What is heart failure? There is no simple answer when it comes to this complex condition. With approximately 550,000 new cases diagnosed in the U.S. each year, it touches the lives of millions of people of all ages. Advanced heart failure specialist Sandra Chaparro, M.D. joins host, Dr. Jonathan Fialkow to explore causes, symptoms and treatments on this episode of Baptist HealthTalk.
For more information about COVID-19 please visit BaptistHealth-coronavirus.com
What is heart failure? There is no simple answer when it comes to this complex condition. With approximately 550,000 new cases diagnosed in the U.S. each year, it touches the lives of millions of people of all ages. Advanced heart failure specialist Sandra Chaparro, M.D. joins host, Dr. Jonathan Fialkow to explore causes, symptoms and treatments on this episode of Baptist HealthTalk.
For more information about COVID-19 please visit BaptistHealth-coronavirus.com
Announcer:
At Baptist Health, South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk Podcast, where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life. What is heart failure? There's no simple answer when it comes to this complex condition. Listen in as we explore causes symptoms and treatments on this episode of Baptist Health Talk.
Dr. Jonathan Fialkow:
Good day, and welcome to Baptist Health Talk Podcast where we work to bring you information about your health that you can use. I'm Doctor Jonathan Fialkow, a practicing cardiologist specializing in lipid disorders and prevention as well as Chief Population Health Officer at Baptist Health, South Florida.
Dr. Jonathan Fialkow:
With the continued pandemic, the majority of our attention and resources have been applied to COVID-19 related matters. Unfortunately, other medical conditions do not take a pause while the coronavirus rages. Congestive heart failure, or heart failure in the vernacular, remains one of the most common reasons for hospital admissions in the United States for people over 40 years old. One reason maybe people are living longer with heart disease, which over time can damage or weaken the heart muscle and lead to heart failure. To help us understand more of what heart failure is, what are the symptoms and signs of this condition, and what we can do to prevent it or decrease its consequences, as well as the conversation regarding what we're seeing in cardiology related to COVID-19 is one of our leading cardiology experts at Miami Cardiac and Vascular Institute, Doctor Sandra Chaparro. Doctor Chaparro is the medical director of advanced heart failure, and MCBI, and BHSF. Welcome to the podcast. Sandra,
Dr. Sandra Chaparro:
Thank you so much, Jonathan.
Dr. Jonathan Fialkow:
So Sandra, I mean, there's a lot obviously to unpack in heart failure and we don't want to get too far into the weeds, but for the layperson, what is heart failure? It's a broad term. So articulate when we choose the term heart failure as practitioners what are we thinking about? And what are we looking at?
Dr. Sandra Chaparro:
Heart failure is a chronic condition in which the heart doesn't pump enough blood. And therefore, it doesn't send the requirements, the nutritional requirements to the rest of the body. So that's the basic concept of heart failure.
Dr. Jonathan Fialkow:
So if someone has heart failure, and as you said, the heart's not able to pump enough blood to bring the body its nutrition, it's nutrients and oxygen, what are the symptoms? What are the signs? What do people... What do we look for as practitioners to say, you may have heart failure, or what can people look for to determine if they may be showing signs of heart failure?
Dr. Sandra Chaparro:
So the symptoms and the signs pretty much depend of which chamber of the heart is being affected. So there's a big range of symptoms and signs, and some of them are very [inaudible 00:02:48] specific. So some of them are for example, shortness of breath. So it's like when you exert yourself and then you don't feel like you're getting enough oxygen. Another one that is very common is fatigue. You don't have enough energy to do the regular activities. You feel weak. Another one is, for example, when you accumulate fluid, so you have what is called swelling or edema in your legs.
