Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association | Circulation
Signs That Chronic Heart Failure Is Getting Worse
By Maya Guglin, MD, as told to Mary Jo DiLonardo
Your heart's job is to pump blood around your body to supply all your organs with the oxygen they need to work well. When your heart doesn't pump as strong and as efficiently as it's supposed to, you have heart failure.
As your heart struggles to pump blood, fluid levels build up in your body. This excessive fluid causes almost all symptoms of heart failure.
Typically, people with heart failure complain of shortness of breath and fatigue. They might also gain some weight.
Shortness of BreathThere are two pumping chambers in the heart: the left and right ventricles. The left side of the heart collects oxygen-rich blood from the lungs. So, if the left ventricle is more affected by heart failure, the fluid builds up in the lungs, and the main symptom is shortness of breath.
At first it happens only when you try to do something really physically challenging like running. But as the disease progresses, it becomes difficult to walk up the steps. Then it becomes harder to walk fast, then harder to walk at all. You have to stop often and catch your breath.
CoughEventually, you start waking up at night because your lungs fill with "unpumped" fluid. You have to sit up, then the gravity pulls the fluid down, and your lungs can breathe again.
At this stage, you may even have wheezing like in asthma and you may even start coughing. The cough follows the same pattern as shortness of breath: It's worse when you are lying down and better when you sit up.
But if it gets this far, it's time to go to the emergency room or call an ambulance. This is serious.
Fluid and SwellingThe right side of your heart collects the blood from your whole body. If your right ventricle fails, extra fluid accumulates in your liver, kidneys, gut, and legs.
At first, you might notice that your ankles and feet swell by the end of the day. It's not unusual at all for this to happen to people who spend a lot of time on their feet, so this symptom is easily overlooked.
Next, the swelling can continue to creep up your body and move into the shins, thighs, and pelvis. If you put your fingertip on your leg and press lightly, the pit where your fingertip was stays and slowly goes away over the next minute. The medical term for that is "pitting edema."
Eventually blisters may form, skin may break, and the clear fluid inside can start to seep out. When the tissues are in that condition, it's easy to catch an infection called cellulitis, and legs become purple and angry.
Don't let that happen! See a doctor before it gets that bad.
It's more common to have the left ventricular failure first. For example, a large heart attack almost always involves the left ventricle. But if you allow the fluid accumulation in the lungs to persist, this will spread to the rest of the body.
It's important to be aware that heart failure is not the only condition that causes feet and legs to swell. Dilated veins called varices can cause very similar symptoms. That's why you should always let your doctor know about any symptoms you're having. Let the specialists sort this out.
Stomach Pain and Weight GainSometimes you might eat just a little, yet suddenly feel very full. But even though you are barely eating, you notice that you're somehow gaining weight. That's also from all the fluid that you're collecting in your body.
When the liver gets swollen from it (your doctor may call it "distended"), it may cause stomach pain on the upper right side. Some people think they might have an inflamed gallbladder. It's actually an enlarged liver.
Fatigue and Activity ChangesThe easiest way to know that heart failure is getting worse is you're able to do less and less.
People start pacing themselves. They stop doing hobbies that involve any physical activity. They used to go fishing, but not anymore. They used to play 18 holes—now they are down to nine. They avoid stairs whenever they can.
They choose to only walk short distances, and they do it very slowly. They don't use the bedroom upstairs and instead sleep on the couch in the living room. Then they decide to sleep in a recliner. Then they can't sleep at all.
If you notice that the disease makes you change your habits, it's time to visit a doctor. They will almost always be able to help.
There are medications that can treat heart failure, including diuretics—or water pills—that work the fastest. There are also plenty of other treatments that can help.
Heart failure is a chronic condition and doesn't go away. But you can always work with your doctor to treat the symptoms and in some cases even improve the course of your disease.
Food Is Medicine: Worsening Heart Failure
With chronic heart failure, it's crucial to restrict foods high in sodium. High sodium consumption can cause your body to hold on to water, increasing fluid build Up. This will make your heart work harder and cause swelling and shortness of breath. Foods typically high in sodium include processed or cured meats, such as bacon, sausage, deli meats, canned soups, chips, salted nuts, and fast foods.
