Advanced Heart Failure

Advanced heart failure is when traditional therapies and symptom management to treat heart failure are no longer working. You may feel shortness of breath and other cardiac symptoms even at rest.

The symptoms of advanced heart failure are similar to those of heart failure in an earlier stage. They include:

• Fatigue.


• Chest pain.


• Dyspnea (shortness of breath).


• Swelling in the legs, feet or abdomen.


• Irregular heartbeat (arrhythmia).


• Weight loss without diet or exercise changes.

At the advanced stage, patients often have severe symptoms, poor quality of life, and a low survival rate. Medical treatments may not even be tolerated. However, improvements in technology and better disease management have improved the lives of many advanced heart failure patients.

What happens once you have advanced heart failure?

Advanced heart failure is when people with heart failure have heart problems that won't go away, even when treated.

Common signs of advanced heart failure include:

• Irregular heartbeats.


• Low blood pressure.


• Not being able to exercise.


• Unintentional weight loss.

In this advanced stage, chances of dying increase with each hospitalization. The presence of repeated, planned, or unplanned hospitalizations, especially for intensive care, can point to advanced heart failure.

As your heart failure gets worse, you may develop symptoms such as shortness of breath, lightheadedness, or fatigue even when you're sitting.

Limits in physical activity typically include not being able to walk short distances like a city block, or perform everyday activities like bathing or dressing.

What causes advanced heart failure?

Causes of advanced heart failure can include:

• Earlier diagnosis of heart failure


• Strokes.


• Aneurysms.


• Heart attacks.


• Coronary artery disease.


• Stenosis (stiffening of the arteries).

Progression to advanced heart failure may be gradual, and it is often difficult to pinpoint an isolated incident that caused the decline. Patients may start to have less physical activity, need more trips to the hospital, or have heart rhythm complications. Advanced heart failure may make patients more likely to develop other medical problems as well.

What types of tests are used to diagnosis advanced heart failure?

Typical tests for advanced heart failure include:

• Angiogram (angiography): A special dye is injected through a thin, flexible tube called a catheter. Then a special X-ray is taken to detect blockages or aneurysms in blood vessels.


• Cardiac catheterization: A thin, flexible tube called a catheter is guided through blood vessels to evaluate the heart and vessels' problem areas.


• Carotid duplex ultrasound: Carotid duplex ultrasound uses Doppler and traditional ultrasound to assess blood flow in the arteries that supply blood to your brain.


• Chest X-ray: Chest X-rays use a small dose of radiation to create pictures of the chest's structures, including the lungs, heart, and chest wall.


• Computerized tomography (CT) scan: The cardiac computed tomography scan, or cardiac CT, uses X-rays to create three-dimensional images of your heart and blood vessels.


• Echocardiogram: An echocardiogram uses high-frequency sound waves to create images of your heart.


• Electrocardiogram (EKG): An electrocardiogram, also known as an EGK measures the heart’s electrical activity.


• Heart biopsy: In a heart biopsy, your doctor will remove small samples of your heart muscle tissue to monitor heart function or diagnose a problem.


• Magnetic resonance imaging (MRI): Magnetic resonance imaging is a combination of radio waves, magnets, and computer technology to create images of your heart and blood vessels.


• Stress tests: Stress tests are used to assess how your heart works during physical activity. There are several stress tests, including treadmill or bike stress tests, nuclear stress tests, stress echocardiograms, and chemically induced stress tests.

What types of treatments and procedures are used to treat advanced heart failure?

At the advanced heart failure stage, quality of life may become the priority.

Your wishes might change depending on your overall health and chance of recovery. Here are some end-of-life treatment options that your doctor can tell you more about:

• CPR (cardiopulmonary resuscitation) tries to restart your heart and lungs if they stop working.


• A respirator keeps you breathing. Air is pumped into your lungs through a tube that’s put in your windpipe.


• Tube feeding provides you with food and fluids through a tube or IV. It is given if you can’t chew or swallow.


• A kidney (dialysis) machine cleans your blood when your kidneys can no longer work independently.


• Hospice care means comfort care. Hospice nursing staff may help with bathing or provide food and fluids by mouth. This care is given during the last stages of an illness.


• Pain medication can be given to help keep you comfortable.

However, having advanced heart failure doesn’t mean you’ve run out of therapeutic treatment options. In fact, there are an increasing number of therapies and state-of-the-art technologies to improve your quality of life.

• Open-heart surgery.


• Coronary artery bypass graft.


• Valve surgery.


• Pericardiectomy.


• Percutaneous interventions.


• Pacemaker.
  • Permanent.
  • Temporary.
  • Leadless.
  
  
• Implantable cardioverter defibrillator (ICD).


• Temporary devices:
  • Intra-aortic balloon pump.
  • Left ventricular assist device (LVAD).
  • Extracorporeal membrane oxygenation (ECMO).
  
  
• Positive inotropic drugs.


• Renal replacement therapy.


• Heart transplant.

What can I do to support my health when I have advanced heart failure?

Ask your doctor what health decisions you may have to make in the future. Think about your preferences and document them in an advance directive, which can be updated as your wishes change.

For example, you may want to consider palliative care. The goal of palliative care is to help improve quality of life by relieving your symptoms. This is not the same as hospice, which is the care you receive when you decide to end therapeutic treatment.

Palliative care can provide:

• Relief of pain and symptoms.


• Emotional and spiritual support.


• Support services for your family caregivers.


• Help with making complex treatment decisions.


• Assistance with practical issues, such as advance directives or insurance.

When quality of life becomes your priority, it may be time to end treatments. Hospice care is often provided in the home by a team that includes a doctor, nurse, therapist, social worker, and other professionals. Hospice services may include:

• Medical care to manage symptoms.


• Emotional and spiritual counseling.


• Physical and occupational therapy.


• Art therapy, music therapy, and other complementary therapies.


• Respite care to provide a break for caregivers and families.


• Home health aides.


• Help with insurance, legal documents and other practical issues.


• Trained volunteers who provide various support services, such as babysitting, running errands and preparing meals.


• Bereavement support and counseling for caregivers and families.

Making plans for how you want to spend your remaining life can be tough. But difficult discussions now can simplify difficult decisions later.

Why choose Presbyterian for advanced heart failure treatment?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options, including lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.