Dr. Sandra Chaparro:
Sometimes you can feel a rapid heartbeat or irregular heartbeat, palpitations. Sometimes it could be just cough. Sometimes it could be that you feel that your abdomen is getting bigger, that you feel that you are gaining weight without a specific cause. On the other hand, it could be that you are not eating well. You're losing weight because you have no appetite. Sometimes you have [inaudible 00:03:42]. Sometimes it's just lack of concentration. You don't have enough energy to be alert and you sleep a lot during the day or sometimes it could be the chest pain. So it could be a combination of all of these things.
Dr. Jonathan Fialkow:
So the things you mentioned, all of which are relatively common in people with heart failure, fatigue, shortness of breath when you exert yourself, swelling in the ankles, it's important to note more common... There are very common things that we do so symptoms that are not heart failure. So how can one differentiate that maybe I'm gaining weight because I'm eating poorly. Maybe I'm a little short of breath when I ran up the stairs, but I haven't exercised. We want to alert people to the signs and symptoms of heart failure, but we don't want to scare them into thinking every symptom is heart failure. So what should someone do if they think they have it or what are the general ways we would want people to differentiate what may be heart failure or something explained otherwise.
Dr. Sandra Chaparro:
So that's why it's so important to have a recommendation of some of the symptoms, but you have to have close communication with your provider. Your provider can tailor those symptoms and can address them with very simple tests. For example, with your physical exam, your history and your physical exam, that will give us an idea of what's the problem. And then you can move to an electrocardiogram and then an echocardiogram, which is the ultrasound of the heart. So those are the basic steps that any provider can take to figure out if what you have is heart failure.
Dr. Jonathan Fialkow:
So well said, it's not something an individual at home should diagnose themselves as having or not having, they should speak to their medical provider and have the discussion and feel reassured. In fact, because it very well may not be heart failure. On the other hand, if it is heart failure, the benefit of getting evaluated and treated early is recognized as well. So to that end what are the causes of heart failure? What are the more common reasons we see people developing heart failure?
Dr. Sandra Chaparro:
There are multiple causes. But it's important to emphasize that the most common cause of heart failure is coronary artery disease. What we mean is what we commonly say as a heart attack. So if the build of those plaques of fatty deposit in the arteries that reduce the blood flow to the heart muscle. But that's the most common one. There are some other ones, for example, high blood pressure, hypertension. So over time, that makes the hard weaker. Other areas of the heart that can affect the rest of the muscle could be when you have faulty heart valves, when the valves of the heart are not closing well, and the blood actually goes backwards in different direction that is supposed to and that makes the heart sometimes weak. Sometimes it could be related to just the muscle. So there are a lot of, for example, infections or toxins like alcohol, drugs, cocaine, sometimes chemotherapy that can affect the heart muscle. Sometimes it could be genetic factors and sometimes it could be an arrhythmia and still there are multiple reasons but the most common one, it's the coronary artery disease.
Dr. Jonathan Fialkow:
So as that's the most common and it remains prevalent in our society in our country, it speaks to the prevention aspects, which remain control your blood pressure, stay at a healthy weight. Don't smoke, follow your lipids. All the same recommendations which would decrease heart attacks, which can lead to heart failure, strokes, and other chronic conditions remain valuable to prevent heart failure as well. One, so now we have a patient who might have some of these symptoms, mild or more significant. The doctor recognizes this might be heart for failure. Either refers them to a cardiologist or does some testing. Finds it's heart failure, heart unable to provide the nutrition and oxygen sufficiently. So what are the general treatments for heart failure?
Dr. Sandra Chaparro:
So pretty much once someone have a weak heart, we need to investigate and find out what's the reason for that heart to be weak. So I'd say said the most common cause is the coronary artery disease. So the first step is to make sure there are not blockages that you can fix with a stent. At the same time, the patient will be on medical therapy, meaning a lot of medicines that will help with the heart getting stronger. And at the same time, we have to do a lot of life changes. For example, as you said, if you're smoking, you need to stop smoking. If you don't exercise, you probably need to be enrolled in a cardiac rehab program. Nutrition is part of that as well. So it's a team of experts and advanced providers and pharmacists that will help that specific patient get back into a normal, healthy heart condition.
