Ben (Moderator) - 10:50 AM:
Greetings and welcome to the NorthShore University HealrthSystem's latest chat: Heart Failure and Treatments with Nitasha Sarswat, MD. The chat will begin in about 10 minutes, but please start submitting your questions now so we can get to all of them.
Nitasha Sarswat - 10:59 AM:
Ready to chat!
Sharon (Evanston, IL) - 11:00 AM:
I am in my mid-50s, in good health, but noticed moderate swelling in my feet and ankles at the end of the day. Is this type of swelling normal or could it be indicative of a heart issue?
Hi there, this is most likely related to venous stasis or pooling of blood in the legs, which is benign. The valves in our veins don't work as well in all of us as we get older.
That said, I would say that it worthy of a simple evaluation to make sure that its not indicative of something more - I would get an echocardiogram (ultrasound of the heart), proBNP (blood test), and comprehensive physical exam with particular attention paid to the JVP (pressures in the heart we can see by examining the neck)
Felicia (Niles, IL) - 11:05 AM:
Do you see heart failure in one gender more than the other?
No, we see it in men and women. Just as in other forms of cardiovascular disease, heart failure is overall under-recognized in women. Similarly, in the clinical trials that provide evidence for our treatments, women are unfortunately under-represented. We're working as a community to change this!
Alice (Skokie, IL) - 11:09 AM:
Are there any long-term warning signs of heart failure? Or is it a sudden onset?
Heart failure can be sudden or slower onset depending on the cause.
A heart attack (caused by problems in the arteries that feed the heart) can cause sudden heart failure as can viruses that affect the heart or medications that cause toxicity to the heart.
Genetic conditions, long-standing high blood pressure, and other things can cause slower onset.
Warning signs: shortness of breath, decreased exercise tolerance, swelling in legs, shortness of breath when sleeping or bending over, needing more pillows to sleep
Frank (Northbrook, IL) - 11:15 AM:
Are there any "best practices" to avoid heart failure?
Good question. A lot of avoidance is really aimed at general good health:
Avoid salty foods
Keep blood pressure under control
Exercise 3-5 times a week
Try to stick to a low carbohydrate diet to avoid obesity
Get yearly physical exams and ECGs
I think it's also important to know your family history and be aware of signs of illness (don't wait!)
Unfortunately, a lot of what causes heart failure is often out of our control
James (Evanston, IL) - 11:23 AM:
What is the likelihood a person will survive heart failure? What treatments happen after to prevent further failure?
There is a large variability among patients.
Most survive and lead lives with very good quality.
Once a patient has been diagnosed, we have an excellent armamentarium of drugs to help remodel the heart and make it stronger which include beta-blocker, ace-inhibitors/ARBs, or entresto and spironolactone. There are also several new and very promising drugs including SGLT2 inhibitors, which were initially marketed as diabetic drugs.
For those that progress the wrong way despite the above, we have left ventricular assist devices (LVADs) and transplants. Our LVAD program at NorthShore is growing and is very strong!
Robert (Evanston, IL) - 11:27 AM:
Should Type 1 diabetics who have had the disease for a long time be on the lookout for heart failure or heart blockages?
Absolutely. Diabetes poses a significant risk for the development of coronary artery disease, which is a very common cause of heart failure. The better controlled the diabetes is, the less likely of progression to problems in blood vessels throughout the body.
There is a lot of good data for screening calcium scores and CT scans of the coronary arteries before someone develops significant symptoms
Charlotte (Evanston, IL) - 11:33 AM:
What does heart failure feel like?
A lot of people will have fatigue and shortness of breath. Others may have swelling in the legs and abdomen. Signs are fluid weight gain, decreasing ability to exercise, shortness of breath when bending over or trying to sleep, and needing more pillows behind your head to sleep. Heart failure is truly a syndrome of the above symptoms coupled with a few diagnostic tests.
John (Wilmette, IL) - 11:44 AM:
40 year old here. I sometimes have what I would call a "twitching" of my skin right where my heart is. It does not cause any other symptoms other than the twitching (no lightheadedness, irregular beating, or anything), but it's worrisome due to where it happens and that it's happened more than once. Could this be something with the heart? or is it more likely that it's something else?
I think it depends if you mean on the outside or something you feel from the inside. From the outside could be a muscle spasm and I would make sure your electrolytes (potassium, magnesium, calcium are ok).
If you're feeling it on the inside of your body, it could be from a rhythm abnormality and warrants further testing.
Tina (Chicago, IL) - 11:50 AM:
What causes heart failure?
There are many causes.
We often divide them into ischemic (from coronary artery disease - blockages in the arteries that feed the heart) and non-ischemic.
Causes of non-ischemic include:
1. Genetic abnormalities
2. Infiltrative cardiomyopathies such as amyloidosis, sarcoidosis
3. Hypertrophic cardiomyopathy
4. Secondary to medications that are toxic to the heart (such as certain chemotherapies)
5. Long-standing uncontrolled high blood pressure
6. Valve problems
7. Congential disease - problems with the formation of the heart prior to birth
Ben (Moderator) - 11:55 AM:
That's all the questions we have for today. Thank you, Dr. Sarswat, for your time and expertise.
Nitasha Sarswat - 12:00 PM:
Thanks everyone for your questions! I enjoyed the opportunity to interact!