For the next 11 months, the Fellows will be focusing on heart failure. It’s a condition that providers have difficulty explaining and patients have trouble understanding. Here’s your 60 second crash course.
Contrary to what its name suggests, heart failure does not mean that the heart is in imminent danger of ceasing to beat. Rather, the heart cannot pump enough blood to meet the body’s needs.
There are two types of heart failure, split about 50:50 in prevalence: systolic and diastolic. Systolic heart failure means weak, floppy heart muscle — it’s unable contract to pump enough blood. Diastolic heart failure means stiff heart muscle — it can’t relax to suck in and refill with enough blood. Both of these lead to insufficient flow of blood to the body.
The body is programmed to misinterpret this insufficient flow as a sign of an inadequate quantity of blood — the body thinks it’s bleeding to death. To remediate, it attempts to increase the amount fluid in the body.
Reflexes in the body release hormones to induce thirst and to retain sodium and water. More fluid to pump means more work for the heart — work that it isn’t able to manage. The result is fluid build-up or congestion. This can be quite dramatic, and patients can have as much as 70 pounds of excess fluid in the body.
The first sign of fluid build-up is rapid rise in body weight. Symptoms that follow are dizziness/weakness, swelling in the abdomen, legs, and feet (as fluid builds up in the body), and shortness of breath (as fluid builds up in the lungs). Those with heart failure are likely to feel that their shoes and pants are tighter and will need to prop themselves up on extra pillows to sleep due to suffocation from congestion.
If a patient is holding too much sodium and water there can be a massive fluid build-up. Patients have to act quickly to reduce fluid and are advised to do one or more of the following:
Limit their sodium intake
Drink less fluid
Weigh themselves daily to monitor fluid build-up
Take prescribed medications (diuretics) that rid the body of excess fluid, reduce swelling, ease breathing, reduce work for the heart, or help the heart pump.
Take other medications that lower blood pressure and improve heart function making it easier for the heart to beat.
Remember: heart failure is not about heartbeat. It’s about the heart functioning as a suction pump, and being unable to pump enough blood to meet the body’s needs.