Heart Failure Treatment at Scripps
Scripps cardiovascular teams are nationally recognized for breakthrough work in diagnosing and treating heart failure, a life-threatening condition that affects more than 5 million people in the U.S. Our skilled physicians have decades of highly specialized experience helping patients overcome heart problems and manage serious conditions which, if left unchecked, can be fatal.
What is heart failure?
Heart failure is a complex condition primarily found in patients 65 or older. It is defined as the heart’s inability to pump blood properly to deliver enough oxygen to the body. It should not be confused with a heart attack, which happens when there is a blockage in one of the arteries that supplies blood to the heart.
Heart failure can be caused by different factors, such as lifestyle choices, family history or even a heart attack. It may be linked to genetics and can affect people regardless of age. Leading causes of heart failure are coronary artery disease, high blood pressure and diabetes, according to the National Heart, Lung and Blood Institute.
Thanks to advancements in cardiovascular medicine, heart failure can be managed and possibly even reversed in some cases. This is possible when heart failure is diagnosed early, treated successfully, and patients make necessary changes to their lifestyle such as diet modifications, taking up exercise, reducing alcohol consumption, or quitting smoking.
Common symptoms of heart failure include swelling of the feet or ankles, weight gain, and/or shortness of breath. Older patients may experience a feeling of weakness, lightheadedness or fatigue with little exertion.
The two main types of heart failure
The heart has four main chambers, two upper and two lower. The majority of heart failure conditions can be traced to the heart’s left bottom chamber (ventricle) that pumps oxygen-rich blood to the body. The phase immediately following when the ventricle contracts and pumps the oxygen-rich blood is called systole. The left ventricle filling with this blood during its resting phase is called diastole.
- Systolic heart failure is when the left ventricle cannot pump blood well and can’t meet the body’s demands. This represents the majority of heart failure diagnoses.
- Diastolic heart failure is when the left ventricle cannot properly fill with oxygen-rich blood.
Advanced or end-stage heart failure occurs when the heart’s pumping capacity is severely decreased and can no longer be managed by medical therapies. Patients with advanced or end-stage heart failure may benefit from mechanical assist therapies, including implantable pumps, such as left ventricle assist devices (LVADs), which help the heart pump blood to the body.
Measuring the heart’s capacity and efficiency
Physicians can measure the heart’s pumping capacity, which is known as ejection fraction. A normal ejection fraction is more than 55 percent, according to the National Heart, Lung and Blood Institute. Enlargement of the heart’s left ventricle can reduce its ability to pump the same amount of oxygen-rich blood to the body, resulting in a lower ejection fraction.
- An ejection fraction of 60 percent would be the result for a healthy heart with a total blood volume of 100 mL pumping 60 mL.
- An ejection fraction of 43 percent would be the result for a heart with an enlarged left ventricle and total blood volume of 140 mL pumping 60 mL.
Heart failure risk factors
Left unchecked, heart failure can exist for years before symptoms, such as feeling very weak, lightheaded and fatigued, develop. Heart failure can also cause fluid to build up in the lungs or feet and ankles, resulting in swelling and shortness of breath.
Seeing your physician for annual physical exams is an important way to catch heart problems early. Common causes of heart failure include:
Heart failure diagnosis
Scripps teams use the most advanced heart screening technologies and procedures to detect and diagnose heart failure. Test and exams may include:
- Medical history including review of medications being taken and family history.
- Physical exam including heart rate, blood pressure, weight, lungs and breathing, and any noticeable signs of swelling in the legs or belly region.
- Blood tests to detect other undiagnosed risk factors such as diabetes, and to check if the kidneys and liver have been affected.
- An electrocardiogram (EKG or ECG) records the heart’s electrical functions such as heart rate, heartbeat rhythm, and strength and timing of electrical signals as they pass through each part of the heart.
- Stress EKG (physical test typically involving a treadmill) that can detect reduced blood flow to the heart.
- Chest X-ray provides a picture of the heart and lungs, as well as major blood vessels.
- Echocardiogram (ECHO) that uses sound waves to create moving pictures of the heart — particularly its chambers and valves — and can detect possible blood clots, fluid buildup in the sac around the heart or problems with the heart’s aorta, the main artery through which oxygen-rich blood flows to the rest of the body.
- Cardiac blood pool scan (also called nuclear ventriculography) that shows how well the heart pumps blood to the rest of the body.
- Cardiac catheterization that involves the insertion of a long, thin flexible tube called a catheter to check the blood vessels that supply the heart with blood. The procedure is performed through a blood vessel in the arm, upper thigh or neck.
Heart failure treatment options
Scripps heart specialists treat heart failure with the latest therapies and surgical procedures practiced in state-of-the-art hospitals and facilities. Treating heart failure may involve one or more of the following:
One or more medications may be prescribed to treat heart failure. Patients who respond well to one medication may not do as well with others, which is why your physician may recommend a combination – or a change, based on results and follow-up. Medications to manage heart failure symptoms or prevent a worsening of the condition can include:
- ACE inhibitors to block the action of an enzyme that causes blood vessels to narrow, resulting in a reduction of the heart’s workload, lower blood pressure and reduced swelling.
- Angiotensin II receptor blockers (ARBs) to block the action of chemicals that also narrow blood vessels and may be prescribed for patients who cannot tolerate an ACE inhibitor.
- Aldosterone receptor antagonists to help block the hormone aldosterone that helps rid the body of extra fluid, reduce swelling, improve breathing and lower blood pressure.
