Help for Failing Hearts
May 17, 2001 (New York) -- Despite its ominous-sounding name, heart failure is an extremely treatable condition.
Twenty years ago, patients with heart failure were told to go home and settle their affairs. Now, thanks to currently available medications and surgeries, people with the condition can live more comfortable -- and longer -- lives if they recognize the signs of heart failure and seek help.
And experimental drugs, surgical techniques, and devices on the horizon soon may offer even more relief to both the five million people in the U.S. with heart failure and the additional 15-20 million who are at risk because they have heart disease, which impairs their heart's pumping action. Experts recently discussed advances in treating heart failure at an American Medical Association meeting on heart disease in New York City.
Congestive heart failure occurs when the heart can't pump enough blood to meet the needs of the body's other organs and is caused by many factors, including narrowed arteries, high blood pressure, or a congenital heart defect. The "failing" heart keeps working but doesn't work as efficiently as it should. As a result, people easily become short of breath and tired, even after little exertion.
Heart failure also causes swelling in the belly and around the ankles and feet because blood flow out of the heart slows and blood returning to the veins backs up.
"A lot of people attribute these symptoms to other processes, like aging," says Milton Packer, MD, a professor of medicine and of pharmacology at New York's Columbia University College of Physicians and Surgeons. But "if you have these symptoms, recognize that they may be due to heart failure. And don't panic because there are a lot of very effective treatments."
As many as one in 10 people older than 65 have heart failure, says Packer, who is also the director of the Center for Heart Failure Research and chief of the division of circulatory physiology at Columbia-Presbyterian Medical Center in New York City.
To diagnose heart failure, doctors will review the patient's medical history, perform a physical examination, take an X-ray of the heart, measure the heart's activity with an electrocardiogram, and perform a noninvasive ultrasound scan of the heart -- a test called an echocardiogram, or ECG.
Once diagnosed, heart failure is treatable.
"We use four drugs in combination to ease symptoms, slow the progression of disease, and extend the lives of 80% of heart failure patients," Packer says.
This drug cocktail includes Digoxin to increase the heart's pumping action; diuretics, or water pills, to help the body eliminate excess salt and water; ACE inhibitors to expand blood vessels, allow blood to flow more easily, and make the heart work more efficiently; and beta-blockers to improve the function of the heart's left ventricle. Beta-blockers also block a natural stress hormone capable of damaging the heart. Blocking this hormone gives the heart a chance to recover and helps prevent continued injury.