Dr. Sean Virani, MD, MSc, MPH, FRCPC, FCCS, Cardiologist, gives and explanation of what heart failure is and how it occurs.

Dr. Sean Virani, MD, MSc., MPH, FRCPC, FCCS, Cardiologist, talks about the different treatments and lifestyle modifications for heart failure.

Heart failure is a great masquerader, and patients can present with any number of symptoms. I would suggest the most common, however, is shortness of breath. That’s because patients will develop fluid in their lungs as a complication of heart failure, and that leads to shortness of breath.

That fluid can build up in other parts of the body as well, though: in your feet, leading to edema, or swelling of the feet; in your tummy, leading to abdominal bloating or ascites; patients may have difficulty breathing when they go to bed at night and have to prop themselves up on pillows.

So a lot of changes around breathing and feeling short of breath. If patients aren’t getting enough oxygen or blood going to their muscles or other tissues, they may get fatigued. Other patients will be foggy or may not be thinking clearly because they’re not getting enough blood going to their brain. Again, changes in your breathing may be an important symptom of developing or worsening heart failure.

Dr. Sean Virani, MD, MSc., MPH, FRCPC, FCCS, Cardiologist, talks about the symptoms a person might experience when they have heart failure.

First and foremost heart failure is a clinical diagnosis, so we look to patients to see if they have the cardinal signs and symptoms of heart failure. If they do, then the clinician will typically want to do some type of confirmatory testing.

And there are many different options for that. Perhaps the easiest and simplest is to do a blood test called natriuretic peptide. Natriuretic peptides, or NPs, are elevated in patients with heart failure. It’s a very effective and easy tool to be able to make the diagnosis at the bedside. It does not require patients to be admitted to hospital, and can be carried out in the lab.

If we wanted to be more sophisticated in terms of making the diagnosis, most patients will go on to have an echocardiogram. An echocardiogram is an ultrasound of the heart, which allows us to measure the pumping and the relaxing function of the heart. And it’s perhaps the gold standard for the diagnosis of heart failure.

Once we make the diagnosis of heart failure—either with natriuretic peptides or by echocardiography, we do need to go forward, however, and figure out why the patient has developed heart failure. Those two tools that I mentioned are useful for making the diagnosis, but they don’t tell us anything about why the patient has developed heart failure, and so in that case additional testing will be necessary.

If you have any more questions about how heart failure is diagnosed, I would encourage you to follow up with your general practitioner or cardiologist to learn more.

Dr. Sean Virani, MD, MSc, MPH, FRCPC, FCCS, Cardiologist, talks about the importance of lifestyle with heart failure.

Broadly speaking, heart failure is the inability of the heart to pump blood and oxygen to our organs and tissues. The heart only does two things: it pumps, and it relaxes. So any dysfunction in the pumping function or the relaxing function can result in heart failure.

Heart failure is typically a disease of the elderly. Many of the risk factors for development of heart failure are things that we see in higher prevalence in the elderly; for example, high blood pressure. They can also be the cumulative effect of a number of different toxins that you’ve consumed over your life, or degeneration of the heart valves. But for whatever reason you develop heart failure, it tends to be more common in the elderly, and that’s sort of people over the age of 65.

What’s interesting is that as the population ages and we see changes in the population pyramid, there’s going to be an increasing number of people in North America—and worldwide for that matter—who have heart failure. And it’s estimated that by 2050 about 40 percent of the population will be over the age of 65. So we’re going to clearly see an increase in the prevalence of heart failure as we move forward.

If you have any of the conditions I talked about: high blood pressure, problems with your valves or others, and think that you might be at risk for heart failure, I would encourage you to talk to your GP or cardiologist about it.

The treatment for heart failure really depends on what type of heart failure you have—whether it’s a problem with the pumping function of the heart or the relaxing function of the heart. And the medications we use to treat patients will really depend on these factors. It may also depend on what the cause of the heart failure is.

Regardless of what the cause of your heart failure is, or what type of heart failure you have, one thing that we recommend for all our patients is lifestyle modification. Focusing around making good choices with respect to diet, salt, fluid restriction, as well as engaging in a structured exercise program to improve your overall cardiovascular well-being.

Wearable technology measuring your heart rate, blood pressure and weight on a daily basis can be helpful to your physician in terms of helping you to manage your heart failure. It can also be helpful in terms of optimizing the medications that you’re receiving for treatment of your heart failure, and get you on a path to wellness sooner.

If you’re looking to make some changes, including your diet, and lifestyle, engage in an exercise program, I’d encourage you to reach out to your primary care physician to figure out what resources might be available in your community to help you along this path.

Dr. Sean Virani, MD, MSc., MPH, FRCPC, FCCS, Cardiologist, talks about how heart failure is diagnosed accurately.

Dr. Sean Virani, MD, MSc., MPH, FRCPC, FCCS, Cardiologist and Dr. Donald Sin, MD, FRCP MPH, Respirologist, discuss how patients and doctors can distinguish between COPD and Heart Failure.

Dr. Virani: Shortness of breath is a common feature of both heart failure and COPD. Complicating matters further is the fact that many patients with COPD will have heart failure and vice versa. So oftentimes it’s really challenging for the physician and for the patient to know whether their dysthymia is due to heart failure, COPD or both.

Dr. Sin: Many patients with COPD also have heart disease. It’s estimated that about four in ten COPD patients have a concomitant heart failure disorder. And both of these conditions cause shortness of breath, so diagnostically it may be very hard for you and your doctors to separate out COPD from heart failure—what’s causing what.

In this case, more advanced diagnostics may be required to really understand what’s driving your symptoms. Some of those diagnostics may include blood test; so there is a very sensitive blood test for heart failure—it’s called BNP. And that your doctor can order to see whether it’s the heart failure that’s driving the shortness of breath.