Another type of food that can be detrimental to those who are managing heart failure is foods containing saturated and trans fats. Fried foods, for example, are typically high in saturated fats and trans fats, which contribute to plaque buildup in the arteries, making blood pressure worse and increasing cholesterol levels-- all of which can be very dangerous for patients managing heart failure.
Too much alcohol can make heart muscles weaker and cause an increase in your blood pressure. Heart-healthy foods can help manage or even improve symptoms and prevent complications in heart failure. These foods will help reduce inflammation, promote a healthy heart rate, support blood pressure management, improve cholesterol levels, and prevent fluid retention.
Here are some examples of foods to add when managing chronic heart failure. Leafy green vegetables, like spinach, kale, Collard greens, and Swiss chards, are rich in potassium and magnesium, which can help to regulate blood pressure and maintain electrolyte balance. Berries, like strawberries, raspberries, blueberries, and blackberries, are loaded with antioxidants. These antioxidants reduce oxidative stress and inflammation, both of which contribute to heart disease.
Whole grains, like oats, quinoa, millet, and barley, are great additions to managing heart failure. The fiber in these foods help lower LDL, or bad cholesterol, and stabilizes blood sugar. These foods also include essential nutrients, like magnesium and potassium, that promote a healthy blood pressure.
Lean proteins, like chicken and turkey with the skin removed, fish, legumes, like beans, lentils, and even tofu, can be a great addition when managing heart failure. They are essential for muscle maintenance and repair, including the muscles of your heart.
Nutrition labels will provide information about the micronutrient and the macronutrient content of that specific food or package. Those looking only to consume foods low in sodium should look for foods with 140 milligrams or less of sodium per serving. Paying attention to that per-serving information is essential, as many packages contain more than one serving. This means that if you consume the entire package, you're serving intake of sodium for that food will increase.
There is a big misconception that reducing salt intake means sacrificing flavor, which is far from the truth. To keep your food flavorful despite its low sodium content, use herbs and spices when you're cooking. You can do this by using sodium-free mixed seasonings or purchasing individual herbs and spices and adding them during the cooking process.
Using citrus fruits is another way to enhance the flavor of your meals. They work well in marinades, dressings, soups, seafoods, poultry, and vegetables. Dining out with heart failure will require some advanced planning and attention to food choices to ensure that your meals are low in sodium and that they are heart-healthy.
Plan ahead before going to eat out at a restaurant by checking the menu online and the nutrition information that is available. Once you arrive at the restaurant, clearly state that you would like your meals to be prepared without added salt and that you would like sauces, gravies, and dressings, which are often high in sodium, to be provided on the side of your food. Try sticking to grilled, steamed, or even baked dishes rather than fried or sauteed ones, as these options are usually healthier, and they are lower in sodium and fat.
Follow the guidelines that your medical team has provided for you specifically, as this will be beneficial to your success in managing chronic heart failure. [MUSIC PLAYING]
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[MUSIC PLAYING]JOHANE FILEMON
Hi. My name is Johane Filemon, and I am a registered dietitian/nutritionist and owner of Wonderfully Nutritious Solutions.With chronic heart failure, it's crucial to restrict foods high in sodium. High sodium consumption can cause your body to hold on to water, increasing fluid build Up. This will make your heart work harder and cause swelling and shortness of breath. Foods typically high in sodium include processed or cured meats, such as bacon, sausage, deli meats, canned soups, chips, salted nuts, and fast foods.
Another type of food that can be detrimental to those who are managing heart failure is foods containing saturated and trans fats. Fried foods, for example, are typically high in saturated fats and trans fats, which contribute to plaque buildup in the arteries, making blood pressure worse and increasing cholesterol levels-- all of which can be very dangerous for patients managing heart failure.
Too much alcohol can make heart muscles weaker and cause an increase in your blood pressure. Heart-healthy foods can help manage or even improve symptoms and prevent complications in heart failure. These foods will help reduce inflammation, promote a healthy heart rate, support blood pressure management, improve cholesterol levels, and prevent fluid retention.
