Heart Failure

If you or someone you love suffers from heart failure, receiving proper care and treatment is essential. Torrance Memorial's Lundquist Lurie Cardiovascular Institute is one of the leading centers for treatment of heart failure in the greater Los Angeles area. Torrance Memorial offers a comprehensive in-patient and out-patient program to improve quality of life and manage every aspect of heart failure.

A Team Approach

At Torrance Memorial, we offer a comprehensive team approach. You and your family will join a team of skilled and dedicated staff including cardiologists, nurses, dieticians, pharmacists, and case managers that will help you every step of the way.

• We offer the most technologically advanced therapies
• We provide in-depth patient and family education including nutritional and fitness counseling
• Support groups are available to help patients and families deal with the emotional aspects of living with a chronic condition
• Advanced telephone monitoring allows assistance with home management
• A dedicated practitioner is available to provide assistance to you 24/7

What is Heart Failure?

Heart failure is condition that occurs when the heart has lost its ability to pump enough oxygen rich blood to the body's tissues. It is also known as congestive heart failure or CHF. There are many causes of heart failure including

• Coronary artery disease leading to heart attacks
• Hypertension (high blood pressure)
• Heart valve disease
• Alcoholism and drug abuse
• Cardiomyopathy from viral infections or other toxins
• Abnormal heart rhythms

Symptoms

If the heart can't pump effectively, the fluid can build up in your body resulting in a variety of symptoms including:

• Shortness of breath during activity or rest
• Swelling of legs, ankles and feet
• Feeling tired and weak
• Lack of appetite or nausea
• Persistent coughing or wheezing, most often when laying down
• Confusion or feelings of disorientation
• Chest pain or palpitations

Diagnosis

After a careful medical history has been taken and a physical examination has been completed, there may be several tests your provider may order to help determine if you have heart failure. These tests include:

• Blood tests: A blood test to check for a chemical called brain natriuretic peptide (BNP) can be helpful in diagnosing heart failure. Other blood tests can be done to check for possible causes of heart failure or to check for problems made worse by heart failure.
• Chest x-ray: An x-ray is done to look for fluid around your heart and lungs. This x-ray can also show the size of your heart which may be enlarged in heart failure.
• Electrocardiogram (EKG or ECG): This is a non-invasive test that records the electrical activity of the heart. This test is helpful in looking for heart rhythm problems that may be causing heart failure. It can also be done to determine if the heart muscle is damaged and acutely not getting enough oxygen, both leading to symptoms of heart failure.
• Echocardiogram (ECHO): This test is useful for both diagnosing heart failure and monitoring heart failure. It is a non-invasive procedure that uses sound waves (ultrasound) to evaluate how well the heart is working. It can identify if there are problems with the heart muscle or problems with the heart valves.
• Cardiac catheterization or coronary angiogram: This test is done if your physician suspects blockages in the arteries that supply the heart muscle. Narrowing of the arteries caused by blockages can cause heart failure.
• Exercise Stress Test: This test is done to provide information about the heart when it is stressed. It can be used to help determine if there is adequate blood flow during increased levels of activity.

Treatment

Although heart failure is most often a chronic condition requiring lifelong management, in some cases it can be controlled by treating the underlying cause. The aim of treatment is to control symptoms, delay the progression of the disease, and help patients live a longer and happier life despite their condition. The most common treatment options include lifestyle changes and medications.

Lifestyle Changes

• Don't smoke and avoid second hand smoke
• Dietary changes that include maintaining a low salt, low fat diet
• Reduce stress
• Monitor your weight daily to watch for fluid build up
• Maintain a healthy weight
• Limit alcohol and fluids
• Remain active

Medication

Heart failure patients often need multiple medications to manage their condition and control their symptoms. They each work a little differently to make it easier for your heart to work. It is important that you understand what medications you are taking and why you are taking them.

Types of Medications

• Angiotensin converting enzyme (ACE) inhibitors: These drugs widen blood vessels to lower blood pressure and decrease the workload on the heart
• Angiotensin II Receptor Blockers (ARBs): These drugs widen blood vessels to lower blood pressure and decrease workload on the heart. They can be used as an alternative when an ACE is not tolerated.
• Aldosterone antagonist: A diuretic that preserves potassium and has been shown to reduce hospitalization and prolong life when used to treat advanced heart failure
• Anticoagulants: These drugs are also commonly known as "blood thinners". Some patients with heart failure have an irregular heart rhythm called atrial fibrillation. This irregular rhythm can lead to the formation of clots. These drugs prevent clots from forming and are given to prevent strokes.
• Beta blockers: These drugs lower your heart rate and lower your blood pressure to reduce the workload of the heart. They have been shown to reduce signs and symptoms of heart failure and improve heart function.
• Diuretics: These drugs are also known as "water pills". They result in more frequent urination by removing excess fluid from the blood stream and body tissues. Patients taking diuretics may also lose potassium and may need to have a potassium supplement.
• Nitrates: These drugs help improve blood flow to your heart by widening or dilating the arteries that supply the heart muscle.
• Vasodilators: Vasodilators may be used to improve blood flow by making the blood vessels in your heart and lungs wider.

Surgical Options

Depending upon the cause and type of heart failure, there may be some surgical options available as treatment for heart failure.

• Coronary Artery Bypass Graft (CABG) Surgery: This surgery is also known as "open-heart surgery" or heart-bypass surgery. It is done to increase blood flow to the heart when there are blockages in the arteries that supply the heart muscle itself. This surgery can lower the risk of having a heart attack in the future.
• Heart Valve Surgery: Heart failure can be a result of a valve in the heart that is not functioning properly. Some patients may benefit from repairing or replacing the valve.
• Implantable Cardioverter-Defibrillators (ICDs): This is a small implantable device that monitors your heart rate and rhythm. It can function similar to a pacemaker and help speed the heart rate if it is too slow. If the device senses a dangerous rhythm or senses that the heart has stopped, it can provide a small electrical shock to help the heart start beating normally again.
• Cardiac Resynchronization Therapy (CRT): This is also called a biventricular pacemaker. Electrical impulses coordinate the lower chambers of the heart (right and left ventricles) to pump more efficiently. This device is usually combined with an ICD to function as one device.