Most common heart-related
conditions
- provided by America's leading
cardiologists
Heart Failure
Approximately 10 million people suffer from heart
failure a year, but this condition, which occurs
when the heart loses the ability to pump blood efficiently,
can be caused by a number of different conditions.
Select a program below to learn more about the many
causes of and treatments for heart failure.
What is Bypass Surgery?
Coronary bypass is a form of heart surgery
that uses new arteries to "bypass" and
replace clogged heart arteries. Tune in to learn
more about this important type of heart surgery.
Participants:
Lawrence I. Bonchek MD
Webcast Transcript:
ANNOUNCER: A coronary bypass is a type of heart
surgery that re-routes blood vessels around heart
arteries that have become clogged with cholesterol
build-up.
LAWRENCE I. BONCHEK, MD: Bypass surgery is done
in order to route blood around obstructions in the
coronary arteries, which are the arteries that supply
blood to the heart. They're actually very small
arteries, so it doesn't take a lot of cholesterol
buildup in the wall of the artery to block an artery
that size.
Surgeons will take a healthy blood vessel like
an artery from the chest wall or a vein from the
leg, and then connect the blood vessel above and
below the blockage to bypass it.
LAWRENCE I. BONCHEK, MD: There are two major ways
that bypass surgery is done nowadays, and people
will hear the terms off-pump and on-pump bypass
surgery. Traditionally, bypass surgery has always
been done with a heart-lung machine so that the
heart could be stopped and the lungs are not being
inflated, and the heart-lung machine is doing those
functions while the heart is absolutely stationary
to allow very precise, meticulous sewing while the
bypasses are being attached.
But in recent years, with advances in technology,
there have been pieces of equipment developed that
allow you to stabilize a small area of the heart
that you're working on, and to do the bypass operation
without the heart-lung machine. And that's known
as off-pump bypass surgery.
ANNOUNCER: Lifestyle modifications are important
after surgery so that the new blood vessels don't
become blocked as well.
LAWRENCE I. BONCHEK, MD: The most common lifestyle
modifications are correcting all the bad things
that people have been doing beforehand, such as
not smoking. They should lose weight. They should
watch the salt in their diet. They should eat a
healthier diet.
ANNOUNCER: Bypass surgery is still a major procedure,
but most people can be fully recovered and active
in as little as two months.
LAWRENCE I. BONCHEK, MD: My advice to anyone who
has had bypass surgery is to enjoy life, because
that's the purpose of having the surgery so that
they can get back to full and normal activity.
What is Ejection Fraction and Why is it Important?
How does the amount of blood you heart pump
affect your health? Get the facts about this key function
of the heart.
Participants:
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Webcast Transcript:
ANNOUNCER: In understanding how the heart works,
it important to know the meaning of the term "ejection
fraction."
ERIC MICHELSON, MD: The heart is a very effective
pump, and under normal conditions every time the
heart fills with blood, the pumping chambers, the
major chambers, the ventricles, eject that blood
into the major blood vessels. Ejection fraction
is a measure of the pumping function of the heart.
At rest, a normal person may have an ejection fraction
of approximately 55 percent. That means when the
pump is full and contracts, 55 percent of the blood
that was in the heart before it began to contract
is now ejected.
JACQUELINE NOONAN, MD: When you're not able to
maintain that normal level, it's usually because
your heart is not functioning well as a pump. Because,
remember, the heart is a pump. It's a muscle that
pumps blood and, when your ejection fraction is
low, it means the pump isn't working as well as
it should.
NANETTE KASS-WENGER, MD: The lower the ejection
fraction, the worse the pumping function of your
heart, and ejection fractions lower than 30 or 35
percent have a number of adverse consequences on
your health.
What Does it Mean to Have a Low Ejection Fraction?
An ejection fraction is a measurement of
the amount of blood pumped out of the heart with each
beat. Find out what the experts say are normal and
below normal numbers.
Participants:
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of
Maryland, Baltimore, MD
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Webcast Transcript:
ANNOUNCER: Ejection fraction is the measure of the
amount of blood pumped out of the heart during each
beat.
MANDEEP MEHRA: An ejection fraction less than 35
percent refers to what we call severe to moderate
left ventricular dysfunction, and this is essentially
a decline in the pumping capacity of the heart that
qualifies a patient as being in the realm of what
is referred to as systolic heart failure.
