Stages of Heart Failure

Classification systems of the various stages of heart failure have been developed to help physicians determine the severity of the condition and develop a program to treat your heart. To determine the best course of treatment, physicians may classify heart failure using one of two measurements.

There are two different systems because one focuses on the symptoms of the disease, while the other focuses on the physical functioning of the heart. While physicians will use both to define heart failure, the New York Heart Association is more established and will be the focus on this website.

New York Heart Association (NYHA) Classification Scale

This scale classifies heart failure in categories from one to four based on a patient's symptoms. In NYHA Class I heart failure, the mildest form, individuals can perform everyday activities and not feel winded or fatigued. NYHA Class IV is the most severe, and individuals are short of breath even at rest. The NYHA classification system is very useful for physicians and nurses who treat patients with heart failure. It helps them determine if the condition is improving, staying the same or getting worse. It is also used in research studies to evaluate the effectiveness of new heart failure treatments.

American College of Cardiology (ACC) / American Heart Association (AHA) Classification System

This newer classification system uses the letters A to D to define the heart's condition. The system includes a category for individuals who are at risk of developing heart failure. For example, a person who has several risk factors for heart failure is Stage A. Even though this person may not yet have symptoms of heart failure or any structural abnormality of the heart, physicians can use this classification to identify the risk factors and begin early, more aggressive treatment to help prevent or delay the onset of heart failure.

Early-Stage Heart Failure Treatments

There are many heart failure treatment options available now, and researchers continue to explore new and exciting options for the future. Chances are you've come to this website because you have spoken with your personal physician or cardiologist about heart failure and you want to know more. Learning about the types of drugs and treatments and how they work will help you decide what's best for you.

It is important to follow your physician's instructions carefully. Don't alter the dosage of your medications or stop taking any medication suddenly. Keep your follow-up appointments and be sure to inform your physician of any new symptoms.

Commonly Asked Questions

1. How long will I live?

This is most likely your first question and biggest concern. Since so many factors come into play, it is also the most difficult for physicians to answer. Furthermore, a lot has to do with your compliance with medications and lifestyle changes. If you follow the physician's orders, your prognosis will likely improve and you will likely maintain a higher quality of life.

 

2. Will I be able to work?

Most early-stage heart failure patients are able to perform tasks that are not overly strenuous. Many patients are able to do their jobs without any limitation whatsoever. To determine this, your physician will most likely prescribe an exercise stress test to help determine your physical ability.

 

3. What about hobbies and physical activities?

Your physician will probably prescribe an exercise stress test. The main concern is preventing arrhythmias that could occur with an unsafe level of physical activity. Patients with ejection fractions of less than 35% may carry an increased risk of arrhythmias or congestion in the lungs. Activities such as lifting heavy objects or those that could lead to shortness of breath, light-headedness or fatigue should be avoided. Ask your physician for specific recommendations.

 

4. What types of food should I limit or avoid?

Eat healthy. Avoid fatty, processed and fried foods; eat fresh fruits and vegetables. Discuss sodium intake with your physician. Learn how much sodium, fat and calories are in the foods you eat, and learn to read nutrition labels. Learn about the nutritional content of foods you commonly eat. Learn which options are healthy choices to make when dining out.

5. Is it OK for me to drive?

Your physician, your family and you should discuss and determine whether you should drive. Typically, heart failure is not seen as a limiting factor in obtaining or renewing a drivers' license.

 

6. What if I miss a dose of my medication?

Never alter a dose without consulting your physician. If you miss a dose, notify your physician. It is a good idea to discuss in advance what you should do if you miss a dose or forget your medication while traveling or away from home. Only your physician should direct you to reduce or increase the dosage of any medication you are taking.

7. What tests can I expect?

Several tests are used to diagnose heart failure. An echocardiogram is the primary diagnostic test. It uses sound waves to produce pictures of the walls, chambers and valves of the heart to determine what the heart is capable of pumping. Other tests include chest x-rays, EKG (electrocardiogram), MRI, exercise tolerance testing and blood panels.

 

8. How can I join a heart failure support group?

There are many support groups available for patients and caregivers.  . Your medical team can give you additional suggestions. You may also meet with a counselor who specializes in cardiac rehabilitation. Most communities have many additional resources that may be useful. Contact hospitals, eldercare facilities, community centers, churches and the YMCA/YWCA for additional options.

9. How am I going to pay for medications/procedures?

Many medications and procedures for heart failure patients are covered by insurance. Some drug companies offer patient medication assistance programs in cases of financial hardship. Ask your physician about the use of less expensive, generic medications that are proven to be effective.

Drug Therapies

While several types of medications are used to treat heart failure, advanced-stage heart failure means, in part, that your medication alone no longer adequately controls your symptoms. While you're on device-related therapy, your physician may continue to prescribe ACE inhibitors, Beta-blockers, blood thinners and diuretics, among others. It is common for a combination of heart medications to be required.

If your heart failure symptoms flare up, you may need to be hospitalized for a few days. While in the hospital, you may receive additional intravenous diuretics, vasodilator medications or inotropic medications. These drugs work to quickly relieve your symptoms and help your heart pump better.

Ventricular Assist Device (VAD)

For advanced-stage heart failure patients, drug therapies may not be enough. And as heart failure progresses to an advanced-stage, namely NHYA Class III or Class IV, a VAD may become a consideration.

