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Melanie Cole (Host): For patients with heart failure, recent years have brought an increasing number of treatment options for this serious condition. My guest is Dr. Jim Bergin, he is board certified in cardiovascular disease and is medical director of Cardiac Transplant Heart Failure at UVA. Welcome to the show Dr. Bergin, please explain for the listeners, what is heart failure because they always associate this with heart attack, two different things.

Dr. Jim Bergin (Guest): Yes, thank you for having me, on the difference between or the problem with heart failure is that heart is not able to meet the demands of the body, so the primary issue with that most people consider it as a weak heart pump and so that’s the easiest way to think about someone just not getting enough flow to their body to do the natural things that they would like to do.

Melanie: Okay, so what would be some of the symptoms that would signal that this is what they have?

Dr. Bergin: The most common symptoms are going to be fatigue, they just get playing tired doing everything they want to do, shortness of breath, and those two often times go hand in hand, other symptoms that we can talk about are going to be things like early satiety, so they eat and fill out very quickly and despite that they continue to gain weight and the reason behind that would be that they are gaining fluid and so they gain fluid in their liver, gain fluid in their feet and so they will see those puffy ankles.

Melanie: Now, you know, it tends to affect older patients, who is at risk for heart failure?

Dr. Bergin: So, in my opening comment, I mentioned that’s weak heart pump and so often times you are right, it is the older patients and about 60% or so the people that we see or that are seen nationally are going to have had a prior heart attack, so its related to heart attack, but prior heart attack because of the damage to the heart muscle, so you see a big group of those people are at risk, so someone who has had a big heart attack involving the front wall of their heart will be at risk for heart failure in the long term, there are people who have multivessel coronary artery disease or diabetic that tend to have diffuse disease, but the other group that is quite common and makes up about 50% of all the heart failure patients we see are the older patients who have had a long history of hypertension and diabetes and so their problem is their heart muscle is quite strong, but it just doesn’t relax, so you get this thick kind of muscle bound heart or heart is infiltrated with some protein for example and it just cannot relax and so the pressures inside the heart go up and cause the exact same symptoms.

Melanie: So, someone has had high blood pressure for many years or diabetes, that is going to predispose them to have.

Dr. Bergin: Exactly right.

Melanie: So, in the recent years, what has come up for treatments for people that are suffering from congestive heart failure?

Dr. Russel: So sadly, the last script that we just talked about those with diabetes and high blood pressure who have the thick heart muscle that squeezes well and they have a lot of symptoms and unfortunately that group, not a whole lot of advancements have been made. The other group, that weak heart muscle group, is really where we have done much better and the advancements are the medical therapies to help the heart muscle unload the blood that comes into it and that would be drugs like what are called ACE inhibitors or angiotensin receptor blockers and then we tend to use a lot of beta-blockers with drugs like for example carvedilol and metoprolol and those help out the heart muscle and try to keep it from continuing to dilate and weaken over time. We use a lot of diuretics to help out with symptoms, so if someone doesn’t have shortness of breath or doesn’t have swelling then they don’t need a diuretic, but otherwise we like to use those to keep the fluid off of those people and so those are the kind of mainstays of therapy and then a drug that has been around forever is a drug called spironolactone, its kind of a weak diuretic and we use that also and that’s also been shown to be very helpful in those group. The other things that have come out has been around for about a decade now that’s going to be the pacemaker, so defibrillators to prevent heart rhythm disturbances and then pacemakers in selected patients, they can improve the heart function. Those are patients who have what are called bundle branch blocks and then often times in that group of people, we can significantly improve their symptoms by putting in a pacemaker.

Melanie: What would you like patients to do at home whether or not they have got a pacemaker and they are adhering to their medications, are there some lifestyle management things you want them to be aware of?

