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Questions and Answers
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Have a heart failure related question for our physicians?  Use the form above to submit your question – your name, email address, and location are all optional.  Please note if your question is answered that your first name and location will be displayed on the answer unless you specify otherwise.  Your email address will never be shared and is kept completely confidential.  You will be notified via email, should you choose to provide it, if your question is chosen to be answered.

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There are currently 21 answered questions available, displayed from newest to oldest.

Showing 16-20 of 21

Question asked by Debopom from India
What is the recommended treatment strategy for a patient with pneumonia and heart failure?
Answered by Dr. Brian Jaski

Both pneumonia and heart failure are common conditions that can result in shortness of breath. By definition, pneumonia is an inflammation that results in filling of the air spaces of the lungs—usually due to infection. Heart failure can also result in congestion of the lung air spaces by salt and water displaced from the circulation because of a high fluid pressure “backed up” behind the left ventricle. On a chest x-ray, different distributions of opacification of the lungs can help distinguish the two conditions. Pneumonia is usually associated with fever. Heart failure may be associated with other findings of fluid retention including elevation of a heart failure blood test. Nevertheless, especially in patients with a history of heart disease, distinguishing between the two conditions can be difficult including the possibility that both could be present at the same time. Whereas pneumonia usually requires antibiotics to improve, heart failure with lung congestion may need therapies to increase the removal of excess salt and water from the body.

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Question asked by Aishah
My 74 year old grandmother was recently diagnosed with heart failure. Doctors claim she has just 29% of her heart’s life left. She is diabetic and has high blood pressure as well. She recently became very ill when fluids filled up in her lungs leading to breathing issues and an increased heart rate. While in the hospital she had to receive cardioversions twice to reduce her heart rate. Kindly advise me on what precautionary measures we can take and what we can expect for her future health.
Answered by Dr. Brian Jaski

Several important points emerged from your question. First, I would define ejection fraction as the amount of blood ejected by the heart with each beat as a fraction of what it starts with at the beginning of a beat. For example, if the heart has a 100ml of blood at the beginning and ejects 60ml leaving 40ml, that would be an ejection fraction of 60%. If the heart were to flatten like a pancake when it contracted, the ejection fraction would then be 100%, but that never happens. Normally the heart ejects about 2/3 of the blood it starts with at the beginning of a beat. So if your grandmother has an ejection fraction of 29%–that is seriously decreased but it’s not 29% of 100%, but 29% of a normal range of 55-75%.

Secondly, your mother was given a diagnosis of “Heart Failure”, I like to use the analogy of a car–this would be like a mechanic saying you have “engine trouble”. The question is why? For example is there a problem with her heart arteries (“fuel lines”)? Is her heart muscle weak despite an adequate blood supply (“bad cylinders”)? Does she have a problem with the electrical activation of her heart (” a problem with the distributor”). The answer to these questions may lead to specific therapies that could help her.

Lastly, In general, there are recommendations that should come from her doctor and medical team, including medication, diet and exercise. Please look at the sections in our website specific to these topics which may help.

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Question asked by Gregory K. from Oklahoma
Hello Dr. Jaski, I was once a patient of yours and I have since relocated out of state. My question is, can cardiomyopathy and/or congestive heart failure (CHF) be a result of untreated sleep apnea? It is a question of mine since I have both of these at such a young age.
Answered by Dr. Brian Jaski

Hi Greg,

As you know, sleep apnea is a relatively common condition typically associated with periodic obstruction of breathing by the tongue during sleep. Frequently it is suspected when someone is noted to be a loud snorer and has fatigue during the day due to ineffective rest at night. It is more common in individuals who are overweight–the condition can be improved by weight loss. It is often treated by having someone wear a special mask at night that provides continuous positive airway pressure (CPAP) to prevent or relieve the tendency to airway obstruction.

It has been increasingly recognized that untreated sleep apnea can exacerbate the findings of heart failure if someone is prone to the condition. Blood pressure is elevated during episodes of obstructive breathing at night. Other hormonal systems are activated as well that lead to the progression of heart failure. Ironically, heart failure itself can complicate things by making disordered breathing more likely. In general, if you have a suspicion for sleep apnea, it is best to be evaluated, especially if you have a history of heart failure. Whether sleep-apnea by itself can cause heart failure or cardiomyopathy without other risk factors is currently uncertain, but a topic of ongoing clinical research.

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Question asked by Anonymous
My father had a mitral valve replaced 30 years ago and today underwent an angiogram to see what’s going on with his heart. His mitral valve is still working well and his arteries are clear however he has been told that he has another badly leaking valve and will not be offered surgery to correct it as his heart is too weak. He is already taking high doses of diuretics to help alleviate the buildup of fluids around his lungs and abdomen. As surgery has been ruled out what other treatments could be offered to help his condition?
Answered by Dr. Brian Jaski

A leaky heart valve that regulates the direction of the flow in or out of the left ventricle (atrial or aortic) can by itself lead the heart to weaken. The heart is working “overtime”. If the hearts impaired condition is too advanced it is possible that the surgery to repair or replace would be too risky.

In those cases medications including diuretics and others can still help. Other factors including your father’s age at this time may also be relevant.

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Question asked by Nicole from Phoenix, AZ
Can a patient with heart failure experience a cough and facial periorbital edema from the disease process? Or, could these symptoms be unrelated?
Answered by Dr. Brian Jaski

There are 2 aspects to your question. Cough is a symptom that has many causes including congestion of the lungs associated with heart failure. When this is the cause, cough often improves with an increase in  the dose of diuretics- less commonly, a dry cough especially at night may be a side effect of a class of heart failure medications called angiotensin-converting enzyme inhibitors (for example, lisinopril, enalapril, captopril).

Fluid retention associated with heart failure usually is seen in the locations of the body most affected by gravity: the ankles, calves, or possibly abdomen. Although facial swelling may be seen with heart failure, other causes should in general be considered (such low protein states or facial inflammation). If this symptom persists, you should bring this up with your doctor.

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