findaphysicanbuttonSIZING7

Heart Failure

The heart is an amazing organ. Every part of your body depends on it. It speeds up when you exercise, are excited or scared. It slows down when you are relaxed or resting. On average, it beats about 70 times a minute, every minute of your life – more than 2.5 billion times over an average lifetime.

But sometimes the heart doesn't beat the way it should. It may beat too fast, as if you were running for your life instead of just sitting on the sofa. It may beat too slowly. It may skip beats. It may beat at the right speed, but pound like a sledgehammer. It may do any or all of these things, then settle down as if nothing were wrong.

Irregular heartbeat is called cardiac arrhythmia. An arrhythmia can be a serious, life-threatening event, or it can be an inconvenience that interrupts the activities of daily living.


Appalachian Regional Healthcare System  comprehensive line of EP services and procedures includes:
• Holter and event monitoring
• Cardioversion
• Tilt table testing
• Implantable Devices
• Resynchronization therapy for heart failure

Signs & symptoms
• Palpitations (the feeling like your heart is "running away"), fluttering, skipping beats
• Dizziness, feeling light-headed, fainting
• Pounding in your chest, chest discomfort, shortness of breath, weakness or fatigue

*** Severe symptoms may be a medical emergency: Call 911 ***

Heart Failure FAQs:

What is heart failure?
Heart failure is a condition in which your heart becomes too weak to pump blood as effectively as it should. It may come on suddenly, after a heart attack for example, or it may develop slowly as you age or in response to a variety of diseases and conditions, especially high blood pressure. Symptoms may develop so slowly that your body at first is able to compensate. As the disease progresses, however, symptoms will become noticeable and may eventually interfere with your enjoyment of life.

Is heart failure a "death sentence"?
Definitely not. Heart failure can be controlled and managed. Modern treatments such as those available through St. Mary's and Athens Cardiac Arrhythmia Center can help most heart failure patients continue to lead active, meaningful lives for many years. Talk to your cardiac specialist to develop the treatment plan that is right for you. Common treatment options include:

  • Weight loss and management – Because the swelling, fatigue and shortness of breath that often come with heart failure can make exercise difficult, many heart failure patients become overweight. Excess weight increases the strain on all parts of your body, including your heart, and also makes exercise harder and more uncomfortable. Safe, supervised weight loss can reduce symptoms, improve heart function, and help other organs such as the lungs, brain and kidneys.
  • Medication therapy – Medicines such as ACE-inhibitors and diuretics can reduce the workload on the heart and relieve the build-up of fluids in the body
  • ICRDs – Implantable cardiac resynchronization devices help the chambers of the heart contract at the right time and can boost the strength of heart contractions. Improved strength and timing boosts the heart's efficiency and helps move more blood through the heart.
  • Cardiac Rehabilitation – Carefully monitored and supervised exercise can strengthen your heart while improving your overall fitness and lifestyle

More about ICRDs...
Appalachian Regional Healthcare System  makes it possible for cardiac specialists to implant the newest, most sophisticated ICRDs available. Features of this new generation of implantable devices include:

  • Defibrillation. For patients at risk of fibrillation, in which the heart loses its normal rhythm and quivers without pumping, these ICRDs can deliver a life-saving electrical jolt to restart the heart.
  • Pacemaking/Resynchronization. For patients whose hearts beat irregularly or in poor synchronization, these devices can set a steady beat and cause chambers of the heart to contract together at the right moment.
  • Wireless monitoring. The ICRD monitors and records its own activity. When the patient goes to bed at night, a small unit by the bedside automatically uses wireless technology to download information from the ICRD. This information, along with other information the patient can manually enter (especially each day's weight), can be transmitted directly to the physician anywhere in the world via the Internet.
  • Miniature size. Thanks to rapidly evolving technology, new ICRDs are smaller than a credit card and not much thicker. They can now be implanted under the skin near the collarbone in a fast, minimally invasive procedure performed under mild sedation. Improved battery technology allows them to work for many years before replacement is necessary.

What causes heart failure?
The leading cause of heart failure is coronary heart disease, in which the arteries providing blood to the tissues of the heart become narrowed by accumulations of plaque on the inside of artery walls. The heart, like all other muscles, must have its own blood supply to work; it cannot absorb the oxygen and nutrients it needs from the blood in its chambers.

When a spot in a cornary artery becomes too narrow, blood can't pass freely through it and may form a clot, entirely blocking the artery. Just like closing a dam on a river, blood stops flowing to tissues "downstream" of the blockage. Within minutes, the muscle tissue that depends on that artery for its blood supply begins to die. The sudden distress and death of this tissue is what causes the pain and disability of a heart attack, technically known as a myocardial infarction, or MI).

