Heart Failure Service
Heart failure affects nearly 5 million Americans, with over 400,000 new cases being diagnosed each year. Tremendous advances in medical and surgical therapy for coronary artery disease, congenital heart disease, valvular heart disease and life-threatening arrhythmias have significantly extended the lives of patients with serious cardiac conditions.
In addition to the usual risk factors (diabetes, hypertension, coronary disease), a host of less common but not rare instances of acute and chronic heart failure occur and require special insight into diagnosis and treatment. When younger patients present with heart failure, it is more commonly a consequence of myocarditis, an inflammatory response often to a common viral illness which may resolve or may go on to significant cardiac sequelae. Early on in the course it is imperative to assess for different types of inflammation which may require specialty treatment or urgent interventions. Other less common causes of “systolic heart failure” may include cardiac noncompaction, consequences of cancer treatment, systemic illnesses which may effect the heart including connective tissue and inflammatory diseases (sarcoid, lupus, rheumatoid arthritis, scleroderma spectrum of disease), or fatty infiltration of the heart (ARVD).
Heart Failure with preserved ejection fraction (HFpEF), sometimes referred to as diastolic heart failure, is increasingly recognized as the most common etiology of heart failure among the elderly. It is likely that this “disease” is a combination of multiple different diseases which may include the sequelae of high blood pressure, stiff and aging systemic and pulmonary vasculature, repetitive and cumulative ischemic insults, concomitant valvular involvement (aortic mitral tricuspid valve disease) and disorders of the upper chamber. “Left atrial abnormalities” are often a consequence of atrial fibrillation and consequences of renal disease. Here too, there are some more esoteric diseases such as amyloid, which deposit the abnormal amyloid protein in the heart, which may be due to a hematological abnormality (AL amyloid), an aging protein (wild type abnormal transthyretin) or an inherited abnormality (genetically abnormal transthyretin protein). Hypertrophic Cardiomyopathy (with or without outflow obstruction, apical variant) may present with heart failure symptoms, chest pain or arrhythmias. Treatment approaches will necessitate appropriate imaging (MRI, echo, CT), hemodynamic and arrhythmia assessments, and appropriate genetic testing in some. Treatment modalities may include medications and occasionally surgery, with less enthusiasm for alcohol ablation. Complications of iron overload conditions such as thalassemia and other transfusion-dependent conditions may lead to particular types of heart failure.
Heart Failure symptoms are due to the inability of the heart to respond normally to an increased demand with activity. The abnormal heart has an altered “pressure-volume” relationship by which either the heart responds with one or another type of enlargement of the cardiac chambers (hypertrophy or dilation). This often leads to fluid retention, symptoms of shortness of breath, swelling, exercise intolerance, general fatigue and arrhythmias. In its most extreme form, patients cannot perform the activities of daily living – like dressing and bathing – without assistance. They also may have cardiac related sleep disordered breathing patterns.
For all, early diagnosis, treatment, and long-term care of patients with heart failure requires a team approach with physicians, nurse practitioners, dieticians, physical therapists, and social workers working together to maximize patients’ functioning, know when it is appropriate to consider high risk surgical or catheter-based techniques, advanced therapies including mechanical circulatory support devices, transplant consideration, how to empower patients and partner with the team to adjust medications and maximize their capabilities.
The Perkin Center for Heart Failure, Mechanical Circulatory Support and Pulmonary Vascular Disease at Weill Cornell Cardiology offers the following services:
- In-patient treatment. We offer the most advanced care for heart failure. In some cases this includes invasive monitoring procedures to establish the diagnosis, achieve the most effective treatment for heart failure management. Some patients may have consequences of advanced valvular heart disease. For those patients who are most critically ill, evaluation for mechanical circulatory support and/or transplant evaluation, and in-patient consultation for complicated heart failure, perioperative management, high risk conventional cardiac surgery, and cardiac obstetrical care.
- Management of ventricular assist device therapy for patients in which the unassisted heart is unable to pump enough blood from advanced heart failure or occasionally following a heart attack or open-heart surgery.
- ECMO support for the “crashing patient.”
- Cardiopulmonary exercise testing to identify those most at risk for advanced heart failure, to identify individuals who would benefit from resynchronization therapy, and to determine whether the cause of a patient's difficulty breathing is heart-based or lung-based.
- Out-patient management of individuals with compensated heart failure. This includes intensive nutritional/dietary counseling, as well as weekly telephone follow-up by a Nurse Practitioner trained in heart failure management.
- Opportunities for participation in multi-center clinical trials as well as ongoing original research.
- End-of-life management and palliative care for patients with unresponsive symptoms and limited life expectancy.