Dr. Jonathan Fialkow:
So we try to treat the underlying causes of heart failure. And then when there's the heart failure status, we want to decrease these symptoms and the effects of that status as well to improve quality of life and keep people out of hospitals which is complicated. And it speaks to what you said. It's a team of people, obviously experts like you, the nurse practitioners, dieticians, exercise physiologists. You mentioned exercise very important for patients with heart failure. They can decrease their symptoms and help themselves with an exercise regimen. Pharmacist to make sure that the medications are being used appropriately.
Dr. Jonathan Fialkow:
But I think the take home point is get treated. Don't think it's going to go away. Don't take care of it yourself. There are lots of things we can take care... We can help people with. Two quick questions regarding this further before we move on to some COVID issues. The first is, can you speak about heart failure ejection fraction preserved heart failure with diastolic heart failure? We know that heart failure occurs when the heart muscle weakens but isn't it true there are situations where the strength of the heart muscle is not necessarily the cause?
Dr. Sandra Chaparro:
So that's a very interesting question. When the heart muscle is contracting well, but it's not relaxing well we still can have some of the symptoms of congestion. And so that shortness of breath, that fluid accumulation. Unfortunately, a lot of the therapies and technologies and advances that we have are for patients that have reduced ejection fraction, meaning the patients that have problems with the contractility. For the patients who have the preserved ejection fraction or the patients who have the relaxation problem, we have limited options. So what we mainly use is risk factor modification, management of blood pressure, management of arrhythmias, weight control, exercise, diuretics, medicines that make you pee. So you can reduce the amount of fluid in your lungs. And for example, a medicine called Aldactone that helps with what we call remodeling of the heart. So very limited in terms of options for this group of patients. And unfortunately, that's almost half of the patients in the United States.
Dr. Jonathan Fialkow:
So are there differences in heart failure risk or the cause of heart failure by age, race, gender? Meaning everyone should be treated as an individual, of course, but do we see trends in populations that might place one at higher risk for heart failure than somebody who doesn't have the same, a demographic?
Dr. Sandra Chaparro:
Yes. So patients who are older, they tend to develop more heart failure over time and patients, for example, with hypertension. And so obviously the patients that don't have access to healthcare, to management of these preventable causes are the ones that in the long term are going to have the consequences of heart failure. So for example, African American patients, Hispanic patients, Latino patients that don't have access to a lot of services will eventually... Like for example, diabetes management, obesity, tobacco cessation, all these things eventually will lead heart failure. So those demographics are a higher risk.
Dr. Jonathan Fialkow:
Right. It makes sense. It's unfortunate. Switch gears a little bit. So what is an advanced heart failure expert? You were highly accomplished and highly recruited to join Miami Cardiac and Vascular Institute. Explain a little bit what the advanced component is.
Dr. Sandra Chaparro:
So what we do is we compliment what is already in place. So a regular cardiologist would do the screening part and they usually will put you on some of the heart failure medicines. And when that patient is not improving and is still having symptoms, that's when we actually go in as a heart failure specialist. So we have different tools and also have different type of knowledge that will allow us to push the medicines. [inaudible 00:13:14] trade the medicines to the max and add some of the technology that is available. There's a point where a lot of the medicines would not work and that's when we have to move to work with called advanced heart failure therapies. So we would use intravenous medicines and sometimes we have to use mechanical pump devices. Sometimes those devices are temporary devices. Sometimes those are longterm devices. Sometimes these patients will live the rest of their life with these devices to improve their quality of life and their survival. And a small number of patients will require transplantation. So we add to the amount of things that we can offer to the patient. That's what the heart failure expert does.