ERIC MICHELSON, MD: Normally, the ejection fraction
at rest, sitting quietly, might be a number of approximately
55 percent. Patients who have had some damage to
the heart will have an ejection fraction often that's
some number less than that 55 percent. Many patients
often remain asymptomatic or only minimally symptomatic
when the ejection fraction might be even 40 or 45
percent. Typically, as the ejection fraction begins
to drop below a number such as 40, many more patients
are typically symptomatic, and patients whose ejection
fraction is less than 35 percent more often than
not will not be able to do all the things they'd
previously been able to do. It might be such patients
have easy fatigability. They may have shortness
of breath. They may even have difficulty sleeping
at night.
ANNOUNCER: Although most patients don't know if
their ejection fraction is low, it is important
to consult a physician if you have health concerns
or risk factors related to heart disease.
ERIC MICHELSON, MD: So patients who have cardiovascular
risk factors or conditions and begin to develop
symptoms such as easy fatigability, inability to
do the activities that they usually do with having
some symptoms, being short of breath, having trouble
sleeping, seeing that their ankles are swollen,
such patients should not just assume it's part of
the normal everyday aging process, but should seek
medical attention.
NANETTE KASS-WENGER, MD: The patient who has a
low ejection fraction at times may be completely
free of symptoms, have a perfectly normal exercise
tolerance, not have shortness of breath, and these
are the patients where we as clinicians are challenged
to make the diagnosis, because these are the patients
where the institution of appropriate medical treatments
has the likelihood of preventing the progression
of the disease or preventing adverse consequences.
What Conditions Can Lead to Heart Failure?
Heart failure affects approximately 5 million
people in the United States. It can be caused by a
number of conditions and treatment options may vary
depending on the cause.
Participants:
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of
Maryland, Baltimore, MD
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: Heart failure affects approximately five
million people in the United States. It can be caused
by a number of conditions and treatment options
may vary depending on the cause
MANDEEP R. MEHRA, MBBS, FACC: The two most common
conditions that lead to heart failure in the United
States, and perhaps worldwide, are high blood pressure
and the development of coronary artery disease.
Thus almost any risk factor that is associated with
the development of coronary artery disease will
also typically be a risk factor for the development
of heart failure. For example, smoking, poor lifestyle,
diabetes, obesity. Even a family history of heart
disease is a very, very important risk marker or
a risk factor for the future development of heart
failure.
ERIC L. MICHELSON, MD, FACC: Patients who had previous
heart attacks due to blockage of coronary arteries
is another very common reason.
There are a number of other causes, all with relatively
small proportions of patients having those conditions,
and many of these we sort of lump together and call
idiopathic, because by the time the patient gets
to us, we're not quite sure which one of these may
have been the specific cause.
JACQUELINE A. NOONON, MD, FACC: It's possible to
develop heart failure from severe anemia, because
your heart has to beat so hard and to try to make
up for the low hemoglobin in your blood.
You can have heart failure if you're born with
heart disease. Children with large holes in their
heart can develop heart failure.
Then there are things that can happen. You had
a normal heart, but then you got an infection. You
got what's called myocarditis. That could cause
heart failure.
You could be born with a tendency to develop what
we call a cardiomyopathy and, again, that might
not show up. Might show up when you're a child,
but sometimes it doesn't show up until you're an
adult.
So there are many, many causes of cardiac failure.
And it's important to find out what the cause is
because the treatment may differ, depending on the
cause.
Are There Any Dietary Restrictions Needed When I Have Heart Failure?
If you have heart failure it's important
to follow a heart healthy diet. Join experts as they
discuss recommended dietary restrictions necessary
to keep your heart pumping.
Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of
Maryland, Baltimore, MD
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: What you eat is your choice and if you
have heart failure it's important to choose wisely.
While some foods are heart friendly others can do
more damage than good, so you should know your limitations
MANDEEP R. MEHRA, MBBS, FACC: There are a number
of dietary restrictions that a patient with heart
failure should follow. And foremost in them is the
need for salt in their diet. A patient should know
the salt content of almost every dietary food that
they are exposed to. It is very vital that they
understand how to read the labels on canned food
items, for instance, because one will be surprised
by looking at many of these labels as to how much
salt is contained in many of these foods. For example,
chicken broth is loaded with salt. Chinese food
is very, very, very rich in salt, and one has to
be very careful with their diet.
