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Dr. Shyama Wickramaaratchi: Living with heart failure, not failing, is the reality for most patients who have it

Heart image and stethoscope

Early diagnosis and treatment can improve quality and length of life for people who have heart failure. Patients are urged to track their symptoms each day so they can discuss them with their health care team.

Just the name of the condition itself — heart failure — is scary enough to make you think the end is near.

But in truth, most of the more than six million Americans living (not failing) with a heart failure diagnosis are leading active and productive lives, thanks to a combination of treatments, medications and lifestyle changes aimed at reducing symptoms and restoring heart function.

While there is no cure, the number of people who die from heart failure has steadily declined over the past few decades due to a better understanding of the disorder and advancements in treatment. Still, it remains one of our most serious medical conditions.

Heart failure, sometimes called congestive heart failure, is the leading cause of death and the top cause of hospitalization for people over age 65. Heart failure costs the nation’s health care system well over $30 billion a year, greatly straining local and national health care resources. Each year some 550,000 new cases are diagnosed.

Heart failure is a problem with how well your heart pumps blood and oxygen to meet your body’s needs. That function is measured by a term called ejection fraction — the amount of blood pumped out of the heart with each beat.

There are two main types. With one, called reduced ejection fraction or systolic heart failure, the heart can’t pump or squeeze enough blood out to the body; the heart’s weak chambers enlarge over time. With the second type of heart failure, called preserved ejection fraction or diastolic heart failure, the heart can’t fill with enough blood; the heart’s stiff chambers fill with less blood than needed.

As the heart weakens with both forms of heart failure, circulation slows and fluid collects in the tissues of the legs and may also back up into the lungs. Common symptoms include extreme tiredness or weakness, shortness of breath, trouble breathing while lying down, light-headedness, rapid changes in weight and swelling in the legs, ankles, feet or stomach.

Common causes of the condition include coronary artery disease, damage to the heart from a heart attack, diabetes, high blood pressure, heart rhythm disorders, thyroid disease, and kidney disease. Obesity can also be a major contributing factor.

Early diagnosis and treatment can improve quality and length of life for people who have heart failure. Treatment usually involves taking medicines, reducing sodium in the diet, drinking less liquids, devices that remove excess salt and water from the blood and getting regular physical activity. People with heart failure are urged to track their symptoms each day so they can discuss them with their health care team.

Multiple medications are available for doctors to prescribe for heart failure patients, each tailored to the specific symptoms and needs of the patient.

Since many people with heart failure also have a problem with the way their heart beats (arrhythmia), they may benefit from small electric devices implanted in the chest, just under the skin, wired to the heart to help it beat with regularity.

One such device is an implantable cardioverter defibrillator that keeps track of the heart rate, releasing an electric shock if it detects a dangerously accelerated rate, resetting the rhythm.

Because it’s a chronic lifelong condition, patients with heart failure must take an active role in their care to stay well. Following a prescribed treatment plan, maintaining a low-salt diet and taking all medications reliably is essential.

A daily log of weight, blood pressure and physical activity is highly recommended. The more actively informed and equipped patients are to manage heart failure, the better they will feel and the longer they will live.

Shyama Wickramaaratchi, DO, is a cardiologist with Berkshire Health Systems

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