Heart failure

There are two types of heart failure:

• Systolic heart failure (systolic left ventricular dysfunction) — in which the left ventricle (heart chamber) doesn't contract enough, preventing enough blood from being pumped out to the body
• Diastolic heart failure (heart failure with preserved left ventricular function) — in which the ventricles do not relax after contracting, preventing enough blood from entering the heart

Methodist Healthcare offers a range of treatment and procedures for heart failure and related conditions, including:

• Adult congenital heart disease treatment
• Aortic disease treatment
• Advanced heart failure treatment
• Cardiac amyloidosis
• Cardiac catheterization
• Cardiac device monitoring
• Cardiac genetic testing
• Cardiac resynchronization therapy
• Cardiac sarcoidosis
• Cardiogenic shock
• Cardiomyopathy
• Coronary artery bypass graft
• Coronary artery disease treatment
• Echocardiogram
• Enrollment in clinical trials
• Heart arrhythmia treatment
• Heart attack treatment
• Heart disease treatment
• Heart disease prevention
• Heart failure treatment
• Heart screening and imaging
• Heart transplant
• Heart valve disease procedures
• Hemodynamic monitoring
• Home inotropic therapy
• Hypertrophic cardiomyopathy
• Impella
• Left Ventricular Assist Devices (LVAD)
• Mechanical circulatory support
• Precision medicine
• Pulmonary artery pressure monitoring
• Pulmonary hypertension
• Sports cardiology
• Women’s heart disease treatment

Congestive heart failure (CHF) occurs when excess fluid starts to leak into the lungs and/or other surrounding parts of the body. Normally, the pumping actions of the left and right sides of the heart complement each other, producing a continuous flow of blood. Heart failure may occur with both ventricles failing, although one ventricle may begin to fail before the other.

Heart failure has many causes, including:

• Cardiomyopathy — Cardiomyopathy describes a weakness in the heart muscle's ability to contract. This may result from the effects of long-standing hypertension, diabetes, alcohol abuse or multiple heart attacks, all of which can damage the muscle to the point that its pumping function becomes compromised.
• Myocardial infarction — This can cause sudden acute CHF in cases where a substantial portion of the heart muscle has become severely damaged. The lack of oxygen to the cardiac muscle results in poor contraction.
• Severe anemia — This condition can cause heart failure in a patient with a very low red blood cell count. The heart will go into congestive failure as it attempts to compensate for the inadequate number of circulating red blood cells. Red blood cells are necessary for adequate oxygenation of the tissues.
• Valvular heart disease — A leaking or blocking of the heart valves leads to an ineffective flow of blood through the heart. Over time, the heart will attempt to compensate for the problem by enlarging, eventually leading to CHF, heart attack, cardiac arrhythmias or cardiac arrest (heart stops beating). Valve replacements have improved the survival rate in patients with valvular heart disease.
• Viral myocarditis — In addition to irregularities of the heart beat (arrhythmias), this viral infection of the heart can result in poor cardiac muscle function. Viral myocarditis is one of the few causes of heart failure seen in young people.

Heart failure symptoms show up in a variety of ways. It's important to speak with your doctor if you are experiencing:

• Fatigue and weakness
• Feeling of suffocation while sleeping, or awakening in the middle of the night short of breath
• Increased heart rate
• Leg swelling and/or abdominal swelling
• Persistent coughing or wheezing
• Shortness of breath during normal activities
• Sudden weight gain from fluid retention

Your evaluation will include a complete medical history and physical examination. Blood tests or a chest X-ray will be performed. Additional tests are used to determine the nature and extent of heart failure.

An electrocardiogram (EKG or ECG) can reveal evidence of a potential heart attack or other suspected heart abnormalities. Catheterization or angiography, which shows the inside of the coronary arteries, is sometimes recommended.

Our dedicated heart care specialists offer a wide range of treatment options for your comfort and care. In some cases, medications used in an outpatient setting can be an effective treatment option for heart failure. For other scenarios, we offer a more comprehensive touch that treats your heart at the root of your condition.

Pulmonary artery pressure monitoring

Pulmonary artery pressure monitoring helps us accurately track your heart and lung function in real-time through remote monitoring. This method allows us to measure your blood flow pressure and heart rate, allowing us to identify and detect early indicators of worsening heart failure for a better chance at supporting your recovery.