JACQUELINE A. NOONON, MD, FACC: When you have heart
failure, you can collect fluid called edema and
that is promoted more if you take too much salt.
Now, today, we have many more drugs that help to
get rid of fluid. We have diuretics; those are drugs
that will help the body get rid of excess fluid.
But this is something that the doctor will talk
to you, depending on your particular kind of heart
failure, how much salt and how you need to adjust
your diet to make the best treatment for your heart
failure.
How Do I Manage My Fluids and Salts if I Have Severe Heart Failure?
One of the most important ways of managing
moderate to severe heart failure is to control fluid
and the salt content in your diet. Tune in to find
out how.
Participants:
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of
Maryland, Baltimore, MD
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: If you or a loved one has moderate to
severe heart failure you know how important it is
to maintain a heart healthy diet. One key step is
to limit the amount of salt you consume. Too much,
can cause the body to retain fluid causing high
blood pressure which puts added strain on the heart
MANDEEP R. MEHRA, MBBS, FACC: One of the most important
ways of controlling heart failure is by controlling
the fluid and the salt content in your diet. One
should restrict their sodium content to under two
grams a day if they have severe heart failure. But
it becomes very, very difficult for a patient to
adhere to that guideline. We typically recommend
not adding any additional salt to diet.
NANETTE K. WENGER, MD, FACC: I send my patients
to a dietitian. Of course, it's no fun to eat food
that doesn't taste good, and a good dietitian can
show patients what can be done instead of salt that
is perfectly safe in the setting of heart failure
and that makes food taste good. And in addition
to a number of herbs and spices, simple things,
like pepper, onion, garlic, lemon are perfectly
applicable.
MANDEEP R. MEHRA, MBBS, FACC: As far as fluids
are concerned, one must weigh themselves every day.
If their weights are increasing dramatically on
a day-to-day basis, that is a candidate patient
for very strict fluid restriction.
NANETTE K. WENGER, MD, FACC: Certainly, you have
to learn to restrict the amount of liquids to about
five small glasses a day, and that takes practice,
and that takes measuring.
ANNOUNCER: In addition, diuretics also known as
water pills, may be prescribed to flush out excess
sodium and water from the body. They help reduce
blood volume which lowers blood pressure.
With heart failure, adherence to medications is
crucial and being vigilant about what you eat and
drink is essential
NANETTE K. WENGER, MD, FACC: Again, the patient-
you--you have to know that if you use garlic, it's
garlic, not garlic salt. Garlic salt has sodium
in it. It's onion, not onion salt. You have to learn
how to read labels. Virtually all the prepared foods
are just loaded with sodium.
Many of the fast foods will give you your week's
sodium allowance in one meal. So you and a trained
dietitian are the best resource, because you are
responsible at home. I can't go home on your shoulder
and show you what to do with the fluids and the
salt. You must learn this part of your management.
Do Swollen Ankles Mean I Have Heart Failure?
Swollen ankles can be a symptom of heart
failure but swelling can also be a result of factors
unrelated to the heart so it's important to recognize
the difference.
Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of
Maryland, Baltimore, MD
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: One common symptom of heart failure is
edema which is swelling in the body due to fluid
buildup. Swelling can occur in the ankles, legs
and lower back.
JACQUELINE NOONAN, MD: Swollen ankles are common.
They're common in the summertime, they're common
when you sit with your legs down, if you've been
on an airplane. They also can occur in heart failure,
but the fact that you have swollen ankles does not
necessarily or probably very often really mean that
you have heart failure.
MANDEEP MEHRA: Swollen ankles can occur from a
variety of different things. There are some medicines
that can in fact result in swollen ankles. But when
you have a swollen ankle, it is critical that you
see a physician. It could be an insight into the
early development of heart failure. The physician
should be able to examine the patient and come up
with a differential diagnosis that tells them whether
these swollen ankles are really because of heart
failure, or do they represent a medication side
effect, for instance?
The information
published on this page has been provided by the
Heart Authority
in collaboration with Cardiosource – American College of Cardiology
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