Here are some examples of foods to add when managing chronic heart failure. Leafy green vegetables, like spinach, kale, Collard greens, and Swiss chards, are rich in potassium and magnesium, which can help to regulate blood pressure and maintain electrolyte balance. Berries, like strawberries, raspberries, blueberries, and blackberries, are loaded with antioxidants. These antioxidants reduce oxidative stress and inflammation, both of which contribute to heart disease.
Whole grains, like oats, quinoa, millet, and barley, are great additions to managing heart failure. The fiber in these foods help lower LDL, or bad cholesterol, and stabilizes blood sugar. These foods also include essential nutrients, like magnesium and potassium, that promote a healthy blood pressure.
Lean proteins, like chicken and turkey with the skin removed, fish, legumes, like beans, lentils, and even tofu, can be a great addition when managing heart failure. They are essential for muscle maintenance and repair, including the muscles of your heart.
Nutrition labels will provide information about the micronutrient and the macronutrient content of that specific food or package. Those looking only to consume foods low in sodium should look for foods with 140 milligrams or less of sodium per serving. Paying attention to that per-serving information is essential, as many packages contain more than one serving. This means that if you consume the entire package, you're serving intake of sodium for that food will increase.
There is a big misconception that reducing salt intake means sacrificing flavor, which is far from the truth. To keep your food flavorful despite its low sodium content, use herbs and spices when you're cooking. You can do this by using sodium-free mixed seasonings or purchasing individual herbs and spices and adding them during the cooking process.
Using citrus fruits is another way to enhance the flavor of your meals. They work well in marinades, dressings, soups, seafoods, poultry, and vegetables. Dining out with heart failure will require some advanced planning and attention to food choices to ensure that your meals are low in sodium and that they are heart-healthy.
Plan ahead before going to eat out at a restaurant by checking the menu online and the nutrition information that is available. Once you arrive at the restaurant, clearly state that you would like your meals to be prepared without added salt and that you would like sauces, gravies, and dressings, which are often high in sodium, to be provided on the side of your food. Try sticking to grilled, steamed, or even baked dishes rather than fried or sauteed ones, as these options are usually healthier, and they are lower in sodium and fat.
Follow the guidelines that your medical team has provided for you specifically, as this will be beneficial to your success in managing chronic heart failure. [MUSIC PLAYING]
Women Face Increased Heart Health Risks As They Enter Menopause, But Many Don't Know It
Less than a minute into Lara Shayne's daily workout a few years ago, she couldn't catch her breath.
"I felt like an elephant was on my chest and I couldn't breathe," the North Center resident recalled.
Shayne, then 53, drove to urgent care, where a physician assistant advised she go to an emergency room after they performed an electrocardiogram to test heart function.
A CT scan later revealed Shayne's diagnosis: an 80% blockage of the left anterior descending (LAD) artery, a major supplier of blood to that side of the heart. After a night in the hospital, she had an angioplasty procedure to unblock the artery and a stent implanted to keep it open. If not caught in time, she would have had a heart attack.
Now 56, Shayne experienced her cardiac event a year after starting menopause, a life stage 6,000 U.S. Women reach daily and when cardiovascular disease risks such as heart disease, heart attack and stroke can accelerate in women.
Though menopause doesn't cause heart disease, dropping estrogen levels cause bodily changes that impact cardiovascular health, according to the American Heart Association. But despite the increased risk, many women aren't aware of the risk and many doctors don't discuss it.
"I cried until I had survived the stent surgery. I've never been so scared in my life," said Shayne. She acknowledged being "very lucky" because a 100% LAD clogged artery can cause a massive heart attack often called a "widow-maker" due to its low survival rate — but they pose a huge risk to women as well.
"I cried until I had survived the stent surgery. I've never been so scared in my life," said Lara Shayne of North Center. She acknowledged being "very lucky" because a 100% LAD clogged artery can cause a massive heart attack called a "widow-maker," due to its low survival rate.
Tyler Pasciak LaRiviere/Sun-Times
Heart disease is the No. 1 killer of women in the U.S. — and Chicago. Of the more than 4,600 deaths from the disease citywide, 42% are women, according to the latest data from the Chicago Health Atlas. And for women who hit menopause before age 40, considered premature menopause, experts say there is a greater risk of developing coronary heart disease.
