Diagnosis and Treatment of Heart Failure
An average of 659,000 people die in the U.S. each year from heart disease, according to the Centers for Disease Control and Prevention (CDC).
One of the most severe forms of heart disease is called heart failure. “Heart failure, strictly defined, is the inability of the heart to maintain normal cardiac output,” says Jim Januzzi, MD, a Mass General Brigham cardiologist who cares for patients at Massachusetts General Hospital.
Heart failure means the heart does not pump enough blood to the rest of the body. Over time, this can be fatal. Learn more about heart failure symptoms and the importance of early diagnosis.
Risk factors of heart failure
Heart disease risk factors include:
Lifestyle factors like smoking and diet
“This may result in other forms of heart disease, such as coronary artery disease and valvular heart disease. As they run through their course, they can ultimately result in heart failure,” says Dr. Januzzi.
Signs and symptoms of heart failure
Heart failure may have several different signs and symptoms, including:
Fatigue
Shortness of breath
Persistent wheezing or coughing
Swelling in the feet, ankles, legs, or abdomen
Lack of appetite or nausea
Confusion or impaired thinking
Increased heart rate
Not enough blood flow to organs like the kidneys (also known as inadequate perfusion)
The first symptoms may be subtle, but worsen over months to years. If heart failure isn’t diagnosed at an early stage, patients may develop other serious conditions, like heart arrhythmias (which includes AFib). These conditions make heart failure more difficult to treat.
“When a person is hospitalized for heart failure, their prognosis immediately worsens. This is why it’s critical to diagnose heart failure at an earlier stage,” says Dr. Januzzi.
Diagnosis of heart failure
Heart failure is usually diagnosed in visit to the doctor. Your cardiologist takes a detailed medical and family health history, and does a physical exam. Sometimes doctors use other imaging and testing, like echocardiograms (or ultrasounds of the heart). These tests can help identify the type of heart failure you have and how severe it is.
The ancient Greeks believed that “humors” in the blood stream could be linked to disease. It turns out they were on to something. “We can now measure substances in the bloodstream called biomarkers, which reflect exactly what the ancient Greeks were talking about,” explains Dr. Januzzi.
Doctors use blood tests to measure biomarkers. “Early diagnosis has become a major priority, and measurement of biomarkers has taken on an especially important role,” says Dr. Januzzi. “They can tell us so much about the presence and severity of heart failure.”
For instance, if a patient has shortness of breath, biomarkers can reveal if they have heart failure. For someone with established heart failure, “These blood tests may tell us whether a person is doing well or doing poorly. It may give us an opportunity to adjust their treatment in order to improve their prognosis,” says Dr. Januzzi.
Treating heart failure
Treatment options for heart failure depend on the patient’s condition. Treatments can include:
Diet changes, like reducing salt intake or drinking less fluids
Lifestyle changes, like getting more exercise. Strength training for healthy blood pressure is one option.
Medication
Surgery for implants like ventricular assist devices. These help the heart pump blood to the rest of the body.
Some patients with very severe cases may eventually need a heart transplant.
Preventing heart failure
Researchers at Mass General Brigham are also studying new ways to treat and diagnose heart failure, especially in the early stages.
“I see patients suffering from heart failure every single day. Our goal is to identify heart failure at its earliest stages so that we can intervene and prevent its development,” confirms Dr. Januzzi.
Learn about Mass General Brigham Heart services