  • If the blocked coronary artery is small, serving only a small amount of heart muscle, the damaged area is small. While immediate risk of death is not great, the damaged area will have a mild but permanent affect on the heart's ability to function. Multiple "mild" MI's can cause severe heart failure.
  • If the blocked coronary artery is large, serving a significant part of the heart muscle, the damaged area potentially is very large. The risk of immediate death is high, and the damage could have a serious effect on heart function

Can a heart attack be stopped once it starts?
The clot-busting drug TPA, available at Appalachian Regional Healthcare System, can dissolve clots, which restores blood flow and can save tissues that are in distress but have not yet died. However, TPA is effective only if given soon after the onset of symptoms. No drug can restore life to dead tissues. This is why is essential that people who suspect they may be having a heart attack should get medical care immediately. Time is muscle! Call 911!

What are the symptoms of a Heart Attack?

  • Pressure, squeezing, fullness or pain in the chest
  • Pain or discomfort in other areas of the upper body, including the arms, jaw, neck, back or stomach
  • Shortness of breath
  • Nausea, lightheadedness, breaking out in a cold sweat
  • While some heart attacks produce sudden, severe symptoms, most come on with mild symptoms that many people ignore or think will go away. Women are especially likely to experience mild, ambiguous symptoms. Remember, delaying treatment increases your risk of death and disability.

What other factors can cause heart failure?
In addition to coronary heart disease, other causes of heart failure include:

  • high blood pressure
  • diabetes
  • obesity
  • smoking
  • high cholesterol levels
  • sedentary lifestyle
  • alcohol and drug abuse
  • certain infectious diseases
  • congenital heart disease
  • heart valve damage
  • some genetic disorders

How is heart failure diagnosed?
Usually, the appearance of symptoms is the first clue. If your symptoms point toward heart failure, your regular physician may order a diagnostic test such as an echocardiogram or refer you to a cardiac specialist. An echocardiogram uses safe, painless sound waves to determine how well the heart is functioning, including providing your ejection fraction. This is the percentage of blood that is pumped out of the heart with each contraction. An EF of 50 percent is below normal. (see related article, Ejection Fraction).

Diagnostics:

Computed tomography (CT)
Appalachian Regional Healthcare System features a 64-slice CT scanner, the only kind of CT scanner available today fast enough to capture detailed 3-D images of the heart between beats. With these images, physicians can diagnose potential blockages in coronary arteries, study valve and chamber structure, assess pumping efficiency and measure ejection fraction. CT studies are fast and non-invasive, usually lasting just a few minutes and requiring a low dose of x-rays and the injection of a medically approved dye, called contrast, that highlights blood vessels in x-ray images.

Cardiac catheterization
Appalachian Regional Healthcare System, state-of-the-art cardiac cath lab allows cardiologists to diagnose problems with the heart and its blood vessels. While the patient rests under mild sedation, the cardiologist carefully guides a wire into the heart and injects contrast solution. X-ray images highlight the heart's blood vessels and can reveal a wide array of potentially dangerous conditions, including coronary artery disease.


Ultrasound
Appalachian Regional Healthcare System Cardiac/Vascular Services Department provides inpatient and outpatient EKG, echocardiogram and stress echocardiogram testing. St. Mary's Doppler ultrasound systems use safe, painless sound waves to create images of the heart in action. "Echoes" are done on patients as they lie comfortably in a darkened room; "stress echoes" are performed on patients as they exercise on a treadmill, which provides information on how well the heart functions as the body's needs increase.

Pulmonary function testing
Many heart failure patients have trouble with shortness of breath due to fluid build-up in and around the lungs and from the heart's reduced ability to provide enough blood for gas exchange (giving up waste carbon dioxide and absorbing needed oxygen). Appalachian Regional Healthcare System pulmonary function lab provides accurate, detailed information that can help your physician assess lung capacity and function.

Treatment & Continuing Care:

The Cardiology Center
The first and only center of its kind in the Athens area dedicated to the treatment of abnormal heart rhythms.  ACAC provides a "one-stop shop" where patients can receive all phases of care – from diagnosis to treatment – under one roof. ACAC provides all levels of arrhythmia care, including initial assessments, medication management, patient education, and device therapy. Practitioners with ACAC are Moe H. Bishara, M.D, FACC, and Amit D. Shah, M.D., Ph.D. For more information call (706) 389-7800.

Device implantation
Several types of devices can be implanted at Appalachian Regional Healthcare to improve heart function and return the heart to a normal rhythm. Broadly, these devices fall into three types. All can be implanted under the collarbone and linked to the heart with tiny wires in a simple surgical procedure that is performed under mild sedation.