Across Illinois, nearly 45% of the 25,630 people who die from heart disease are women, and 11% are in the 40-to-64 age range, Illinois Department of Public Health (IDPH) 2023 statistics show. Despite the condition's prevalence, research shows that awareness gaps exist between women and health care providers about the increased heart health risks surrounding menopause.
Until recently, Shayne, a labor lawyer, said no doctor had ever discussed the link between the two. She also faced an increased risk because her dad died of a heart attack at 43, and cardiovascular experts agree there is heightened concern for women who also have a family history of heart disease.
How does menopause affect heart health?Menopause is when a woman goes one year without a period, representing a natural end of her reproductive years. Although the average menopause age for U.S. Women is 51, estrogen levels begin decreasing earlier in the transitional years called perimenopause. During this phase, periods become irregular. Sleep disturbances, hot flashes and night sweats may also appear, symptoms associated with higher rates of cardiovascular disease, American Heart Association data show.
Dr. Priya Freaney, a cardiologist at Northwestern University, said women face greater risk factors for heart disease around the time of menopause as the body's natural estrogen declines and drives worsening health outcomes.
Dr. Priya Freaney, a cardiologist at Northwestern University, said women face greater risk factors for heart disease around the time of menopause as the body's natural estrogen declines and drives worsening health trends. Total cholesterol and LDL (or "bad" cholesterol) increases as HDL ("good" cholesterol) decreases, blood pressure rises, body fat mass goes up as muscle mass declines, vascular — or blood vessel — health worsens as arteries stiffen, and sleep quality declines, she explained.
The downstream effect is increased cardiovascular risk, which can continue after menopause. Still, not everyone develops heart disease, Freaney noted.
"Naturally-produced estrogen by the body is protective," said Dr. Tochi Okwuosa, a professor of cardiology and director of Rush University Medical Center's cardio-oncology program. She emphasized that blood vessels are healthier with the hormone on board: It protects what's called the endothelial function, ensuring blood vessels relax and dilate as needed to regulate blood pressure and keep arteries healthy to protect the heart.
At menopause, a sharp drop in estrogen levels makes it easier for cholesterol plaque to build up along the artery walls. If the arteries get too narrow, Okwuosa said, there is an increased likelihood of chest pains that "you tend to see in women." Both higher cholesterol and blood pressure increase heart attack and stroke risk.
Lifestyle changes can lower these risks.
In the years leading up to menopause, consistent cardiovascular exercise and strength training, maintaining a healthy diet and weight, and avoiding tobacco and alcohol are key. Freaney advised home-cooked meals and a Mediterranean-style diet with lots of lean proteins such as chicken, turkey and fish, vegetables, whole grains — plus, avoiding fried foods and bready sweets.
The American Heart Association recommends 150 minutes of moderate-intensity aerobic exercise a week like fast walking or tennis, or 75 minutes of high-intensity activity like running or swimming.
Okwuosa urges patients to dance, bike and make movement fun, and stick with a low-cholesterol, low-sodium diet to control risk factors and improve overall cardiovascular health and life.
Dr. Tochi Okwuosa is a professor of cardiology and director of Rush University Medical Center's cardio-oncology program.
Despite experiencing hot flashes, Shayne decided against hormone replacement therapy (HRT) after weighing the risks with her doctor at the Women's Heart Care Clinic within Northwestern Medicine's Bluhm Cardiovascular Institute, where she is a patient.
Taking estrogen can be beneficial in managing some menopause-related symptoms such as night sweats, hot flashes and sleep disturbances depending on factors such as age, timing and health history. And for some individuals, Freaney said, it's been shown to be safe for the heart.
But sometimes, taking estrogen can actually worsen heart disease, according to Freaney. "Someone who's had a heart attack, stroke or gotten a stent because of severe blockages in the arteries around the heart, those are the group of patients generally advised to avoid systemic hormone replacement therapy," she said. "Data shows that in these groups taking systemic HRT can lead to clotting problems."
Today, Shayne lifts weights and completes 45-minute daily elliptical workouts. She takes blood pressure medications, baby aspirin and a statin for cholesterol. "I don't want anything to risk my heart," Shayne said.
Reflecting on her experience, she acknowledged: "I do recognize how lucky I am."
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