Successful Strategies for Failing Hearts -- David O. Taylor, MD. -- 02/12/03

WebMD Live Events Transcript

Nearly 5 million Americans live with heart failure, and millions more are at risk of developing this complex condition. But living with heart failure doesn't always mean you have to march to a slower beat. We talked about getting your heart and your life back up to speed with Cleveland Clinic cardiology expert David O. Taylor, MD.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello Dr. Taylor. Welcome to WebMD Live. Can you get us started by defining heart failure?

Taylor: Sure. Heart failure simply means that the heart is unable to pump an adequate amount of blood for the body's demand. It's very different from a heart attack where the blood supply to the heart has been interrupted. A heart attack can cause heart failure but heart failure can be caused by many other diseases.

Moderator: What are the common symptoms of heart failure?

Taylor: The common symptoms of heart failure include shortness of breath, fatigue, weakness, dizziness, fluid retention, such as ankle or leg swelling, or rapid heart beats.

Moderator: What are the lifestyle changes a patient can make to improve life quality while living with heart failure?

Taylor: There are many things you can do to improve your quality of life with heart failure.

  • The most obvious is to carefully follow the dietary and medical regimen that you have been prescribed, in order to maximize heart function.
  • In addition, it is very important to maintain as active a lifestyle as possible. The WebMD site has a host of useful advice. One can get involved in a formal exercise program, typically called cardiac rehabilitation, where activities can be gradually increased, leading to improved exercise tolerance.
  • Plan your day so that you do not become excessively tired. Conserve energy for activities that you know are coming up.
  • Do not become homebound, as this will often lead to worsening of the heart failure syndrome by decreasing activities and, of course, can lead to depression.

We have many heart failure patients who, with careful management, have been able to return to a very active lifestyle.

Moderator: Can you discuss some of the available surgical treatments for heart failure?

Taylor: Sure. Many surgical options are evolving for the treatment of heart failure:

  • Bypass surgery, or valve surgery, for patients with coronary heart disease or heart valve disease. It was once thought that patients who have already developed heart failure were too ill to benefit from heart surgery. We now know that to be incorrect. Even patients with severe heart failure may benefit from bypass surgery or valve surgery.

  • Several new experimental surgeries are being studied. These may include repairing the heart muscle, injecting muscle cells into the scar, or changing the size or shape of the heart.

  • In addition, mechanical heart pumps are continuing to improve such that in the very near future, they will be another option for patients with severe heart failure that does not respond to the usual heart failure treatments.

  • We should not forget about heart transplantation, which is an excellent surgical option for some patients. However, it is limited by the availability of suitable donor organs. We only perform just over 2,000 transplant procedures each year in the U.S., but at least 20,000 or more patients in the U.S. could benefit from the procedure if we had enough suitable hearts available.

  • Another new, somewhat surgical procedure for the treatment of heart failure is pacemaker therapy. It was discovered that pacing both the left ventricle and right ventricle simultaneously improves heart function in some patients with heart failure. In addition, the defibrillating pacemakers also are helpful to treat electrical events within the heart and likely improve survival in many patients with heart failure.

Member: Hi, Dr. Taylor. I'm a 40-year-old male diagnosed with ventricular tachycardia, possibly right outflow tract VT. The only symptoms I'm aware of occurred when I was running as part of my exercise routine. I experienced heart rates in excess of 220 beats per minute, and felt sluggish, but no pain or shortness of breath to speak of. I've stopped running per the cardiologist's advice and am taking 50 mg of toprol. I suppose I'm tolerating it well. I'm having trouble grasping the seriousness of my condition since I don't "feel" anything. Can you help me put the seriousness in context?

Taylor: This is an excellent question about a very unusual disease. This, in particular, is not related to heart failure but related to cardiac rhythm disturbances. This form of ventricular tachycardia, in general, is not associated with severe underlying cardiac abnormalities such as heart attacks or cardiomyopathy. Nonetheless, this can be a serious entity because the tachycardias can cause loss of consciousness. Unlike tachycardias that can arise from a severely diseased heart, right ventricular outflow tract tachycardias can often be treated with medications successfully. It is important to continue on the prescribed medications and receive close follow-up with the cardiologist.

