Heart failure is an extremely serious condition – but there are treatments. Plus, there’s a not-well-known condition called heart failure with preserved ejection fraction. Dr. Abhishek Jaiswal is a cardiologist with the Center for Advanced Heart Failure with the Hartford HealthCare Heart & Vascular Institute.
Q: What is heart failure with preserved ejection fraction? What are its symptoms?
A: Ejection fraction is a measurement that determines how well our heart pumps blood. It is usually expressed as a percentage and is used to properly diagnose and treat heart failure. Usually patients with heart failure have lower than normal values of ejection fraction. However, nearly half of all patients with heart failure have a normal ejection fraction (EF).
Initially these patients have shortness of breath with exertion which eventually progresses to shortness of breath at rest and inability to function, sleep and have meaningful quality of life.
Q: Do we know what causes this condition?
A: When somebody develops congestive heart failure with decreased pump function or ejection fraction, it results from a primary problem in heart which has progressed and now involving other organs and the body.
However, in patients with this condition, it is other way around- problems in other organs work together to increase stiffness of the heart and blood supply or circulatory system of the body. Due to this increased stiff heart the patient is unable to augment heart pump function when needed such as exercise and they get out of breath easily with normal activities which eventually progresses to shortness of breath with minimal activities and with rest.
This condition is common among people with older age, hypertension, kidney disease, diabetes, obese and female sex.
More than 60% of patients with a diagnosis of heart failure with preserved ejection fraction are women typically post-menopausal and are obese. Obesity differently affects men and women. For similar obesity women develop more cardiovascular side effects compared to men.
Q: Tell us about the treatments that are offered at the Center for Advanced Heart Failure.
A: One of the major challenges in the management of these patients is that there is no one definitive test. Traditional tests can either under or over diagnose this condition. Currently, research has not found an optimal set of treatments for HFpEF but we do have enough evidence that individualized approach and management by a dedicated team in collaboration with other healthcare providers can lead to improved quality of life in these patients.
That is why dedicated clinics increase chances of not only appropriate diagnosis and treatment but also increase awareness and appropriate prevention measures.
Q: What other types of conditions for heart failure do you treat at the Center?
A: We offer comprehensive heart failure management at our advanced heart failure center, including cardiomyopathy resulting from problems with blood supply of heart, infections of heart or myocarditis, problems in heart from abnormal immune system such as sarcoidosis, genetic causes of heart failure, amyloidosis which results from deposition of malfunctioning protein in our heart and heart weakness resulting from abnormal electrical system in heart.
We make sure that these patients get appropriate diagnosis and treatment and if they progress despite optimal care then we offer them advanced management options including hear transplant and cardiac assist devices.
We also take care of patients with high pressures in lung called pulmonary hypertension in our dedicated clinic.