Cardiac therapy

Cardiac therapy, otherwise known as cardiac rehabilitation, is a helpful tool for patients who have been diagnosed with heart failure. Cardiac therapy is a supervised exercise program that can help stabilize, slow or even reverse the progression of heart failure, particularly after heart surgery such as stenting. Our program is broken down into three patient-centric phases helping you towards the road to recovery: inpatient, outpatient and home health.

Extracorporeal membrane oxygenation (ECMO)

ECMO is a critical life support technique that allows for the temporary takeover of the heart and lungs to allow them to rest and heal so you can recover from a potentially reversible, severe critical illness. It can also be used to help with other conditions, such as acute respiratory distress syndrome (ARDS), cardiogenic shock, massive pulmonary embolism, severe refractory asthma or accidental hypothermia, drowning and poisoning.

Inotropes

Inotropes are intravenous medications that change the force of your heart’s contractions by either strengthening (positive inotropes) or slowing down (negative inotropes) your heart’s rhythm. Positive inotropes are typically useful for patients with congestive heart failure, or who have recently had a heart attack or heart surgery. Negative inotropes are useful when treating high blood pressure, chronic heart failure, heart arrhythmias and angina.

Left atrial appendage closure implant (LAAC)

LAAC implants are devices that help reduce stroke risk in patients with atrial fibrillation (AFib) not caused by heart valve issue. During this minimally invasive procedure, the LAAC implants are placed to block or close the opening of the appendage to prevent blood clots from entering your bloodstream. This procedure can be combined with other procedures for high-risk patients and can minimize or eliminate the need for blood thinners.

Left ventricular assist device (LVAD)

An LVAD is a mechanical device implanted in the chest that helps circulate blood through the body when your heart is too weak to pump blood properly on its own. Unlike an artificial heart, the LVAD does not completely replace the function of your heart but does help support total function. This system helps provide continuous blood flow, reducing the workload of your heart, can be used in several ways, including bridge to transplant, bridge to recovery and destination therapy. If you are experiencing advanced heart failure and have exhausted medical therapies, you may be eligible to receive an LVAD. Clinical studies have shown patients treated with LVAD can live longer and enjoy an improved quality of life compared to medication management alone.

Transcatheter mitral valve repair (TMVR)

For those who may not be an ideal candidate for open heart surgery, TMVR can be an effective treatment option for those suffering from mitral valve disease. A TMVR is a minimally invasive surgical procedure that repairs or replaces the mitral valve in the heart with a thin, flexible tube called a catheter.

Palliative care and hospice

Our hospice and palliative care specialists offer compassionate care to make you feel as comfortable as possible during heart failure care. Palliative care helps optimize you or your loved one’s quality of life and lessens suffering for those whose conditions have reached critical levels. We offer physical, emotional and spiritual support, creating a space that has all the comforts of home, whether you choose a nursing home, an assisted living facility or to stay within your own home.

ECMO involves the process of removing and oxygenating your blood and returning the blood to your body. It is an advanced life support available to a patient experiencing acute failure of cardio-respiratory system.

Veno arterial (VA) ECMO which supports both heart and lung function, can be considered when you have severe cardiac failure and a potentially reversible cause who meet the following criteria:

• Severe refractory cardiogenic shock on a moderate dose of two or more inotropes/pressors and/or use of other mechanical devices (balloon pump, etc.)
• One of the following: Urine output less than 30 milliliters/hour, central venous pressure over 16, or lactate over 4 millimoles per liter/hour

The goal of our heart transplant program is to exhaust all medical therapies before resorting to a heart transplant, which is reserved as a final lifesaving option. Transplant services are only considered for patients with severe heart failure who meet heart transplant criteria and have healthy organs otherwise.

If your doctor feels you may be a candidate for heart transplant evaluation, you will have to undergo multiple diagnostic tests and medical evaluations. You will also participate in various consultations with members of our heart transplant interdisciplinary team, including our surgeons, dietitian, social worker, psychiatrist, financial advisor and other consulting physicians as necessary. To learn more about our heart transplant program, please click here.