The heart squeezes blood through the circulatory system and also relaxes to accept blood as it returns from the body and the lungs. Any disruption in the heart's ability to either squeeze (systolic dysfunction) or relax (diastolic dysfunction) can lead to failure of the heart to adequately pump blood, which is a disorder called congestive heart failure (CHF). This is different from a cardiac arrest, in which the heart actually stops beating.
Two kinds of congestive heart failure exist:
- Right-side heart failure, in which the heart cannot fill with enough blood
- Left-side heart failure, in which the heart does not have enough force to pump blood to the rest of the body
Often, heart failure is caused by coronary artery disease, in which a substance called plaque builds up in the arteries and makes it hard for blood to flow through the vessels to the heart muscle. As a result, the heart compensates by working at a higher pressure within its chambers. Higher pressures inside the heart can lead to substantial symptoms.
- Ischemia, heart attacks or poor blood flow to the heart
- Valve leakage or valve obstruction
- Viral or bacterial infection
- Family history of heart failure
- Alcohol abuse
- Drug use, including cocaine
- Idiopathic, meaning an unknown cause
- Decline in exercise capacity
- Shortness of breath
- Chest discomfort
Medications are often considered the first line of therapy for patients with CHF. Medications used to improve the heart's function and the patient's ability to function normally include:
- Ace inhibitors
- Beta blockers
- Aldosterone blockers
- Diuretics or ultrafiltration for fluid removal
- Inotropic medication (medications that increase the squeezing capacity of the heart)
As our physicians manage patients through various treatment strategies, we depend heavily on integrating our CHF team of specialists, which includes:
- Cardiologists who cover the fields of heart failure transplantation, imaging, congenital heart disease, vascular disease and pulmonary hypertension.
- Cardiac surgeons with experience in revascularization, valve repair and replacement, as well as advanced mechanical support (VADs) and transplantation.
- Heart failure nurses and nurse practitioners
- Physical therapists
- Research coordinators
- Social workers
Ventricular Assist Devices
In some cases, despite aggressive therapies, the heart muscle cannot adequately sustain the body's circulation. In those situations, advanced cardiac support, in the form of ventricular assist devices (VADs) or transplantation, may be considered in appropriate candidates.
VADs can be used as a bridge to support patients awaiting heart transplantation or as destination therapy for some select patients who are not candidates for cardiac transplantation. VADs often allow patients to regain much of the functional capacity that they have lost to heart failure.
If coronary artery disease is contributing to the heart's dysfunction, the team may consider coronary bypass surgery (CABG). If prior heart attacks have damaged key walls of the heart, surgical reconstruction or new devices may be also be used to improve heart function. If one or several of four heart valves are exacerbating the heart's dysfunction, surgical or percutaneous valve repair or replacement may be considered.