Dr. Bergin: There are, we preach a lot in clinic about salt reduction. There is some controversy about that, but I think that a controlled salt diet would be helpful for anyone who has congestive type symptoms, so what you want to shoot for is about 2 g of sodium or less per day. You want to limit the amount of fluid you take in because the more fluid you take in, the more you have to get rid of, otherwise it just builds up in your system and causes congestion whether it’s the weak heart muscle or the strong heart muscle, so we like people to do that, we really like people to weigh themselves daily so that they can keep an eye on whether fluid is creeping up on them, we really like people to exercise. Exercise is really a key part. It doesn’t really strengthen the heart so much but keeps the rest of the body in much better shape and so that patients do much better long term with that kind of approach.

Melanie: How would someone know if fluid is building up a little bit?

Dr. Bergin: The symptoms really are just going to be that early satiety and so they start to fill up, so they are eating less precariously, they are gaining weight and that just doesn’t go along well together and so that often times means fluid is building and then we also ask people, you know, to weigh yourself if you have gained more than 3 pounds over a 24-hour cycle or more than 5 pounds in a week that more commonly is fluid rather than calorie type weight gain and so you can look for those and then often times people will notice their sock lines, you know, where the sock is on your leg, it starts to leave a line or you have to let the belt out another notch or two because your belly is expanding from fluid, so those are the primary things we ask people to watch for.

Melanie: And should they reduce their fluids, I mean, it would seem that’s a little bit confusing if they think that they could be building up fluids in their body, you know, and should they stop drinking so much water.

Dr. Bergin: So, often times people feel like if they drink more, they will go to the bathroom more and so they will not try to flush the system, but that really works against you. Its actually kind of remarkable that if you add up, just take those space of a month for example if you, everything that you drink in or everything that you eat that has fluid in it has to be matched by what you get rid off, so whether you sweat or spit or go to the bathroom, all of that has to be equal, otherwise you are going to gain or, you know, gain too much fluid or dehydrate, so the body is just remarkable on that control, but the more you drink in, if your body is not able to control that, so your kidneys are not quite getting the same amount of blood flow or they are not working quite as well because the heart congestion is leading to kidney problems then you are not going to eliminate the fluid the same ways if you take in, you know, lots of fluid and you don’t get rid of it then you just fill up, so we do like to try to limit people to about 2 liters of fluid a day or less.

Melanie: And what are some of the newest treatments available now at UVA?

Dr. Bergin: The big areas that we, you know, for a long time, we have been doing heart transplantation, bigger area that is coming along now is using these left ventricle assist pumps. We put them into people for either is a what’s called the bridge to transplantation or we put them in as a sole therapy which is called destination therapy, so a lot of the research now has been in these heart pumps to make them smaller, make them better, make them easier to live with and eventually those will continue to improve, so it will be fully implantable and so that’s really the direction that everyone is headed with these assisted devices. The other thing that we have been doing have been part of studies to put in monitors for example, so you can put a pressure monitor within the heart and that can help alert you to the fact that someone is gaining fluid or losing fluid too rapidly and you can make more kind of day-to-day or moment-to-moment adjustments in their fluid intake, so those are probably the big areas where the monitoring in the assist pumps.

Melanie: And Dr. Bergin, please give us your best advice for people living with congestive heart failure and why should patients come to UVA’s Heart Failure and Transplant Center for their care?

Dr. Bergin: I think my advice would be to don’t give up, often times with therapy we can take people who are feeling poorly and limited and improve their quality of life and you never know when new advancements will come along that will revolutionize how we treat, so I say don’t give up, keep socializing, keep getting out there and try to do the best you can with your heart failure disease and I think the reason to come to UVA is because we do have a fully comprehensive center, so its from the nurses that greet you, the nurse practitioners that help out with the care, the physicians that put the care along side the surgeons to putting the new pumps and taking care of these patients, we really offer a full service network.

Melanie: Thank you so much Dr. Jim Bergin, board certified in cardiovascular disease and medical director of the Cardiac Transplant and Heart Failure Center at UVA. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.