Dr. Virani: Natriuretic peptide testing is the gold standard for differentiating heart failure from COPD. Natriuretic peptides are elevated in patients with heart failure, however when levels are low it virtually excludes heart failure as a cause for the patient’s shortness of breath, leading us to think that COPD is probably the driver of their symptoms.

Dr. Sin: Another test that can be done is a chest x-ray to see if your lungs are full of water or full of holes, as in the case of emphysema. Another more sophisticated test would be a CT scan of your chest, and that would give you a very clear picture of the role that heart and lung is playing in driving the shortness of breath, or cough or recurrent chest infections.

Dr. Virani: It’s important to differentiate COPD from heart failure because the treatments will be clearly different, and so understanding the cause of the patient’s symptoms is paramount to understanding the best way to treat them.

Dr. Sin: It’s very important to sort out what’s driving the symptoms. Is it the heart failure? Is it the COPD? Or is it both? Because the treatment for these disorders are different. So for instance for heart failure, the treatment may be a water pill to relieve the pulmonary congestion. If it’s a COPD flare-up, it may be in the form of an inhaler, or antibiotics or a steroid to reduce the inflammation. So getting the diagnosis right in a specific patient is very, very important for how the therapeutics will treat those patients.

Dr. Virani: If you have patients with heart failure and COPD and are unclear about what the cause of their symptoms are, I’d encourage you to get a natriuretic peptide test done on your patient to help clarify the situation.

Congestive heart failure (CHF) is a very common condition with which millions of North Americans are diagnosed each year. It is the stage at which “heart failure” has led to a build up of fluid around the heart. This build up affects the efficiency of the heart muscle to pump blood throughout your body. Early treatment and management of congestive heart failure can have very positive affects on this condition, slowing its progression and possibly reversing it.

Causes & Symptoms of Congestive Heart Failure

There are different reasons why the heart muscle weakens, including a heart attack, heart valve disease or long-term high blood pressure. Symptoms of congestive heart failure include:

• Shortness of breath, especially during exercise
• Cough
• Fatigue
• Swelling of the feet and legs

If your healthcare provider suspects you may have congestive heart failure, he or she will perform a physical exam and tests such as echocardiogram, electrocardiogram, blood tests and stress tests. Depending on the results, you may need further testing such as a coronary angiogram.

Treatment of Congestive Heart Failure

Medications

The earlier congestive heart failure is diagnosed, the better the outcome. There are a number of medications that work to improve the heart’s pumping function and decrease heart failure symptoms, including:

• Beta blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Diuretics
• Angiotensin II receptor blockers
• Inotropes

​

Surgery

may be an option to improve heart function, while an implantable defibrillator can correct abnormal heart rhythms.

Lifestyle Changes

Lifestyle changes will also determine how successful your chronic heart failure treatment will be. It’s important to talk to your healthcare team to ensure your nutrition and exercise program are right for you and if other monitoring, such as daily weigh-ins, would be beneficial.

Nutrition

Regular follow-ups with your dietitian will help ensure you are getting all the nutrients you need and avoid hidden salt sources which could be impacting your condition.

A well balanced diet allows the body to receive all the nutrients it needs to thrive and effectively manage chronic conditions. The diet should include a colourful variety of vegetables and fruit, lean proteins and healthy fats. It is also very important to limit sugar and avoid processed foods.

Limiting dietary salt is a crucial component to managing congestive heart failure as it directly affects how much water your body retains. Fluid retention is one of the biggest issues heart failure patients face. In terms of salt intake, you should aim to eat less than 2,000 milligrams of sodium daily. On average the North American diet includes between 4000-5000 milligrams each day!

An effective dietary strategy to reduce sodium intake is by following the DASH diet. The DASH diet stands for Dietary Approaches to Stop Hypertension. The DASH diet encourages whole grains, lots of vegetables and fruit, nuts/seeds and legumes, lean meats and fish.

Here is an example meal plan:

Breakfast:

• 2/3 cup steel cut oatmeal with ¼ cup ground almonds and ¼ tsp cinnamon
• 1 cup mixed berries and 2 tbsp Greek yogurt

Lunch:

• Quinoa and bean salad – 1 cup cooked quinoa, ½ cup mixed beans, cucumber, green beans, red onion, shredded carrots, celery, balsamic vinaigrette.
• 1 cup cantaloupe

Snack:

• 1 cup seedless grapes and 1oz cheese

Dinner:

• Kale salad in lemon Caesar dressing
• 4oz grilled salmon
• Roasted cauliflower, sweet potato and white potato
• Baked apple in cinnamon

To learn more about the DASH diet click here.

In terms of nutrition and weight management, If you’re overweight or obese, and this weight is not caused by fluid retention, you’ll also need to address weight management with your healthcare team.

Exercise

Many patients will benefit from a cardiac rehabilitation program, and regular exercise is essential for all patients. Exercise is an important lifestyle factor that can help manage chronic heart failure. Ideally, an exercise prescription would include 10 -15 minutes of warm-up activities plus 20-30 minutes of aerobic and resistance exercise followed by a cool-down period of at least 5 minutes. This exercise prescription should be repeated 3-5 times a week.

Weight Monitoring

Another effective tool to managing water retention is daily weight monitoring. Just as a diabetic would do daily blood glucose check to manage their blood sugars, a person with heart failure should be doing a daily weight checks to monitor for fluid retention. Weigh yourself before breakfast and consult with your healthcare provider  like a family physician if you gain five pounds in a week or four pounds in two or three days.

With early diagnosis the patient and healthcare team can work together to manage congestive heart failure, allowing individuals to live a long, healthy and active life.

Talk to your cardiologist if you’d like more information on congestive heart failure.

Visit HealthChoicesFirst.com for more videos and resources on heart health.