can be given intravenously to people who are hospitalized with certain types of severe heart failure. Inotropes help the heart pump blood more efficiently and maintain blood pressure. Long-term use of these drugs is associated with an increased risk of death in some people. Discuss the benefits and risks of these drugs with your health care provider.
Digoxin (Lanoxin). This drug, also called digitalis, increases the contractility of the heart muscle. It also tends to slow the heartbeat. Digoxin may reduce heart failure symptoms in systolic heart failure. People with heart rhythm problems (such as atrial fibrillation) are more likely to take it.
Hydralazine and isosorbide dinitrate (BiDil). This combination of medications helps relax blood vessels. It may be added to your treatment plan if you have severe heart failure symptoms and ACE inhibitors or beta blockers are not helping.
Vericiguat (Verquvo). This new drug to treat chronic heart failure is taken by mouth once a day. It is a drug called an oral soluble guanylate cyclase (sGC) stimulator. In the study, patients with high-risk heart failure who took Vericiguat spent less time in the hospital for heart failure and heart disease-related death than those who took the inactive pill (placebo).
Other medicines. Your doctor may prescribe other medications to treat specific symptoms. For example, some people may take nitrates for chest pain, statins to lower cholesterol, or blood-thinning medications to help prevent blood clots.

Your doctor may need to adjust your dose frequently, especially if you first start a new medication or if your condition worsens.

If you have a sudden onset of heart failure symptoms, you may be admitted to the hospital. While in the hospital, you may receive additional medications to help your heart pump blood better and relieve symptoms. You may also receive supplemental oxygen through a mask or small tube placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen for an extended period of time.

Surgery or other procedure

Surgery to implant a heart device or other procedures may be recommended to treat the underlying problem causing heart failure. Surgery or other procedures for heart failure may include:

Coronary artery bypass surgery. If severely blocked arteries are causing your heart failure, your doctor may recommend coronary artery bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm, or chest and connecting it below and above the blocked artery in your heart. The new pathway improves blood flow to the heart muscle.
Heart valve repair or replacement. If a faulty heart valve is causing your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can repair the valve by reattaching the valve flaps or removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing a valve involves tightening or replacing the ring around the valve.

Heart valve repair or replacement can be done through open heart surgery, minimally invasive surgery, or heart surgery using a flexible tube called a catheter (cardiac catheterization).
Implantable cardioverter defibrillator (ICD). An ICD is used to prevent complications of heart failure. It is not a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It is implanted under the skin on your chest, with wires passed through your veins and into your heart.

This ICD monitors heart rhythm. If the heart starts beating in a dangerous rhythm, or if your heart stops beating, the ICD will try to pace your heart or return it to a normal rhythm. An ICD can also work as a pacemaker and speed up your heart if it's going too slow.
Cardiac Resynchronization Therapy (CRT). CRT , also called biventricular pacing, is used to treat heart failure in people whose lower ventricles (ventricles) pump blood out of sync. A device called a biventricular pacemaker sends electrical signals to the ventricles of the heart. These signals trigger your ventricles to contract in a more coordinated manner, improving the heart's pumping of blood. CRT can be used with ICD .
Ventricular Assist Device (VAD). A VAD - also known as a mechanical circulatory assist device - is a device that helps pump blood from the lower chambers of the heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both chambers of your heart, it is most commonly implanted in the left ventricle.

If you are waiting for a heart transplant, your doctor may recommend a VAD . Sometimes, VADs are used as a permanent treatment for people who have heart failure but are not candidates for a heart transplant.
heart transplant. Some people have severe heart failure that surgery or medication doesn't help. These people may need to replace their heart with a healthy donor heart.

Heart transplantation is not the right treatment for everyone. A team of doctors at the transplant center will evaluate you to determine whether the procedure is safe and beneficial for you.

Organ donation registration

Palliative and hospice care

Your doctor may recommend adding palliative care to your treatment plan. Palliative care is specialized medical care focused on relieving symptoms and improving quality of life. Anyone with a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the illness, such as pain or shortness of breath, or to reduce side effects of treatment, such as fatigue or nausea.

Your heart failure may worsen to the point where medications no longer work and a heart transplant or device is no longer an option. If this happens, you may need hospice care. Hospice provides special treatment options for terminally ill patients.

Hospice care allows family and friends—with the help of nurses, social workers, and trained volunteers—to care for and comfort a loved one at home or in a hospice. Hospice care provides emotional, psychological, social and spiritual support to the sick person and those closest to them.

Hospice care is available in your own home or in nursing homes and assisted living centers. For those who remain in the hospital, hospice care specialists can provide comfort, compassionate care and dignity.

Although it may be difficult, it is important to discuss end-of-life issues with your family and health care team. Part of that discussion may involve advance care directives—a general term for the oral and written instructions you give regarding medical care if you are unable to speak for yourself.

If you have an ICD , an important consideration to discuss with your family and doctor is whether it should be turned off, lest it send an electric shock that keeps your heart beating.

Clinical Trials

Mayo Clinic research tests new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and Home Remedies

Lifestyle changes often help relieve the signs and symptoms of heart failure and prevent the disease from getting worse. These changes may be among the most important and beneficial changes you can make:

Stop smoking. Smoking damages your blood vessels, raises your blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster.