- Beta-blockers that can slow heart rate and reduce blood pressure rates.
- Vasodilators that help widen blood vessels, making it easier for the heart to pump blood. They may be combined with other medications to treat heart failure.
- Isosorbide dinitrate/hydralazine hydrochloride helps relax blood vessels so the heart is more efficient. The combination drug has proven effective for African-American patients.
- Diuretics that help rid the body of extra fluid and salt (sodium) to reduce swelling associated with heart failure.
Medical procedures and heart surgery
The Scripps commitment to providing the region’s top-rated heart care includes 24-hour coverage for patients by board-certified heart surgeons and cardiologists who specialize in heart failure.
We offer patients with heart failure leading-edge treatments, procedures and access to the most advanced FDA-approved heart devices. Our teams are at the forefront of clinical trials and have experience with new minimally invasive techniques.
Your heart requires personalized care from skilled doctors in a collaborative setting. Scripps multidisciplinary heart teams can include a cardiologist, electrophysiologist physician, cardiac surgeon, cardiology nurses, social workers and several other specially trained clinicians and practitioners.
Scripps comprehensive heart failure services include:
- Cardiac resynchronization therapy (CRT) to increase the heart’s pumping efficiency.
- Implantable cardiac defibrillator (ICD) implantation to keep the heart beating at a healthy rate. The ICD is implanted under the skin and delivers a shock to stop abnormal heart rhythms when detected.
- Pacemaker implantation of a small battery-powered device to provide a healthy heart beat and rhythm for patients with a slow heart rate (bradycardia) or a condition known as heart block, in which electrical impulses from the heart’s top chambers (atria) cannot reach the lower chambers (ventricles). In early 2014, Scripps became the first health system in Southern California to implant a new wireless pacemaker that is one- tenth the size of a traditional pacemaker.
- An advanced extracorporeal membrane oxygenation (ECMO) device for life-saving procedures for hospital-admitted patients whose heart and lungs have become so weakened they can no longer function properly.
- Ventricular assist devices (VADs), including left ventricular assist devices (LVADs) that improve the circulation of oxygen-rich blood to organs when a patient’s left ventricle has become weakened and no longer functions properly.
- Transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that doesn’t require a traditional chest incision and “open” surgery.
- Heart valve repair or replacement that can be performed through a laparoscopy or endoscopy, percutaneous procedure (catheter inserted into an artery) or robotic-assisted minimally invasive surgery.
- Ablation procedures for arrhythmias, including cryoblation to correct abnormal heart rhythms without surgery.
- Angioplasty and stent placement to open blocked or narrowed arteries and restore healthy blood flow.
- Coronary bypass surgery, in which surgeons graft a healthy vessel from another part of your body (usually arm, leg or chest) to “bypass” a blocked coronary artery and restore healthy blood flow for the heart.
- Interventional cardiology, which includes procedures using catheters for minimally invasive access through the artery of the heart to perform procedures on the heart.
Recovering faster and making necessary lifestyle changes to guard against repeat heart problems are the foundation of Scripps cardiac rehabilitation offerings. We can help you adopt a healthier lifestyle, including an exercise program and healthy diet designed to improve your health and help you move forward in a positive way after surgery or interventional cardiology procedures to treat a heart condition.
Scripps also offers a custom program, Lifestyle Change Program, which combines complementary therapies with medical therapies in a holistic mind-body approach. The 3-month program is part of the comprehensive offerings of the Scripps Center for Integrative Medicine.
Some types of heart disease can be inherited, putting family members at risk of developing heart problems such as heart rhythm disorders, cardiomyopathies and heart valve disorders. Scripps has genetics counselors on staff to help patients identify potential heart trouble and take proactive steps with their physician to address it.
Heart patient support
As part of our commitment to the community, Scripps offers wellness and heart health classes free of charge to the public as well as cardiac rehabilitation services. Scripps is a partner with WomenHeart, a national program that provides education and support for women living with heart disease.
Clinical research and clinical trials
Scripps is consistently on the leading edge of cardiovascular research and clinical trials, working to bring the most innovative treatments and care options to patients. Locally and regionally, we’ve led the way with many firsts for cardiovascular breakthroughs.
Our physicians and scientists are actively involved in research and studies to provide greater understanding of heart disease and enable a faster availability of new treatments to patients. If you are interested in participating in clinical trials, please discuss with your physician clinical trials options and potentially appropriate matches.
Scripps has the only San Diego heart program consistently recognized as one of the nation’s best for cardiology and heart surgery by U.S. News & World Report. Locally, Scripps is ranked number one among regional health care providers in cardiology and heart surgery.
The Joint Commission has also recognized several Scripps hospitals as a Top Performer on Key Quality Metrics for clinical outcomes in heart failure and heart attack care. Scripps Health is the only health system in San Diego County to receive top performer distinction at three different hospitals, which can mean all the difference when you need emergency heart treatment close to home.
Personalized and accessible heart care for you
The dedication of Scripps physicians, combined with our world-class facilities, ensure that you or your loved ones have the best opportunity to survive life-threatening heart conditions.
Scripps doctors are on the leading edge of heart treatment innovation that can provide patients with the kind of medical care for which Scripps is known.
From advanced electrophysiology labs for the diagnosis of irregular heartbeats to the use of minimally-invasive surgeries and procedures with globally adopted devices pioneered or invented by Scripps cardiologists, we have you covered.