Member: I am retaining water because of heart failure. I am using lasix to help. Are there any liquids I can drink to help me urinate? I want to reduce the use of the lasix, as I understand it damages the kidneys over time. Any advice you offer is greatly appreciated.

Taylor: Excellent question. This question is common in heart failure. Lasix or other diuretics are commonly given for heart failure. There has been concern about their effects on the kidneys; however, the effects of heart failure on the kidney are probably greater than the effects of the diuretic. Diuretics primarily remove sodium from the body and water simply follows. If one is careful with the daily salt intake, one would require fewer diuretics.

In regards to the question about the types of liquids, remember that all liquids are water plus some other components. For example, orange juice is water with orange pulp and a variety of other minerals. Most physicians feel that fluids should be somewhat limited in intake and I, generally, recommend that heart failure patients limit their total daily fluid intake to no more than two to three quarts per day. That would include all beverages, including ice and fruits and soups, etc.

If one can carefully restrict the salt in the diet, one can successfully manage the fluid balance with appropriate doses of diuretics. Once again, I would stress that the damage done to the kidneys by heart failure would be much worse than the potential damage done by the diuretics.

Member: My grandmother is 83 and has heart failure. She is in a nursing home and isn't very active. She's on diuretics, but still swells. Should we be worried?

Taylor: Excellent question. Sometimes when patients are less active, the swelling, or edema, can be greater than expected. Diuretics do not always remove all of the edema. Edema, by itself, rarely causes severe complications. So, if the patient is relatively free of other symptoms, such as severe shortness of breath or abdominal distention and discomfort, the presence of residual edema is acceptable.

Member: My 80-year-old mother had a quadruple bypass and later had stents. She adjusted her diet to eliminate as much sodium as possible because her doctor wanted her to lower her blood pressure. Now her blood pressure is too low and they want her to add sodium in her diet. How will this affect her heart?

Taylor: Remember that the body requires some amount of sodium for normal functioning. It is only when we ingest excess amounts of sodium or we have certain diseases that interfere with our kidney's ability to appropriately balance the sodium. While it is important to limit sodium intake for patients with heart failure and high blood pressure, not all patients require sodium restriction. Therefore, if the physician instructed increased sodium intake, it is likely that he or she felt that the patient was somewhat sodium-depleted. If you become sodium-depleted, it causes generalized dehydration and that can lead to low blood pressure.

Member: Will strength training exercises help the heart to become stronger or will it stress the heart muscle further causing it to work harder?

Taylor: This is one of the most common questions that I get in clinic every day. With heart failure, exercise training likely does not directly improve the strength of the heart. However, there are many studies that show that exercise programs that improve exercise tolerance, indirectly improve heart function. This is accomplished by improving muscle tone, muscle activity, respiratory function, and blood pressure regulation. These factors combine to allow the heart to function at a better level. However, exercise training with heart failure should begin at a very low level and slowly progress upward. The target exercise protocol would include 30 to 45 minutes per day, five to seven days per week at low level so that one can exercise the entire time, comfortably. My general rule is that one should be able to talk and walk at the same time. If one cannot carry on a conversation while exercising, one is exercising at too intense a level.

Member: Does aspirin help prevent heart failure or just heart attacks?

Taylor: Very good question. While aspirin is very helpful in preventing first and second heart attacks, we really have little info on its role in heart failure progression. However, because coronary heart disease accounts for two-thirds of all heart failure, aspirin is very helpful. We often give aspirin in patients with heart failure who cannot take other blood thinning agents to reduce the risk of strokes or pulmonary blood clots. However, many patients without coronary heart disease or risk factors for blood-clotting or strokes do not need to take chronic aspirin.