If you smoke, ask your doctor to recommend a program to help you quit smoking. If you continue to smoke, you cannot be considered for a heart transplant. Also avoid secondhand smoke.
Check your legs, ankles, and feet every day for swelling. If swelling worsens, contact your doctor.
Talk to your doctor about weight monitoring. Weight gain may mean you are retaining fluid and need to change your treatment plan. Ask your doctor how often you should weigh yourself and when to contact your doctor about weight gain.
Maintain a healthy weight. If you are overweight, a nutritionist can help you reach your ideal weight. Losing even a small amount of weight can help improve heart health.
Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean protein.
Salt limit. Too much salt (sodium) can cause water retention, which makes your heart work harder and causes shortness of breath and swelling in your legs, ankles, and feet.

Ask your doctor if you should follow a no-salt or low-salt diet. Remember, salt is already added to prepared foods and be careful when using salt substitutes.
Limit saturated or trans fats in your diet. In addition to avoiding salty foods, limit the amount of saturated fat and trans fat in your diet. These potentially harmful dietary fats can increase your risk of heart disease.
vaccination. Talk to your doctor about getting the flu, pneumonia and COVID-19 vaccines.
Limit alcohol and fluids. If you have heart failure, your doctor may advise you not to drink alcohol because it can interact with your medications, weaken your heart muscle, and increase your risk of abnormal heart rhythms.

If you have severe heart failure, your doctor may also recommend limiting the amount of water you drink.
Be positive. Moderate aerobic exercise helps keep the rest of the body healthy and in shape, reducing the demand on the heart muscle. But be sure to talk to your doctor about an exercise program that's right for you. Your doctor may recommend a walking program or a cardiac rehabilitation program at your local hospital.
relieve pressure. When you are anxious or upset, your heart beats faster, you breathe harder, and your blood pressure often increases. This can make heart failure worse because your heart can no longer keep up with your body's needs.

Find ways to reduce stress in your life. To give your heart a rest, try taking a nap or putting your feet up when possible. Spend time socializing with friends and family to help relieve stress.
Fall asleep easily. If you feel short of breath, especially at night, use a pillow or wedge to prop up your head. If you snore or have other sleep problems, make sure you get tested for sleep apnea.

response and support

Proper heart failure treatment can sometimes improve symptoms and help you live longer. You and your doctor can work together to make you feel most comfortable. Pay attention to your body and how you feel, and tell your doctor if you feel better or worse. This way, your doctor will know which treatment is best for you.

These steps can help you manage heart failure:

Keep track of the medications you take. Make a list of all the medications you take, keep it with you, and share it with your doctor. Do not stop taking any medicine without consulting your doctor first. If the side effects of any medicine you take are uncomfortable or concerning, tell your doctor.
Check your medications. Some medications available without a prescription, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diet pills, may worsen heart failure and cause fluid buildup. Discuss all medications you take with your doctor.
Be careful with supplements. Some dietary supplements may interfere with heart failure medications or may make your condition worse. Discuss any supplements you are taking with your doctor.
Use a diary to monitor your weight. Take these notes with you to your doctor's appointment. Weight gain may be a sign of fluid accumulation.
Track your blood pressure. Consider purchasing a home blood pressure monitor. Write down your blood pressure numbers between doctor's visits and bring the record with you during your visits.
Write down the questions you want to ask your doctor. Before your doctor's appointment, prepare a list of any questions or concerns you have. For example, is it safe for you and your partner to have sex? Once symptoms are controlled, most people with heart failure can continue sexual activity. Ask for clarification if necessary. Make sure you understand everything your doctor wants you to do.
Get your doctor's contact information. Keep your doctor's phone number, your hospital's phone number, and directions to the hospital or clinic. You'll want to have these ready if you have questions for your doctor or need to go to the hospital.

Managing heart failure requires open communication between you and your doctor. Be honest about whether you are following the recommendations regarding your diet, lifestyle and medications you take. Your doctor will usually recommend strategies to help you stay on track.

Prepare for your appointment

If you think you may have heart failure or are concerned about the risk of heart failure due to another underlying condition, make an appointment with your family doctor. If heart failure is caught early, your treatment may be easier and more effective.

Since dates can be brief and there's usually a lot to discuss, it's a good idea to be prepared for the date. Here's some information to help you prepare for your appointment and know what to expect from your doctor.

what can you do

Please be aware of any pre-appointment restrictions. When you make your appointment, be sure to ask if you need to do anything in advance, such as restricting your diet. For example, for some imaging tests, you may need to fast for a period of time beforehand.
Write down any symptoms you are experiencing, including any that appear unrelated to heart failure.
Write down key personal information, including family history of heart disease, stroke, high blood pressure, or diabetes, as well as any major stressors or recent life changes. Find out if anyone in your family has heart failure. Some heart conditions that lead to heart failure run in families. It may be important to learn as much as possible about your family history.
List any medications, vitamins or supplements you are taking.
If possible , bring a family member or friend . Sometimes it can be difficult to remember all the information given to you during an appointment. The people who accompany you may remember things that you missed or forgot.
Be prepared to discuss your eating and exercise habits. If you're not already following a diet or exercise plan, be prepared to discuss with your doctor any challenges you may face getting started.
Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case you run out of time. For heart failure, some basic questions to ask your doctor include:

What is the most likely cause of my symptoms?
Are there other possible causes for my symptoms?
What tests do I need to do? Do these tests require any special preparation?
What treatments are available? Which one would you recommend to me?
What foods should I eat or avoid?
What is an appropriate level of physical activity?
How often should I check for changes in my condition?
I have other health conditions. How can I best manage these conditions together?
Are there any generic alternatives to the medicine you are prescribing for me?
Does my family need to be screened for conditions that may cause heart failure?
Are there any brochures or other printed materials to take home? What websites do you recommend visiting?