My middle-aged patient was both confused and concerned. “I don’t know what the deal is; I can barely make it the hundred yards to my mailbox and back without huffing and puffing and stopping to rest. And I’ve never been a smoker, so what’s the deal?”
As it turned out, after a full work-up, the deal was heart failure. Simply put, heart failure is when the pumping ability of the heart weakens to where it can’t readily keep up with the demands of the body. It affects nearly 6 million Americans of all ages and is responsible for more hospitalizations than all forms of cancer combined. In fact it is the number one cause of hospitalization for patients 65 years and up. Nearly 50% of heart failure patients will die within 5 years of their diagnosis.
What causes heart failure? There is quite a list of factors that can contribute: everything from blocked coronary arteries, diabetes, high blood pressure, heart valve abnormalities, infections and inflammations, toxins (such as excess alcohol) and certain genetic tendencies. Often a heart which has been weakened a bit by one or more of these factors is pushed into symptomatic failure by excess salt intake, uncontrolled high blood pressure, a new heart rhythm disturbance such as atrial fibrillation, a heart attack or some serious infection.
Initially heart failure may show no symptoms at all. However eventually a person may experience a long list of symptoms including shortness of breath with minor exertion or with laying down flat, rapid heart rate, tiredness, puffy ankles, chest pain or heart palpitations.
If you were to experience some of these symptoms and present to your doctor, several things could be done to help diagnose whether you had the beginnings of heart failure. Of course a thorough description of the course of your symptoms including what makes them better or worse would be undertaken. Likewise a physical exam (with particular focus on the heart, lungs, and blood vessels), blood tests, an EKG and tests such as a chest x-ray and echocardiogram would likely be ordered to assess the heart’s function.
What if in the end you did indeed have the beginning of heart failure? You would then be given an idea of how advanced your heart failure was and a treatment plan would be put in place. Certain lifestyle recommendations such as a low salt diet, quitting smoking or excess alcohol, avoiding certain meds such as NSAIDs (ibuprofen, naproxen), and aiming toward an ideal body weight and modest exercise would be discussed. Likewise, there are a few meds that have been shown to be beneficial in certain types of heart failure and these would likely be started. Risk factors such as high blood pressure, high cholesterol and diabetes would need to be carefully controlled.
Of course to pursue a healthy lifestyle to avoid the factors that lead to heart failure would be best of all. But if in spite of that you or someone you love start showing symptoms of possible early heart failure, have it checked out; the earlier you start treating it with both lifestyle and appropriate meds the better your precious heart is likely to do.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835