Member: Is aspirin just as effective as the prescription blood thinners? Or are the prescription types preferable?

Taylor: If one is talking about the prevention of blood clots in patients who have never had a blood clot or are not at high risk or blood clots, we do not know the answer. There are research trials ongoing to address the question of prescription blood thinners, such as Warfarin, when compared with aspirin for heart failure patients. However, if one is talking about aspirin or Warfarin for patients who have atrial fibrillation, then prescription blood thinners appear to be more effective. You should discuss this issue in detail with your physician since the answer very much depends on your unique situation.

Member: Can heart failure be brought on by aortic stenosis?

Taylor: This is a very good question; in fact, aortic stenosis can cause heart failure. Heart failure simply means the inability of the heart to adequately pump blood to the body. When the aortic valve becomes stenosed, or severely narrowed, the heart is unable to adequately inject the blood. A syndrome occurs which is indistinguishable from the heart failure syndrome caused by heat attacks or hypertension. If the heart failure is severe, the treatment of choice is replacement of the narrowed aortic valve. This surgery alone is often enough to relieve the heart failure syndrome.

Member: What are your experiences with EECP, if any, and what do you think the future holds for this therapy?

Taylor: EECP is a technique where large cuffs are inflated over the legs and abdomen to coincide with the heartbeat. There have been some research studies to suggest that it may be helpful in heart failure. However, at this time we do not have enough info to recommend that it would be helpful for all heart failure patients.

Member: What would cause my child's heart to increase in size on one side? He is 23. Is this part of heart failure? He has a leaky heart has well.

Taylor: What you describe could be a cardiac condition that may lead to heart failure. I am unable to tell by your description exactly what his heart problem is. I would recommend that you speak with his physician and clarify exactly what his heart abnormality is.

Member: What is the risk of heart failure after getting a viral infection? I'm thinking of Jim Henson of the Muppets.

Taylor: We think that many cases of heart failure are caused by viral infections. However, this cause is very small when compared to all of the other causes of heart failure, such as coronary heart disease, diabetes, and hypertension. However, it is known that some viral infections can lead to heart failure. But many millions of Americans have viral infections at any given time and very few will go on to develop heart failure from them. It is probably not just the virus that causes the heart failure, but the body's response to that virus. It is very much like an autoimmune disease. I would not worry particularly about your individual risk of getting heart failure after a viral infection because the odds of that are extremely low. We should worry more about the common risk factors for heart failure, such as high blood pressure, coronary heart disease, diabetes, and obesity.

Member: I was brought up on the traditional meat and potatoes and big breakfasts, just like many Americans were. I have a terrible time trying to get into a mode of non-fat. My cholesterol is fine but my heart is weak, enlarged, and has only an ejection fraction of 30%. Can you recommend a good cookbook that will not be filled with strange things that my husband and I won't both turn our noses up at? Any ideas appreciated. We could both stand to lose weight and our daily diet would help a lot.

Taylor: I would refer you back to the WebMD Health site for dietary recommendations. In addition, the American Heart Association web site contains useful dietary information.

Moderator: Check with dietitian Elaine Magee on her WebMD message board.

Member: My wife is 80 and has had COPD for a long time. In the last six months she has started to get periods of atrial fibrillation about once a month and lasting about four hours. I give her an aspirin each time. What else should we be doing?

Taylor: Atrial fibrillation is common in patients with COPD, hypertension, and coronary heart disease. The treatment of atrial fibrillation depends on many factors, including cardiac function. I would encourage you to discuss this with your physician or cardiologist because there maybe other treatments available to present the episodes if they cause they significant symptoms. However, the benefit of taking single aspirins with each episode is unclear to me. One should take aspirin each day on a regular basis for the full effect. One should discuss this in detail with one's personal physician who is familiar with the details of your case.

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to Dr. David Taylor, and thank you members for joining us today. For more information, please check out the information at the Heart Disease Center on WebMD. Talk with others on our heart related message boards.

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