  • • Pacemakers – Help hearts keep a steady and appropriate pace
  • • ICDs – Implantable Cardioverter Defibrillators constantly monitor heart rhythm and can deliver a life-saving shock if the heart begins fibrillating.
  • • ICRDs – In addition to helping the heart maintain an appropriate pace and delivering a shock if the heart begins fibrillating, implantable cardiac resynchronization devices help the appropriate chambers contract at the same time. Simultaneous contractions help improve heart function and boost the ejection fraction.

Cardiac Rehab
Appalachian Regional Healthcare Cardiac Rehabilitation Program helps people across High Country prevent and recover from heart problems by focusing on creating healthy lifestyles. The program features exercise, dietary changes and other lifestyle improvements, with one-on-one care provided by specially trained personnel and provides ongoing exercise in a class setting at the Paul H. Broyhill Wellness Center to help the patient continue to make progress and reduce the risk of further heart problems. Exercise, camaraderie and dietary education are the cornerstones of Phase III.


Wellness Center
Paul H. Broyhill Wellness Center provides a wide variety of group fitness classes and equipment to help people of all ages and fitness levels improve and maintain their strength, flexibility and cardiovascular fitness. Membership includes fitness assessment and body composition analysis; assistance with goal-setting; access to all equipment and classes, including Yoga,, Spin, Zumba and many others. In addition, the highly qualified fitness staff can help you move through your Wellness journey, regardless of what step you're on.

For more information, call (828)-266-1060 or come by and tour the facility and talk to the staff. We feel certain we can find the right program for you. 

How can I prevent Heart Failure?

Most of the factors that cause heart failure also cause heart attack, stroke and other serious health problems. The good news is that many of the most important factors are within your control. They include:

  • Hypertension (high blood pressure). Experts recommend a BP of 120/80 or lower
  • Diabetes ("blood sugar"). Experts recommend a fasting blood sugar level of 99 or less
  • Cholesterol. Experts recommend a fasting LDL ("bad" cholesterol) of 100 or less and HDL ("good" cholesterol) of 40 or more
  • Tobacco use. Smoking is the leading cause of preventable death and disability. If you don't smoke, don't start. If you do smoke, talk to your doctor about effective ways to end your tobacco addiction
  • Maintain a healthy weight. Obesity is the second leading cause of preventable death and disability, exceeded only by smoking. A good general rule of thumb is the Body Mass Index. A healthy BMI is 19-25
  • Exercise. Exercise is a key factor in managing your weight, enhancing the health of your heart and lungs, and controlling other factors such as blood pressure, blood sugar and cholesterol. Get at least 30 minutes of cardiovascular exercise a day, at least five days a week
  • Watch what you eat. Choose a diet rich in whole grains, vegetables, and fruits, low in fats, sugars and processed foods. For most heart failure patients, it is especially important to control sodium intake, especially salt or foods high in salt. Cut back on portion sizes. A registered dietitian can help you make the transition from an unhealthy diet to a healthy one; ask your doctor for a referral.
  • Use alcohol in moderation or not at all. Some research indicates that a glass of wine now and then may actually be helpful, but too much alcohol damages your blood vessels, brain and other internal organs.
  • Don't use cocaine. Cocaine and certain other illegal substances can cause serious damage to the heart, sometimes on the first use.

Some factors are not in your control. These include:

  • Age. Your risk of heart problems increases as you get older.
  • Family history of heart disease. You are at higher risk if a parent or sibling had cardiovascular disease, especially at an early age.
  • Congenital defects. Birth defects that affect the size, shape or function of the heart can cause heart failure and other cardiac problems.

Since some factors are beyond your control, it's doubly important to focus on the factors you CAN control.

Find out more!

Your best source of information is your doctor. If you are concerned about your risk factors or believe you may be developing early symptoms, schedule an appointment with him or her. Be sure to write down your questions and bring them with you. It's also good to bring a family member or friend to help you remember what the doctor says.

For even more details, there are many excellent articles, websites and books about heart health; ask your doctor for some recommendations. Be aware that not all materials are evidence-based, especially on the Internet. Be sure to note the credentials of the author and his or her sources; information about a field should come from people who are specialists in that field. Research papers should be peer-reviewed and articles and books should state that they have been reviewed by a medical specialist in the field. Look for endorsements by reputable organizations such as the Centers for Disease Control, the American Heart Association, or major research institutions such as the Mayo Clinic.

  • Sources:
  • • Barnes-Jewish Hospital, "Understanding Ejection Fraction"
  • • MayoClinic.com, "Ejection fraction: What does it measure?"
  • • Guidant Corporation
  • • Discovery Hospital
  • • National Institutes of Health, Medline Plus
  • • "Managing Heart Failure," Hospital Educators Resource Catalogue, Inc. (HERC Publishing)