Heart Failure

Heart failure is a serious condition that can be treated with excellent results. Although failure of the main chamber of the heart (the left ventricle) is more common, either chamber of the heart (i.e., right or left ventricle) can fail.

At Yale Cardiac Surgery, our team consists of experienced surgeons dedicated to the management and treatment of heart failure. They have an extensive track record of outstanding clinical outcomes in conventional operations for heart failure, implantation of mechanical circulatory support devices, and cardiac transplantation. They are also national leaders in clinical and basic scientific research in areas relevant to heart failure.

Causes

Heart failure is usually the result of other conditions that have damaged or weakened the heart. Over time, this cumulative damage causes the heart to enlarge, and causes it to have to work harder to pump blood to the rest of the body. The chambers (ventricles) may become weak, enlarged, stiff, and unable to fill properly. When the blood backs into areas of the body it is not supposed to, such as the liver, abdomen, legs, or lungs, causing them to become congested with excess fluid, the condition is called congestive heart failure.

Risk Factors

If you are at risk for any of the following conditions or if you have any of the following conditions, your chances of developing heart failure increase. Having a risk factor does not mean that you will develop heart failure, but knowing if you are at an increased risk and treating your condition may help save your life. Our surgeons and multidisciplinary team will answer your questions and address your concerns regarding your specific risk factors.

  • High blood pressure: High blood pressure means the heart is already working harder to pump blood to the rest of your body. Over time, this extra work causes the ventricles to become weak and may cause heart failure.
  • Coronary artery disease: This condition causes a narrowing of the arteries and may mean the heart is not receiving enough blood, resulting in a weakening of the heart muscle. 
  • Heart attack: A heart attack can cause serious damage to the heart. This is due to the muscle of the heart not receiving enough blood supply, usually due to narrowing of the arteries. This damage can make it difficult for the heart to pump normally and result in heart failure.
  • Irregular heartbeats: An abnormal heartbeat can create extra work for the heart and cause it to weaken over time. This weakening of the heart can increase the risk of developing heart failure. 
  • Diabetes: Diabetes may cause high blood pressure or coronary artery disease. The combination of these factors may lead to an increased chance of developing heart failure.
  • Sleep apnea: This is the inability to breathe properly at night. It often results in low blood oxygen levels and abnormal heart rhythms. Both of these factors can cause the heart to weaken and increase the risk of heart failure.
  • Alcohol: Over time, too much alcohol can weaken the heart muscle and eventually lead to heart failure.

Symptoms

Symptoms of heart failure can indicate either a chronic condition or signs of acute heart failure. If you are experiencing any of the following symptoms, you should contact your doctor immediately. It is important to understand that having any of the symptoms below does not mean that you have heart failure.

  • Shortness of breath during increased physical activity or lying flat
  • Fatigue or weakness
  • Edema or swelling of the legs, ankles, and feet
  • Rapid or irregular heartbeat
  • Persistent cough or wheezing that produces white or pink spit up
  • Fluid retention that results in sudden weight gain
  • Lack of appetite and nausea
  • Chest pain

Diagnostic Tests

Our team of cardiac surgeons is able to identify the signs of heart failure through a variety of diagnostic tests.

Chest X-ray: An X-ray image allows our team of surgeons to evaluate the condition of the heart and lungs. If your heart appears enlarged or your lungs appear filled with fluid, this usually signifies heart failure.

Electrocardiogram (ECG): An ECG helps our surgeons to determine if any heart rhythm abnormalities are present and to see damage that may have been the result of a heart attack, which could cause heart failure.

Echocardiogram: An echocardiogram will allow our surgeons to view an image of the heart using sound waves. The image created by the echocardiogram will show how well the heart is pumping and any underlying causes that may indicate heart failure.

Stress test: A stress test will measure how the heart and blood vessels respond during exertion. Patients are usually asked to walk on a treadmill or pedal a stationary bike while attached to the ECG machine.

Cardiac computerized tomography (CT): A CT test can help diagnose causes of heart failure by producing an image of the heart.

Magnetic resonance imaging (MRI): An MRI is used to diagnose heart failure using radio waves to produce signals that create images of the heart.

Cardiac catheterization: This test uses a small, thin tube called a catheter, which is inserted into the heart through a blood vessel in the groin, neck, or arm. The pressures inside the heart can be measured as can the performance of the heart. In addition, dye visible on X-ray can be injected and used to show how blood flows in the heart.

Treatment

There are several surgical options that our surgeons may perform to treat the underlying problem causing heart failure. These include:

Coronary bypass surgery: If the arteries are almost completely blocked, our surgeons may recommend coronary artery bypass surgery. During this surgery, a vein from the leg, arm, or chest is used to detour blood around the blocked artery in your heart.

Heart valve repair or replacement: Often times a faulty heart valve causes heart failure and needs to be repaired or replaced. Our surgeons are highly experienced at repairing and replacing heart valves using minimally invasive techniques for faster recoveries and less postoperative discomfort. Our surgeons have a track record and regional reputation for offering operations to very high-risk patients.

Heart pumps: These mechanical devices include left ventricular assist devices called LVAD’s. The device is implanted into the chest and attached to the heart to help it pump.

Heart transplant: If the underlying condition of heart failure cannot be treated, a heart transplant may be necessary. Heart transplants can dramatically improve a patient’s quality of life; however, receiving a heart transplant is a serious decision. We have an extensive track record of outstanding clinical outcomes in heart transplantation and the implantation of mechanical circulatory support devices.

We understand that the thought of undergoing heart surgery can feel overwhelming. Our surgeons will review your surgical plan, in detail, so that you know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their innovative strategies in treating or preventing heart failure.