Dr. Esther Shao (Guest): Thank you, Melanie. Heart failure is kind of a big term that encompasses a lot of different diagnoses, and it can include somebody who has had a heart attack. But basically, something has happened to make the heart not function normally. Congestion is typically the symptom that shows up when the heart is not functioning normally. A heart attacks means that the heart has had an artery or blood vessel that’s keeping it shut down, causing sometimes transient damage if they’re able to get that blood vessel open up quickly. If the blood vessel is allowed to clot up, the heart can be damaged permanently, and that can result in a heart that’s not working properly and can result in heart failure.
Melanie: Dr. Shao, what are the symptoms of congestive heart failure? What would send someone to see a doctor that they might even have or be recognized as having congestive heart failure?
Dr. Shao: The most common symptom of heart failure is difficulty breathing. This can be difficulty breathing at night, not being able to lie down flat at night. Having swelling in the legs is another common symptom, or even feeling tired and not being able to do the usual activities that you do. For example, if you usually bike and are not short of breath and now you’re finding you can only do a mile instead of five miles and you’re finding yourself more breathless with what you could have previously considered to be normal amounts of activity.
Melanie: Then what do you do? How do you diagnose congestive heart failure?
Dr. Shao: Usually, the first step is to take a history and understand what the symptoms are and make sure that these symptoms aren’t coming from other potential organ systems in your body or other diseases. Then if we suspect that this likely has to do with your heart based on the story, we would then go ahead and probably order an echocardiogram and EKG and do other diagnostics to try to figure out where the symptoms are coming from and what the cause might be.
Melanie: What’s the first line of defense? If you say yes, you’re in congestive heart failure, what do you do for patients to give them some hope that this is something that they can live with?
Dr. Shao: Most patients with heart failure now are managed by what we call disease-specific programs, and we have one of those at Maine Medical Center. We have a heart failure program here. It is aimed at treating the patient with medications that have been shown to work for whatever disease is causing their heart failure. It is also aimed at improving their dietary nutritional status to give them the best chance of a good outcome.
Melanie: So medications and some of the adherence to medications and compliance. Do you worry as a doctor about making sure that they are taking those medications and that also, with things like potassium, that all of those kinds of things are regulated as they’re taking the medications they need for CHF?
Dr. Shao: Sure. Patients diagnosed with certain types of heart failure have very good response to medications. Those medications need to be taken consistently for the heart function to improve. We do monitor the patient’s rate carefully. We start them on low doses and slowly increase the doses and monitor side effects. Patients do get labs drawn frequently to make sure that the medication doses that they’re on are appropriate for their body.
Melanie: Now, in some cases, you might recommend surgery or other interventional procedures to help with their congestive heart failure. What are some of those that you’re doing at Maine Medical Center?
Dr. Shao: A whole host of new treatments for patients who have heart failure that may be effective. Usually we try medications first and then we move on to thinking about more aggressive therapy. Patients can have heart failure from valve problems, and there are several different valve operations and surgeries that can be done now even without needing to do open heart. There are pacemaker devices that can be used to try to improve the heart function. Lastly, we do partner with several Boston programs with respect to offering even more advanced therapies such as heart transplantation. Recently, in the last several weeks, Maine Medical Center has implanted two patients with what is called a left ventricular assist device. It is an artificial heart pump that is implanted into the chest and augments the blood flow for the heart. This was previously used only as a bridge to transplant, so helping patients who had been listed for transplants stay alive. But now this is available to patients who may not qualify for transplant, and it provides good quality of life and extends their survival.
Melanie: How long can somebody live with an LVAD inserted?
Dr. Shao: The longest living patient in the Boston area now has had the same device for eight years. The Europeans started implanting these long before the Americans did, and their longest living patient on the same device is now out about 15 years.
Melanie: What’s on the horizon, Dr. Shao, for people living with congestive heart failure, and how long? If you’re diagnosed with this in your 70s, how long can you be treated for something like this? Can they go on for 20 years and you can live a relatively normal life with this managed? Give people a little bit of hope if they’ve been diagnosed with congestive heart failure.
Dr. Shao: It’s been shown in many research studies that patients who comply with medications and dietary recommendations and take good care of themselves, those who follow instructions and exercise can do very well with heart failure. They lead a relatively normal life and are able to enjoy the activities that they like to do on a daily basis. Symptom management definitely is possible. At this point in time, based on our research and the medications that we use, there are many patients that I treat with heart functions that are quite low, in the 20 percent realm, who have been stable for anywhere from five to 10 to even close to 20 years.
Melanie: What about things that they can do, lifestyle treatments that they can do to help manage those symptoms as well, like watching your fluids or exercising? Can they do normal activity and exercise if they are someone with CHF?
Dr. Shao: Yes. We encourage exercise. Exercise actually improves survival, and that’s the reason why Medicare recently has approved cardiac rehabilitation or cardiac exercise programs for heart failure patients. So it is now covered by insurance programs to try to encourage patients to exercise and build themselves back up to a level of endurance that they wish or desire to achieve. As far as nutrition, diet is very, very important in heart failure. Our program recommends the guidelines as stated by the American Heart Association, which is a low-sodium diet. Some patients do need food restrictions, and our program and our heart failure education nurses tailor these recommendations for the patients and do extensive nutritional coaching with them.
Melanie: Dr. Shao, in just the last few minutes or so, tell the listeners why they should come to Maine Medical Center for their congestive heart failure care.
Dr. Shao: We have a new program that’s about a year old, and Dr. Nicolosi and myself were brought in by Maine Medical Center to launch an advanced heart failure program. All the aspects of the program I have just described to you are available. We are hoping to make Maine a better place for heart failure patients and improve the quality of life for these patients without having them need to travel so far to get better care.
Melanie: Thank you so much. For more information on the heart failure program at Maine Medical Center, you can go to mmc.org. That’s mainemedicalcenter.org, mmc.org. You’re listening to MMC Radio. This is Melanie Cole. Thanks so much for listening and have a great day.