VADs, which help a weakened or damaged heart pump blood throughout the body, have emerged as a viable option for many patients. These heart pumps work with the failing heart to help it pump blood to the rest of the body. They are not a heart replacement, and your heart will continue to function.

VADs can assist the normal heart function, extend life and provide an improved quality of life for those with heart failure. A VAD may be used for short-term support while a patient is waiting for a donor heart for a bridge-to-transplantation. And for patients who are ineligible for a heart transplant, a VAD may be used for long-term or permanent support.

Heart failure studies have demonstrated that long-term use of VADs can help patients with severe heart failure live longer and enjoy an improved quality of life compared with those being treated with medication.1 In fact, patients with a VAD, who previously had severe symptoms even at rest, were able to resume normal activities with little or no limitation. The reduction in symptoms was both dramatic and sustained over time.

  Commonly Asked Questions

 

1. How does a cardiac resynchronization therapy (CRT) device work? Is it a good option for me?

A CRT device is a small, battery-operated device that stimulates the heart to make it beat more efficiently. If you suffer from advanced-stage heart failure, your physician may prescribe a CRT device for you.

2. What are the benefits and risks of a heart transplant?

As with any major surgery, a heart transplant carries substantial risk. The most daunting risk is the body rejecting the donor heart. There is also a greater risk of infection because of the immunosuppressive drugs (drugs that weaken your immune system) that must be taken to prevent transplant rejection. And, as with any major surgery, there is a risk of bleeding. But many patients who have been successfully transplanted have gone on to live much longer, more normal lives than they would have without the transplant. Your cardiologist and surgeon will discuss benefits and risks with you prior to the procedure.

3. If I am not eligible for a heart transplant, what are my long-term options?

Ventricular assist devices (VADs) are proving to be viable options for many advanced-stage heart failure patients. Clinical trials have shown that patients with advanced-stage heart failure can live longer and enjoy significantly improved quality of life compared with those being treated with optimal medical management (drug therapy) alone. After surgery, the major risks for VADs include infection, internal bleeding and device failure.

 

4. What is a VAD? How does it work?

A VAD is an implantable, electrically powered (through a battery worn outside the body) heart pump, which is designed to help restore proper pumping function to a weakened or damaged heart. It works to improve blood flow in concert with your heart - it does not replace your own heart.

5. What are some potential complications of ventricular assist device (VAD) surgery?

Complications of VAD surgery are similar to the potential complications of any open-heart surgery procedure. You will be asked to sign a surgical consent form prior to the operation, as well as a consent form for blood transfusions. Your surgeon will discuss potential risks and benefits with you prior to the procedure.

Possible serious adverse events include the following:

Death

Bleeding, perioperative or late

Cardiac arrhythmia

Local infection

Respiratory failure

Device malfunction

Sepsis

Right heart failure

Driveline or pocket infection

Renal failure

Stroke

Neurologic dysfunction

Psychiatric episode

Thromboembolic event, peripheral

Hemolysis

Hepatic dysfunction

Device thrombosis

Myocardial infarction

 

6. Can a VAD keep me alive long enough to wait for a donor heart?

One use of VADs is commonly called bridge-to-transplant. In this role, the device can help you regain organ function and improve physical conditioning while you wait for a heart transplant. Patients have been known to survive for more than two years (and some longer) on a VAD while waiting to be implanted with a donor heart.

7. Will my insurance company pay for my VAD?

Some VADs are approved for coverage by the Centers for Medicare and Medicaid Services (CMS) and many private insurance plans in certain facilities. Please contact your insurance provider for more specific coverage information, as policies may vary.

8. Will I need to take any medications?

Other than pain medication after VAD surgery and your current regimen of heart failure medication, you may require only a low dose of blood-thinning drugs. Immunosuppressive drugs (drugs that weaken your immune system) commonly prescribed after a transplant are not necessary with a VAD. Many times, the medications that you've been taking for your heart failure can be reduced or discontinued. Your physician will re-evaluate your medications before you leave the hospital and will continue to monitor them after discharge.

9. How will the VAD affect my daily routine?

VADs are designed to restore blood flow throughout your body, enabling you to breathe more easily and feel less fatigued. All of your organs will receive more blood than they did before your implant, and this will likely improve their function-you will likely feel less light-headed as you receive better blood flow to the brain, and your kidney function will likely improve as well. You should feel better overall and be able to resume most of your normal activities. However, VAD system components are not waterproof and must not be directly exposed to moisture.

People with a VAD must avoid: tub bathing, water sports, participating in vigorous activity or contact sports. Physical exercise is essential to help prevent the unhealthy effects of bed rest and inactivity. Your physician will set expectations in terms of what your activity level should be.

NOW HOW TO SURVIVE A HEART ATTACK WHEN ALONE..

Let’s say it’s 11pm and you’re going home (alone of course),

 after an unusually hard day on the job. You’re really tired, upset and frustrated. Suddenly you start  experiencing severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home. Unfortunately you don’t know if you’ll be able to make it that far. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself..!!

 

 

Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

 However, these victims can help themselves by coughing repeatedly and very vigorously.

 A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

 A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.

 Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

 The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

  Atherosclerotic Plaque


-Physical obstruction

-Increases peripheral vascular resistance

-Restricts blood flow

-Increases blood pressure