Dr. Jonathan Fialkow:
So that's well said. Not everyone with heart failure needs advanced heart failure modalities, but if the general cardiologist can't improve the symptoms further, there are ways to escalate that patient's care and provide support and benefit through your efforts and the offense of our team. So thank you. Thank you for that answer. Couple quick questions about COVID, which is certainly timely. You've given excellent presentations across our system regarding the cardiovascular consequences of COVID, but for the lay public, what have we seen? What are we seeing? And if someone survives COVID with a cardiac condition, are there things they should be concerned with or are there resources available for those people as well?
Dr. Sandra Chaparro:
So it's important to understand what COVID does to the heart. And that there are different from what we understand. Obviously we're learning and there's a lot of information that is changing almost daily, but the basic concept is that the virus can affect directly the heart because it has some receptors that allows the virus to enter directly into the cell of the heart. Sometimes it could be because of the lack of oxygen, when the virus is affecting the lung, obviously there's not enough oxygen to the heart and then therefore the heart can be affected. And the third mechanism is when we have the immune system that is hyperactive. And instead of just defending our body from the virus it's also attacking our own cells.
Dr. Sandra Chaparro:
So those are like the three components or three ways in which the virus attacks the heart. And it's important to recognize the patients who have prior heart conditions are the ones who are at high risk for more complications with COVID-19. And so these patients sometimes are the ones that will end up in the ICU with different organs failing. Therefore, we're going to have consequences in the long term in terms of, for example, risk of heart attack, these patients are more prone to clots. Risk of myocarditis, meaning inflammation of the heart muscle, or risk of arrhythmias, meaning that they can have irregular rhythms.
Dr. Jonathan Fialkow:
So the cardiovascular system is very much part of the COVID pandemic, especially in the ill and critically ill patients. And I know you're very much part of that team that takes care of these patients in the Baptist Health System. So again, thank you for that. So we've touched on an explanation of what heart failure is, which is, as I said, very prevalent and that might help with listeners and something that listeners can bring to family members. We've talked about what are some of the causes and of course, staying healthy, preventing the general underlying cardiac conditions and you getting the biggest bang for your buck. Appreciate your explanation of advanced heart failure and the technology, intravenous medications, devices, we have to help make people maintain, to stay alive, and to have some semblance of quality of life where appropriate. And some of the COVID related to the facts. We've covered a lot. Is there anything you'd like to bring to our listeners attention or reiterate prior to wrapping up?
Dr. Sandra Chaparro:
Yeah. Just want to emphasize that if you have a heart condition and during this pandemia you have to be extra careful. So keep that physical distance in. Make sure that you have plenty of medicines at home. Make sure you don't delay care. There's a lot of telemedicine available. So you don't have to go to do an invasive console. And if you are really having symptoms and you should always go to the hospital, we have units and triage protocols where patients who do have COVID will go to the specific units. So you don't get exposed if you don't have it. And if you do have it, we have a team of experts, a multidisciplinary team, where we can offer you all the ranges of technology to make sure that you get better.
Dr. Jonathan Fialkow:
Thank you for those points. Just before doing the podcast, I was out in my front yard bringing my garbage pails and I was speaking to my next door neighbor, elderly couple, and her husband had a significant medical condition, which he was afraid to go to the emergency room. And of course it escalated and progressed and became much worse. Please folks, ERs, you're not going to get COVID. Things are separated and it's not very prevalent. Our offices are clean and not transmissible. And we do have the capacity for televisits, audio visual visits, where you're being seen, taken care of from home. So use those resources where appropriate.
Dr. Jonathan Fialkow:
Thank you, Sandra. This was, this was wonderful and helpful. Appreciate everything you've brought to Miami Cardiac and Vascular Institute in Baptist Health, South Florida, both in terms of developing our heart affiliate program, supporting and reaching out to the community, driving research, which we're involved with. And to our listeners, stay safe. As always, if you have any comments or thoughts or requests for future topics, feel free to email us at baptisthealthtalk@baptisthealth.net. That's baptisthealthtalk, one word, @baptisthealth.net. Thanks everyone.
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