On Tuesday evening, November 19, Navigating the Medical System featured a virtual lecture on heart failure, hosted as always by Congregation Etz Chaim.
Dr. Mel Breite, Founder and Director of the Lecture Series, welcomed everyone and introduced Dr. Jennifer McLeod, Cardiologist, specializing in advanced heart failure treatment at NewYork-Presbyterian Queens Hospital, and Assistant Professor of Clinical Medicine at Weil Cornell Medical Center.
Dr. McLeod shared a detailed, informative lecture. She shared that treating heart failure involves a multifaceted approach. It is a syndrome diagnosis. Heart failure is a medical term for any condition where the heart muscle is unable to efficiently pump oxygen-rich blood to meet the body’s needs. When the heart muscle is weak, this can cause a buildup of pressure in the heart and lungs.
Heart failure is a chronic condition and a dynamic condition. It’s progressive, so it’s important to identify it early and start medical therapy.
She showed a video of a normally functioning heart, pumping with all four chambers working. She then displayed a diagram of the parts of the heart. The right atrium pumps into the right ventricle, and then it pumps to the lungs. Then the pulmonary veins pump to the left atrium, then to the left ventricle, and then to the big powerhouse, which is the largest artery in the body: the aorta. Diastole is when the heart relaxes and allows itself to fill with blood. The heart is like a balloon, and it gives a little, so pressures don’t rise quickly.
When it squeezes, that is systole pressure, and that pumps the blood to the lungs and the rest of the body.
Ejection fraction is the percentage of how much the left ventricle is pumping to the body. Normal is 50-65%.
When the heart muscle is stiff for multiple possible reasons, then it is not able to give as soon as it fills, and pressure will rapidly go up, and blood back-tracks to the chamber it came from. In this situation, the heart cannot pump or fill properly.
Diastolic heart failure means the heart is pumping but the relaxing aspect is impaired.
When a ventricle is not functioning well, then you do not have the strong squeeze pooling blood, and that is systolic heart failure. This is the more common form of heart failure.
The main issue is that the ventricle is not filling or emptying well. Things back up into the lungs and you get fluid accumulation.
She then detailed the main risk factors for heart failure: coronary artery disease (which is the number one killer in the US), diabetes, high cholesterol, and hypertension. An acute heart attack can cause damage to the heart. Diabetes can cause insidious damage to the heart as it induces inflammation. Diabetes can damage the small arteries.
There is also heart valve disease, which can lead to heart failure. Heart valves act as a door; if they are not able to open or close well, then the heart can’t work efficiently, and this can lead to heart failure.
A structure defect can lead to abnormal heart rhythm. A systemic disease can also lead to heart failure. Alcohol consumption and genetics are other risk factors. Alcohol is toxic to heart tissue.
She related symptoms of heart failure and displayed them in a circle as you could have one or more. Trouble breathing is the number one symptom. Other symptoms include fatigue, exercise intolerance, weight gain, loss of appetite, and swelling of legs or feet particularly on the right side.
She then shared a chart that detailed classification scale of heart failure.
Class Four, when a person had symptoms at rest and was unable to do any physical activity without discomfort, indicated advanced heart failure.
She then shared ways to manage heart failure. Some management includes using diuretics to get rid of fluid, lowering blood pressure, repairing valves, and using medical therapy.
Medications can decrease long-term adverse outcomes. Patients need to make dietary changes, including a low-sodium diet, and adhere to medicine regime.
She shared that the goal with blood pressure is to get it to 120/80. There are antihypertension drugs that can help with this. Diabetes fasting should show an A1C less than 7.0%.
She described the various types of medicines used to treat heart failure.
The community thanks Dr. Breite and Congregation Etz Chaim for these informative lectures.
By Susie Garber
