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Demystifying Heart Failure: A treatable chronic disease

This post is the first in a series examining heart failure written by graduate student Min Joo Kim and physician-researcher Randall Stafford.

The heart supplies oxygen-rich blood to all of the body's cells. For many, the diagnosis of heart failure, like cancer, could sound like a death sentence. Just a few decades ago, this was mostly correct. Those diagnosed with heart failure could expect a declining quality of life, followed by inability of the heart to pump enough blood to the rest of the body.

Now, with advances in diagnostics, medications, and a better understanding of the role of lifestyle factors, heart failure does not necessarily mean a death sentence.

"Heart failure is a chronic disease that is rarely cured, but can often be effectively treated," said Fatima Rodriguez, MD.

The purpose of this blog series is to provide an overview of this frightening diagnosis. We will look into mechanisms and biology of heart failure and highlight common treatment strategies.

First, let's meet someone with heart failure, who is based on a real patient:

Mr. J is a 72-year-old former construction worker diagnosed with heart failure 12 years ago. Since his diagnosis, he has had to modify his diet and exercise, and has become a regular visitor at both his family doctor and cardiologist's offices.

However, with consistent adherence to his medications and attention to improving his lifestyle, Mr. J has coped successfully with heart failure for many years. Mr. J's heart failure has impacted his daily life, but has not been the dramatic end-all sentence so many associate with heart failure.

There are different types of heart failure, but in general, it develops when the heart is unable to keep up with the body's demand for oxygenated blood.

At first, to make up for the inability to pump the necessary amount of blood, the heart will attempt to adapt by stretching to enlarge, developing more muscle mass, and/or pumping faster. The long-term consequences of these adaptations eventually harm the heart. 

Heart failure can have many different causes, which include:

  • Blockages in arteries can lead to heart attacks. Scar tissue can then replace some heart tissue.
  • Hypertension (high blood pressure) can enlarge and stiffen the heart muscle eventually leading to heart failure, as the heart is required to work harder to pump blood at abnormally high pressures.
  • Electrical problems of the heart can cause the heart to weaken over time, leading to heart failure.
  • Heart valve disease can cause pressure and volume damages to the heart muscle.
  • Severe psychological stress can lead to broken heart syndrome.
  • Other cardiomyopathies (direct damage to heart muscle) may be caused by infections, drugs (such as amphetamines or cocaine) and alcohol, or may be hereditary.
  • Chronic diseases, such as diabetes and sleep apnea, can contribute to heart failure.

While heart failure can occur in both the left and right sides of the heart, left-sided heart failure is more common. The two main categories of left-sided heart failure are:

  • Systolic heart failure happens when the heart is too weak to pump the necessary amount of blood. Another way to think about this is that the heart becomes too thin and weak.
  • Diastolic heart failure is when the heart becomes too stiff and the muscles lose their ability to stretch, as if the heart were too thick and stiff to bounce back after each pump.

Heart failure may range in severity. Some cases are mild and can be treated with medications and lifestyle changes, while other cases can lead to significant disability and require intensive treatments. Excess salt intake, infections, missing doses of medications, and other conditions can cause worsening problems for heart failure patients.

Randall Stafford, MD, PhD, internal medicine specialist at Stanford Medicine, stresses that maintaining regular physical activity and adopting healthy eating habits are vital. Preventing high blood pressure and diabetes, as well as managing stress and mental health are key to heart failure treatment. These healthy behaviors can also help prevent heart failure from occurring.

Treatment for heart failure relies on patient self-management, particularly a vital combination of medication adherence and healthy behaviors. Heart failure medications when combined with lifestyle modifications help reduce the stress upon the heart, which will be discussed in future blogs. 

This is the first in a new series of blog posts, Demystifying Heart Failure, to help patients and family members better understand and help mitigate heart failure. The next blog will address misconception about heart failure.

Min Joo Kim is a master's degree student in Community Health and Prevention Research at Stanford studying the patient experience for those with chronic conditions and identifying barriers to treatment. Randall Stafford, MD, PhD, professor of medicine, focuses on strategies to improve chronic disease treatment, including engaging patients in their own health care.

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