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In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart’s function. Procedures used include:

Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is bypass surgery. Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.

Heart valve surgery

Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuloplasty).

Implantable left ventricular assist device (LVAD). The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.

Heart valve surgery

Heart transplant

A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies, but the person’s health is otherwise good.

Heart transplant




How Can I Improve My Quality of Life With Heart Failure


Keep your blood pressure low

In heart failure, the release of hormones causes the blood vessels to constrict or tighten. The heart must work hard to pump blood through the constricted vessels. It is important to keep your blood pressure controlled so that your heart can pump more effectively without extra stress.

Keep your blood pressure low
Monitor your own symptoms

Monitor your own symptoms

Check for changes in your fluid status by weighing yourself daily and checking for swelling. Call your doctor if you have unexplained weight gain (3 pounds in one day or 5 pounds in one week) or if you have increased swelling.

Maintain fluid balance

Your doctor may ask you to keep a record of the amount of fluids you drink or eat and how often you go to the bathroom. Remember, the more fluid you carry in your blood vessels, the harder your heart must work to pump excess fluid through your body. Limiting your fluid intake to less than 2 liters per day will help decrease the workload of your heart and prevent symptoms from recurring.

Maintain fluid balance
Limit how much salt (sodium) you eat

Limit how much salt (sodium) you eat

If you follow a low-sodium diet, you should have less fluid retention, less swelling, and breathe easier.

Monitor your weight and lose weight if needed

Learn what your “dry” or “ideal” weight is. Dry weight is your weight without extra water (fluid). Your goal is to keep your weight within 4 pounds of your dry weight. Weigh yourself at the same time each day, preferably in the morning, in similar clothing, after urinating but before eating, and on the same scale.

Monitor your weight and lose weight if needed
Monitor your symptoms

Monitor your symptoms

Call your doctor if new symptoms occur or if your symptoms worsen. Do not wait for your symptoms to become so severe that you need to seek emergency treatment.

Take your medications as prescribed

Take your medications as prescribed
Schedule regular doctor appointments

Schedule regular doctor appointments



The table below outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.

Stages of Heart Failure

Stage A

Definition of Stage

People at high risk of developing heart failure (pre-heart failure), including people with:

  • High blood pressure
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • History of cardiotoxic drug therapy
  • History of alcohol abuse
  • History of rheumatic fever
  • Family history of cardiomyopathy
Usual Treatments
  • Exercise regularly.
  • Quit smoking.
  • Treat high blood pressure.
  • Treat lipid disorders.
  • Discontinue alcohol or illegal drug use.
  • An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
  • Beta blockers may be prescribed if you have high blood pressure or if you’ve had a previous heart attack.
Usual Treatments for Stage A
Usual Treatments for Stage A

Stage B

Definition of Stage

People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with:

  • Prior heart attack
  • Valve disease
  • Cardiomyopathy
  • The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.
Usual Treatments
  • Treatment methods above for Stage A apply
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB)
  • Beta-blockers should be prescribed for patients after a heart attack
  • Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed
  • If appropriate, surgery options should be discussed for patients who have had a heart attack.
Usual Treatments for Stage B

Stage C

Definition of Stage

Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include:

  • Shortness of breath
  • Fatigue
  • Reduced ability to exercise
Reduced ability to exercise

Reduced ability to exercise

Shortness of breath

Shortness of breath

Fatigue

Fatigue

Usual Treatments
  • Treatment methods above for Stage A apply
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers
  • African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
  • Diuretics (water pills) and digoxin may be prescribed if symptoms persist
  • An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
  • Restrict dietary sodium (salt)
  • Monitor weight
  • Restrict fluids (as appropriate)
  • Drugs that worsen the condition should be discontinued
  • As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended
  • An implantable cardiac defibrillator (ICD) may be recommended

Stage D

Definition of Stage

Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.

Usual Treatments

Treatment methods for Stages A, B & C apply
Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care.

Usual Treatments of Stage D


There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.

Is There a Treatment for Heart Failure?
Is There a Treatment for Heart Failure?

The goals of treating heart failure are primarily to decrease the likelihood of disease progression (thereby decreasing the risk of death and the need for hospitalization), to lessen symptoms, and to improve quality of life.

Together, you and your doctor can determine the best course of treatment for you.



Your doctor will ask you many questions about your symptoms and medical history. You will be asked about any conditions you have that may cause heart failure (such as coronary artery disease, angina, diabetes, heart valve disease, and high blood pressure). You will be asked if you smoke, take drugs, drink alcohol (and how much you drink), and about what drugs you take.

How Is Heart Failure Diagnosed?

You will also get a complete physical exam

Your doctor will listen to your heart and look for signs of heart failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.

Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:

Blood tests

Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood condition that occurs when there is not enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in a person’s blood.

B-type Natriuretic Peptide (BNP) blood test

BNP is a substance secreted from the heart in response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure — even someone whose condition is stable — is higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.

Chest X-ray

A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.

Echocardiogram

This test is an ultrasound which shows the heart’s movement, structure, and function.

The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition is present in your heart.

Echocardiogram

Electrocardiogram (EKG or ECG)

An EKG records the electrical impulses traveling through the heart.

Cardiac catheterization

This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.

Stress Test

Stress Test

Noninvasive stress tests provide information about the likelihood of coronary artery disease.

Other tests may be ordered, depending on your condition.



Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.

A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.

What Are the Types of Heart Failure?

Diastole (relaxation)

(A) Normal

Diastole (relaxation) - Normal

(B) Systolic dysfunction

Systolic dysfunction

(C) Diastolic dysfunction

Diastolic dysfunction


If your doctor tells you that you’ve got an enlarged liver, it means it’s swollen beyond its normal size.

Enlarged liver

Symptoms

Most of the time, if you have a slightly enlarged liver, you won’t notice any symptoms. If it’s severely swollen, though, you may have:

  • A feeling of fullness
  • Discomfort in your belly

Depending on the cause of your enlarged liver, you may notice symptoms like:

Yellowing of the skin or eyes (jaundice)
Nausea
Fatigue and weakness
Weight loss


Edema in foot and ankle (Swollen Feet & Legs)

Edema is swelling caused by excess fluid trapped in your body’s tissues. Although edema can affect any part of your body, it’s most commonly noticed in the hands, arms, feet, ankles and legs.

Signs and symptoms of edema include:

  • Swelling or puffiness of the tissue directly under your skin
  • Stretched or shiny skin
  • Skin that retains a dimple after being pressed for several seconds
  • Increased abdominal size

Swelling of the foot, ankle and leg can be severe enough to leave an indentation, or “pit,” when you press on the area. This swelling (edema) is the result of excess fluid in your tissues — often caused by congestive heart failure or blockage in a leg vei

Edema in foot and ankle

Ascites (Fluid in the Abdominal Cavity)

Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) that accumulates in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm.

Ascitic fluid can have many sources such as liver disease, cancers, congestive heart failure, or kidney failure.

Ascites (Fluid in the Abdominal Cavity)


Emirates Cardiac Society

SHARING MATTERS OF HEART

SHARING MATTERS OF HEART




About Us


Emirates Cardiac Society (ECS) is a non-profit organization comprising of cardiologists within the UAE that work under the umbrella of the Emirates Medical Association.


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