What sparked your interest in studying and treating this condition?
I developed an interest from early on in medical school in cardiology in general and more specifically heart failure. The cardiac anatomy and physiology made sense to me; it was just naturally easy to understand. Meanwhile, cardiovascular disease is the number one killer in United States. I realized that I had an opportunity make an impact and to contribute to the community while doing something I found fascinating.
Heart failure is a common problem, and the number of patients (frustratingly) grows each year. Since the condition is chronic, I really get to know my patients and their families, and I hopefully can play a role in extending their lives and improving quality of life.
Can you define congestive heart failure and explain how it’s distinguished from other heart conditions?
Congestive heart failure is a general term—many different heart problems can lead to it. It occurs any time the heart’s output is inadequate to meet body’s demand. The heart is a pump: when it becomes inefficient, not enough fresh, oxygenated blood gets to tissues and organs. The system starts to back up as well: fluid builds up in the lungs and legs leading to symptoms.
How do you diagnose the problem?
During the initial interview and examination, we look for signs and symptoms of heart failure. For instance, the patient doesn’t have enough energy or stamina; wakes up feeling unable to breathe; experiences swelling in the legs; or gets out of breath doing to day-to-day activities.
We can use an echocardiogram (an ultrasound of the heart) to better quantify the heart function. Sometimes we use a cardiac angiogram to look at potential causes and blood tests to confirm the diagnosis.
Left untreated, congestive heart failure can be fatal. This can occur by progressive pump failure or fatal arrhythmia (abnormal heart rhythms).
What tools are in your toolbox to help patients?
The solutions depend on the causes. If heart function is reduced because of blockage or narrowing in the arteries that supply the heart, then angioplasty or bypass can help. If there’s a heart valve issue, repairing or replacing the valve can fix the congestive heart failure. A number of medicines in combination with appropriate surgical interventions can help patients feel better, relieve congestion and improve heart function.
For instance, Entresto (sacubitril/valsartan) is the first new medical therapy for heart failure in several years. It has demonstrated significant improvement in mortality and symptoms, and it may represent a critical step forward for advanced heart failure patients.
What would you like more people to know about heart failure?
It’s a chronic condition that ebbs and flows. There are times when it gets challenging, and there are more stable times. Patients will often get diagnosed and treated and then go back to old habits. They continue to smoke, eat too much salt or sodium, etc.
How has your work affected your personal approach to health?
Learning about and seeing the pathophysiology of those who are not physically fit—the end state of type 2 diabetes and high blood pressure—has motivated me to live a healthy lifestyle! It’s vital to adopt good habits to prevent cardiovascular disease before it develops.
James Lyons, MD, FACC
Vassar Brothers Medical Center
The Heart Center, a division of Hudson Valley Cardiovascular Practice, P.C.
1 Columbia St
Poughkeepsie, NY 12601
TTY /Accessibility: (800) 421-1220
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