Gilmore Health: A Q&A Session on Heart Failure With Dr. Sony Sherpa

Heart Failure, also known as congestive heart failure or CHF, is a chronic, progressive condition that is characterized by the heart’s inability to pump blood to the body properly. Since the human body depends on blood circulation for its oxygen and nutrient supply, lack of proper circulation due to decreased pumping by the heart can significantly impair the entire body’s functioning, often resulting in several comorbidities.

Heart Failure

Heart Failure is a gradual cardiovascular condition responsible for approximately 287,000 deaths per year, in the United States alone. And each year, around 550,000 new cases of heart failure are diagnosed in the US. Currently, approximately 6.2 million people in the united states alone are suffering from congestive heart failure.

Today, we are speaking to Dr. Sony Sherpa to learn more about heart failure and how it can be treated.

Thank you Dr. Sony Sherpa for taking the time to speak to us. Could you tell us what exactly causes the heart to stop pumping and go into failure?

Of course. So the heart doesn’t exactly stop pumping blood in heart failure, it actually still pumps blood but with less force and that’s not enough to meet the body’s need.

As for the causes of heart failure, heart failure often develops once the heart has become weak or stiff due to other medical conditions. If the ventricles, the chamber of the heart responsible for pumping out blood, become weak, they may lose the ability to pump our blood with enough force. If they become stiff, they won’t stretch to accommodate the influx of blood, which would result in not enough blood being in the ventricle when it pumps the blood to the body. Either way, the blood supply to the body decreases. And over time, the heart function worsens.

Alright, and how do doctors measure the functioning of the heart?

That’s a great question. Cardiac health evaluation is done using an ECG, in which little sticky electrodes are placed on your arm, feet, and chest to assess the heart rhythm. An echocardiogram is also performed, in which the patient an ultrasound probe is used to visualize the heart. Stiffness, thickness, or dilation of the ventricles is very easily detectable using an echo.

Moreover, we can calculate the ejection fraction, which is the amount of blood pumped out per heartbeat, using the echocardiogram. In a healthy person, this value should be 50 to 60 percent, however, it is significantly reduced in a patient with heart failure. It is important to mention that heart failure can sometimes occur with a normal ejection fraction, so a detailed analysis for the diagnosis of heart failure is required.

And what symptoms does heart failure present with?

Heart failure manifests as very general symptoms like shortness of breath, even with minimal activity, swelling of ankles, eyes, scrotum, or stomach, and a general state of tiredness and fatigue. Swelling is due to water retention and if this water reaches and accumulates in the lungs, the patient may suffer from breathlessness on lying down, which negatively affects the sleep quality and general health of the person.

Are there any risk factors for the development of heart failure, apart from having other cardiovascular diseases?

There are many risk factors for the development of heart failure, some modifiable, and others non-modifiable. Non-modifiable risk factors are factors a patient can’t control like being diagnosed with coronary artery disease, a cardiovascular condition that predisposes them to develop heart failure.

Modifiable risk factors, on the other hand, are factors that can be improved upon by lifestyle changes and eventually reduce the risk of heart failure. Some examples include smoking, excessive drinking, sedentary lifestyle, and unhealthy food consumption. Lifestyle modifications can eliminate these risk factors significantly, if not completely.

That’s wonderful. And once a patient’s heart has progressed into failure, what can be done? Is there any treatment that cures heart failure?

After the diagnosis of heart failure is made, it is usually treated with medications and lifestyle changes. However, short of a heart transplant, there is no cure for heart failure.

Radiographic interventions to open the blood vessels for better blood flow and implantation of devices to reduce the workload on the heart may also be considered in the treatment plan of heart failure.

The aim of therapy is to improve the quality of life while also lengthening life by stoping or reducing the progression of heart failure. Treatment options differ from case to case and the extent to which the disease has progressed.

What lifestyle modifications can be made to prevent the progression and improving the general condition of those with heart failure?

It is very important for patients with heart failure to decrease the sodium content in their diet and also, their liquid intake. This is important because heart failure patients often retain a lot of water leading to the swelling of the ankle and feet, periorbital swelling, and sometimes, the fluid even collects in the lungs or the abdominal cavity called pleural effusion and cardiac ascites respectively. These complicate the existing conditions and require invasive therapeutic approaches.

Staying physically active and losing weight, if overweight, is also recommended for heart failure patients.

And you mentioned medications to treat heart failure, what medications can be given and how do they help exactly?

Often, several medications are prescribed for the management of heart failure. One class of drugs is ACE inhibitors which help dilate or open up your blood vessels, making it easier for the heart to pump blood. If the patient develops a chronic, dry cough with ACE inhibitors, they may be prescribed ARBs which work similarly to ACE inhibitors without the side effects.

Patients are also prescribed diuretics to help reduce water retention in the body, hence relieving the breathlessness or the ankle swelling the patient may have.

Another important drug class to be prescribed is beta-blockers which slow down your heartbeat to protect it from the effects of adrenaline in the body.

Does the use of any of these drugs predispose the patients to the COVID-19?

No, not at all. As of now, there are no studies proving that the use of heart failure medication can increase the risk of contracting COVID-19. Heart failure patients should continue taking their medications as per their doctor’s orders and practice social distancing to keep themselves safe.

That’s great to hear. Are there any new studies being performed to find better treatment options for these patients?

That is a great question, thank you. Continuous researches and studies are being conducted to not only develop new drugs and treatment options for heart failure but also to assess if drugs approved for other medical conditions may be of use in managing heart failure symptoms.

In fact, in May of this year, 2020, the FDA approved a drug called Farxiga(dapagliflozin) for the management of heart failure with decreased ejection fraction. Farxiga belongs to the SGLT2 drug family and was initially used to control blood glucose levels and reduce the risk of heart failure in adults with diabetes and other cardiovascular disorders.

However, it was found that it can be used in the treatment of grade II-IV heart failure and is now being used to improve ejection fraction while halting the progression of heart failure.

That is great to hear. Thank you so much for taking the time to talk to us and teaching us so much about heart failure. I really understand this condition now, thank you.

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