Debbie Blank
“Heart failure is a very, very scary and badly-named term,” admitted Dr. Eugene Chung, who spoke at a Margaret Mary Community Hospital-sponsored heart-healthy dinner at The Sherman House Feb. 23.
Listening were 130 attendees, who had just finished eating either salmon or turkey; salads with dried cranberries, almonds, feta cheese and raspberry dressing; and whole wheat muffins.
His definition of heart failure: “when the heart is unable to produce enough cardiac output to meet the demands of the body.”
“Atrial fibrillation and heart failure are the two diseases that are increasing in incidence in the United States and around the world,” even with new medicines and devices.
The director of heart failure for The Ohio Heart and Vascular Center, Cincinnati, pays close attention to one indicator of longevity – ejection fraction. That number in persons with normal heart function is 55 to 60 percent. “If you have a weakened heart, the ejection fraction can drop to 20 or 30 percent.”
Chung cautioned that if someone’s number is less than 30 percent, he or she is at very high risk for heart arrhythmias, which can be fatal.
In additional to the more common cholesterol figures, “it's a cardiac number you should know. Ask your doctor the next time."
The board-certified cardiologist said there are three questions all heart failure patients should be able to answer:
• What is my ejection fraction?
• Am I on an ACE (angiotensin-converting enzyme) inhibitor? These drugs treat high blood pressure by relaxing the muscles responsible for contracting blood vessels, reducing the strain on the heart and kidneys. Captopril, Enalapril, Lisinopril and Ramipril are all inhibitors. If not, why?
• Am I on a beta- blocker, a class of drugs that decrease the rate and force of heart contractions and lower high blood pressure? Included in this group are Carvedilol, Metoprolol and Bisoprolol. If not, why?
Heart failure symptoms range from swelling and shortness of breath to excessive fatigue, said Chung, who was named to the 2007-08 Best Doctors in America database as one of the top U.S. clinicians by his peers.
Ideally, he recommended that adults get their hearts checked before health is impacted to that degree. Once significant symptoms develop, "it takes a lot of effort and cost" to treat the problem.
Therapy can include appropriate medications and lifestyle changes. The cardiologist reported that over the last 20 years, medicines have been developed that improve survival tremendously.
To decrease swelling, diuretics such as Lasix Bumex and Demadex might be prescribed to get rid of fluids. The drug should be taken on an empty stomach 30 minutes before a meal or two hours afterwards.
“Less is better” because of the medication’s impact on the heart. A diuretic shouldn’t be taken daily. “Think of it as ibuprofen for a headache.”
Chung touted a sensible diet and exercise. “No fried chicken,” he chided with a smile, knowing his southeastern Indiana audience.
Instead, “eat like a caveman,” he advised. “Cavemen didn't eat meat every day,” and they were continuously active while gathering berries, plants and other produce.
About three-fourths of heart failure patients who are already on medicines can get better yet with devices. A pacemaker that places a wire on each side of the heart can resynchronize the walls to make them pump together for greater efficiency. An improved configuration has three wires.
Others, like former Vice President Dick Cheney, get defibrillators, which monitor hearts. If a heart goes into a rhythm that might be fatal, the device shocks it back to a better rhythm.
In the most dire cases, a cardiac support device, a sort of net placed around the organ; heart transplant; or artificial heart might be the best treatment.
Chung, who is involved at a national level in designing clinical research studies, explained why Americans, especially heart failure patients, must stop smoking.
Lungs feature thin air sacs where oxygen and blood mingle. Fluid can accumulate in air sacs of persons with heart failure, causing problems.
A smoker makes matters worse. “Every puff you take ... destroys air sacs.” The physician predicted, “For every cigarette you smoke, you lose about eight minutes of your life.”
