eakness, fatigue, shortness of breath. These are the chronic, and frightening symptoms of heart failure. In simplest terms, "heart failure" refers to a heart that is not pumping as well as it should. Heart failure is most often the result of the heart's struggle with an underlying problem, such as clogged arteries, high blood pressure, a congenital defect in the actual muscle of the heart, or a medical condition.
Today, there are five million Americans suffering with heart failure, and a half million new cases are diagnosed each year. Below, cardiologists from the New York Presbyterian Hospital, Dr. Simon Maybaum and Dr. Ainat Beniaminovitz, discuss how heart failure is diagnosed.
The gatekeeper to heart failure diagnosis is the internist. Can the internist generally spot symptoms before things get too dangerous?
AINAT BENIAMINOVITZ, MD: Well, the body does offer clues when there is a problem with the heart, such as extra heart sounds; perhaps a murmur. Typically, when people are actually manifesting signs and symptoms of congestive heart failure, then diagnosis is easy. A patient comes in and describes the symptoms. But before actual symptoms, there are subtle signs and clues that a physician can hear with a stethoscope on a very cursory exam. For instance, with a stethoscope, you can detect when veins are backed up with fluid. That is an example of a subtle sign or symptom that the patient may not even be aware of.
If a doctor and patient are concerned about congestive heart failure, what is the first test that should be performed?
SIMON MAYBAUM, MD: I think that the most useful test is an echocardiogram, which is essentially an ultrasound of the heart. It allows us to look, not only at the cardiac function-or the squeezing of the heart-but also at the size of the chambers to see that they're working properly. It is a very useful tool for giving us clues as to why the heart failure occurred in the first place.
How effective is the test? Is it painful at all?
AINAT BENIAMINOVITZ, MD: It's painless. That's why it's very appealing. It's much like having an ultrasound of a baby when you're going for a prenatal visit. It's performed at most places, including physicians' offices. You don't have to go somewhere special. It's very informative. You basically get the results right as they are obtained. It doesn't pick up on arterial blockages, but it can investigate whether or not there have been blockages in the arteries. For example, the heart muscle may only become dysfunctional in certain regions, rather than a global dysfunctional state, which clues you into the fact that only one artery was blocked, and only one part of the heart muscle died, not the whole heart muscle. It gives you clues and signs as to what the etiology or causal factor is.
Can you describe the causes of congestive heart failure, in their most basic terms?
SIMON MAYBAUM, MD: I think the two big distinctions are whether the heart failure is the result of a decrease or abnormal blood supply to the muscle, or whether it's a problem within the heart structure itself-the muscle or the valves. A problem with blood supply to the heart muscle is what we call coronary artery disease. This is a disease that gives us heart attacks and angina and chest pain.
BENIAMINOVITZ: The other basic category, includes everything else, doesn't involve abnormal blood supply to the muscle. There are many of these. There are toxic agents such as alcohol and drugs and chemotherapeutic agents, and many others that can cause damage to the heart muscle. The most common in this category is probably viral infection. We think that most of the cardiomyopathies-the diseases of the heart muscle that we see and find no cause for-have at some time been related to a viral infection of the heart.
What can someone do to prevent heart failure? And does it run in families?
AINAT BENIAMINOVITZ, MD: One of the causes which is actually preventable is high blood pressure, or hypertensive cardiomyopathy. If you know that you have high blood pressure, getting it treated may save you a lot of pain and suffering later on, by not allowing you to promote more heart failure. Abstaining from alcohol if you've been diagnosed with heart failure is also good prevention. Although it's been touted in the press that alcohol protects the coronary artery, excessive amounts of alcohol have a negative effect on the heart muscle itself. It actually depresses heart function.
So, the one glass of wine with dinner is still okay?
AINAT BENIAMINOVITZ, MD: Not okay for people who have dysfunctional heart muscles. We ask them to refrain from alcohol completely. Even a small amount may be deleterious.
Sometimes the thyroid gets of out whack. Treating that problem can prevent heart failure.
As far as the non-preventable causes of heart failure go, we are just beginning to understand what causes inherited forms of heart failure, or what gene defect causes dysregulation of the heart muscle. Until we're really good at fixing our genetic composition, we're not going to be able to prevent those complications, but just treat them expectantly.
But there are things that you can do in terms of prevention or retarding the progression of heart failure. There is a whole compendium of medications that we're fortunate to have currently to help retard the disease once it's come about.
Closing thoughts, Dr. Maybaum?
SIMON MAYBAUM, MD: I think that we need to understand that congestive heart failure is a serious condition, which, if untreated, can lead to progressive deterioration. But, we are much better at identifying and treating patients with heart failure. Hopefully, we're improving their quality of life and eventual survival.
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