Advanced Heart Failure and LVAD
University's Advanced Heart Failure Center
1350 Walton Way
Augusta, GA 30901-2629
Hours: 8 a.m.-4:30 p.m.
The Advanced Heart Failure Clinic at University Hospital's Heart & Vascular Institute is a multi-disciplinary team of physicians and clinicians that works together to create an individualized treatment program for those with heart failure.
Heart failure is a condition in which the heart does not pump enough blood to meet the needs of the body's tissues. It can have a number of causes. Heart failure can develop slowly over time as the result of other conditions (such as high blood pressure and coronary artery disease) that weaken the heart. It can also occur suddenly as the result of damage to the heart muscle or an acute valve problem.
Common signs and symptoms of heart failure include:
- Shortness of breath
- Wheezing or cough
- Fluid retention and weight gain
- Loss of appetite
- Abnormally fast or slow heart rate
Treatment for heart failure depends on its severity. All patients need dietary salt restriction and other lifestyle adjustments, medication, and monitoring. Patients with severe heart failure may need implanted devices (such as pacemakers, implantable cardiac defibrillators, or devices that help the heart pump blood) or surgery, including heart transplantation.
Heart failure is classified into four stages (Stage A through Stage D) that reflect the development and progression of the condition. Treatment depends on the stage of heart failure.
Stage A is not technically heart failure, but indicates that a patient is at high risk for developing it. In Stage B, the patient has had damage to the heart (for example, from a heart attack), but no symptoms of heart failure. In Stage C, heart failure symptoms manifest.
Stage D is advanced heart failure accompanied by symptoms that may be difficult to manage with standard drug treatments and may require more technologically complex care (defibrillators, mechanical pumps, heart transplantation). The American Heart Association (AHA) emphasizes the importance of a patient-centered approach to treatment decisions. Patients with advanced heart failure should have ongoing honest discussions with their health care providers concerning their personal preferences and quality of life goals.
Management of Risk Factors and Causes
Description of Heart Failure
Heart failure is a clinical syndrome, not a single disease. The heart doesn't "fail" in the sense of ceasing to beat (as occurs during cardiac arrest). Rather, inefficient pumping can be caused by a number of factors.
In classic heart failure, the heart muscle weakens, sometimes acutely (as with a big heart attack) or it weakens over the course of months or years, so that it is unable to pump out enough of the blood that enters its chambers. As a result, fluids build up in the lungs and tissues, causing congestion. This is why heart failure is also sometimes referred to as "congestive heart failure." Other abnormalities can also cause heart failure. Some of them will be described below.
Ways the Heart Can Fail
Heart failure can occur in several ways:
- The muscles of the heart pumps (ventricles) become thin and weakened. They stretch (dilate) and cannot pump the blood with enough force to reach all the body's tissues. This often happens because of coronary artery disease with or without a history of heart attacks. It can also occur as a result of a viral infection, or from drug use (certain prescription or illicit drugs), or the cause may remain unknown (idiopathic).
- The heart muscles become stiff or thick. They lose elasticity and cannot relax. Insufficient blood enters the chamber, so not enough blood is pumped out into the body to serve its needs. The most common reason for this is aging and a long history of high blood pressure (hypertension).
- Sometimes the valves of the heart are abnormal. (Valves open or close to control the flow of blood entering or leaving the heart). They may narrow, such as in aortic stenosis, causing a back-up of blood, or they may close improperly so that blood leaks back into the heart. The mitral valve (which regulates blood flow between the two chambers on the left side of the heart) often becomes leaky in severe heart failure -- a condition called mitral regurgitation.
- The mechanisms that the body uses to compensate for inefficient heart pumping can, over time, change (remodel) the architecture of the heart and finally lead to irreversible problems.
- Heart failure's specific effects on the body depend on whether it occurs on the left or right sides of the heart. Over time, in either form of heart failure, the organs in the body do not receive enough oxygen and nutrients, and the body's wastes are removed slowly. Eventually, vital systems break down.
Failure on the Left Side (Left-Ventricular Heart Failure)
Failure on the left side of the heart is more common than failure on the right side. The failure can be a result of abnormal systolic (contraction) or diastolic (relaxation) action:
- Systolic. Systolic heart failure is a pumping problem. In systolic failure, the heart muscles weaken and cannot pump enough blood throughout the body. The left ventricle is usually stretched (dilated). Fluid backs up and accumulates in the lungs (pulmonary edema). Systolic heart failure typically occurs in men between the ages of 50 to 70 years who have had a heart attack.
- Diastolic. Diastolic heart failure is a filling problem. When the left ventricle muscle becomes stiff and cannot relax properly between heartbeats, the heart cannot fill fully with blood. When this happens, fluid entering the heart backs up. This causes the veins in the body and tissues surrounding the heart to swell and become congested. Patients with diastolic failure are typically women, overweight, and older people, and have high blood pressure and diabetes.
To help determine the severity of left-sided heart failure, doctors use an ejection fraction (EF) calculation, also called a left-ventricular ejection fraction (LVEF). This is the percentage of the blood pumped out from the left ventricle during each heartbeat. An EF of 50-75 percent or so is considered normal. Patients with left-ventricular heart failure are classified as either having a preserved EF (greater than 50 percent) or a reduced EF (less than 50 percent).
Patients with preserved LVEF heart failure are more likely to be female and older and have a history of high blood pressure and atrial fibrillation (a disturbance in heart rhythm). They may also have some of the other risk factors listed above.
Failure on the Right Side (Right-Ventricular Heart Failure)
Failure on the right side of the heart is most often a result of failure on the left. Because the right ventricle receives blood from the veins, failure here causes the blood to back up. As a result, the veins surrounding the heart fill up with blood and fluid. This fluid is pushed out into the body's tissues and causes swelling in the feet, ankles, legs, and abdomen. Pulmonary hypertension (increase in pressure in the lung's pulmonary artery) and lung disease may also cause right-sided heart failure.