What Are the Signs of Heart Failure? (podcast)

Scripps cardiologist explains how heart failure is diagnosed and treatments

Dr. Srivastava discusses heart failure symptoms, causes and treatments in San Diego Health podcast.

Dr. Ajay Srivastava, Cardiology, Scripps Clinic

Scripps cardiologist explains how heart failure is diagnosed and treatments

Heart failure is a life-threatening condition that affects more than five million people in the United States each year.

The term heart failure can be misleading. It doesn’t mean that the heart has completely stopped, just that it can no longer efficiently pump blood. Heart failure can exist for years before it becomes noticeable and can range (or progress) from very mild to extreme, during which a person would need a heart pump or even a transplant.


In this episode of San Diego Health, host Susan Taylor and guest Ajay Srivastava, MD, a cardiologist and heart failure specialist at Scripps Clinic, discuss heart failure and how it’s different than a heart attack, heart failure’s causes, and the different types of heart failure and their symptoms. Dr. Srivastava also outlines how heart failure is diagnosed and treated.


Scripps is consistently ranked by U.S. News & World Report as having one of the best cardiology and heart surgery programs in the country.

Listen to the episode on heart failure causes and treatments

Listen to the episode on heart failure causes and treatments

Podcast highlights

What happens when the heart starts to fail? (0:44)

Let me try to explain heart failure. The heart has two upper chambers and two lower chambers. When we say heart failure, we are typically referring to the left main squeezing chamber of the heart, and it means that the heart is not squeezing well enough or not relaxing well enough. If the heart doesn’t squeeze well enough, we don’t have enough blood flow getting to the body. If it squeezes well and it’s stiff and does not relax well, then fluid builds up in the lungs.

Typically, when we say someone has heart failure, we are referring to either they’re not getting enough blood flow or fluid is backing up into their lungs and the rest of the body.

Does heart failure mean the heart has completely stopped? (1:29)

When we say heart failure, it’s quite a spectrum. You could have really mild heart failure and you could have heart failure to the other extreme where you need a heart pump or a heart transplant. When we see patients referred to us for heart failure, we determine where in the spectrum of heart failure is a given patient and determine what the course of action should be for a given patient.

Is heart failure different than a heart attack? (1:59)

Yes. Heart failure refers to when the heart muscle is not squeezing well or it’s stiff. Heart attack refers to when there’s a blockage in one of the main arteries supplying blood flow to the heart.

What are the symptoms of heart failure? (2:15)

Symptoms of heart failure usually are fatigue, difficulty breathing, tiredness, sudden weight gain and ankle swelling. Those are the most common symptoms of heart failure.

What are the different types of heart failure? Explain systolic vs diastolic heart failure (2:31)

When we say systolic heart failure, we are referring to the pumping function of the heart. It’s not squeezing well enough. When we say diastolic heart failure, we mean the heart muscle is stiff and not relaxing well. We refer to that as diastolic heart failure.

What causes heart failure? (2:53)

Heart failure typically occurs because a patient has had a large heart attack and a big blockage that affected blood flow to the heart.

The other common reasons for heart failure are high blood pressure, high blood sugar, diabetes, certain lifestyle choices like smoking, being overweight.

Is there a genetic component to heart failure? (3:18)

There are some conditions or gene mutations that run in families, and that could predispose a patient to getting heart failure. There are certain other times where you could have the mutation, but not develop heart failure. We work with the patient and do the genetic testing to see if they have just a mutation or have a mutation leading to heart failure.

Can heart failure exist for years before you start showing symptoms? (3:51)

That’s correct. Symptoms of heart failure can exist for a while before the patient goes and sees a doctor because they could be a little short of breath. They could notice they’ve gained a couple of pounds and they might just attribute that to, “Oh, I’m getting a little older,” and might not think much of it. So yes, symptoms of heart failure can take a while to develop before a patient sees a physician.

When should you go see a cardiologist or go to the emergency room? (4:16)

If the symptoms come on suddenly, like if you have sudden shortness of breath, sudden chest pain, you’re dizzy, lightheaded, those are times you don’t want to wait. You just want to go to the emergency room for further evaluation. If the same symptoms came on more gradually, over time. You’ve noticed your breathing is being affected. You’re a little bit more tired. Those are times when you say, “Okay, I’m going to make an appointment with a primary care physician or a cardiologist for further investigation.”

How do you diagnose heart failure? (4:51)

The first test we do when we suspect heart failure, we start with an EKG or an electrocardiogram to look at your heart rate and heart rhythm. Then we follow that up with what we call an echocardiogram or an ultrasound of your heart muscle to see how it’s squeezing and how it’s relaxing, and also looking at the valves along with the heart muscle.

How do you treat heart failure? (5:31)

I advise all my patients to start with lifestyle changes. You want to get a good diet, watch the amount of sodium, watch the liquids, stay away from soda and tobacco and those bad habits. Try to get at least 20 minutes of physical activity most days of the week. Some of my patients like running. Some patients like swimming, but anything that’s fun and you enjoy, try to do at least 20 minutes on most days.

If you do that and then medications and come back to me still with symptoms, we are fortunate at Scripps to have many devices and therapies that as a heart team we can offer to our patient, one of which is the CardioMEMS device. It’s a chip that we place between the heart and the lungs. It’s an outpatient procedure. With this chip-like device, patients can stay at home, and I can real-time monitor their fluid levels. This is a great option for our patients, and it offers them the comfort of staying at home and us still being able to take care of them in real time.

If they still have other conditions or symptoms beyond fluid management, we have a couple more options. If they have a valve problem, we work with the heart team and we can offer them a valve procedure, in some cases open heart surgery, but in many cases without having to do open heart surgery. Just by a stent-like procedure, we can put a valve in here that reduces the amount of leakage. This is great for patients who have heart failure. It really helps them feel a lot better.

If they have weakness of the heart muscle, then we can put in a heart pump. That heart pump takes over the work of the heart muscle. This is just an example, or a couple of examples, of treatment options that we have for our patients with heart failure.

What lifestyle choices do you recommend for patients at risk for heart failure? (7:36)

For patients with heart disease, high blood pressure, or worried about getting heart failure, my advice would be to follow basic healthy principles, which is diet, physical activity and sleep.

With diet, you want to do things in moderation. Stay away from excessive salt, excessive sugars. Try to avoid processed food as much as possible and eat a clean, healthy diet for the most part.

With activity, try to get at least 20 minutes most days of the week, something you like to do, whether it’s swimming, running, jogging, but get out there, have fun and be active.

The third, and maybe the most ignored part of good health, is sleep. Try to get six to eight hours of good sleep.

That’s my advice to patients with heart disease or who want to do the best they can to prevent heart disease or heart failure.

But should you have any symptoms or you’ve been diagnosed with this condition, we can help you at Scripps. We have an excellent heart team and can offer therapies that can help you live a good life.

Lightly edited for clarity.

Watch the video on heart failure

Watch the San Diego Health video with host Susan Taylor and Dr. Srivastava discussing signs, symptoms and treatment for heart failure.

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