Caring for someone with heart failure (HF) can be stressful and scary, and you may have a lot of questions. Knowing more about the disease, and what to expect as it progresses, will prepare you to help your loved one manage their symptoms.
What is Heart Failure?
When someone has been diagnosed with HF, it means their heart is too weak to pump enough blood to meet the body’s need for blood and oxygen. In some cases, the heart simply cannot pump with enough force. In others, the heart cannot fill with enough blood. This can cause a serious interruption to the flow of the entire circulatory system. While heart failure can affect one side of the heart or the other, most cases of heart failure eventually involve both sides.
Congestive heart failure (CHF) is often used interchangeably with HF, but it is a specific type that is very serious. It occurs when the circulatory system is so compromised that blood and other fluids gather in certain areas of the body, congesting tissues. This can lead to edema (swelling) in the lower extremities, the abdomen and even the lungs. When fluid collects around the heart, lungs and other internal organs, it can cause serious symptoms that must be closely monitored.
What Types of Doctors Treat Heart Failure?
Your loved one may receive treatment from a general practitioner (GP) or family medicine physician (FMP) at first. However, as symptoms progress, they will probably make referrals to one or more specialists who have specific qualifications and more experience working with patients who have heart failure.
Internists (doctors who specialize in internal medicine for adults) may manage treatment in conjunction with a cardiologist. Cardiologists specialize in diseases that affect the heart and blood vessels, so they are often involved in patient treatment, especially as heart failure progresses. Some cardiologists have received advanced training and specialize in treating heart failure. Other specialists you may become familiar with include cardiac electrophysiologists, who specialize in heart rhythm problems, and cardiac surgeons, who specialize in heart surgeries.
What Are the Different “Stages” of Heart Failure?
HF is generally organized in four “classes” or stages. Patients can only move forward in the stages, not backwards. Below you will find an explanation of what you and your loved one can expect in each stage.
Class A
Someone with a family history of heart problems, diabetes or high blood pressure (hypertension), or someone who smokes, abuses alcohol or eats a high-fat diet may be considered a candidate for class A heart failure. However, a patient with class A HF does not show any symptoms and does not experience any limitations in ordinary activities.
A senior who has been diagnosed with class A HF will generally need to monitor and manage their blood pressure and cholesterol. They may also be prescribed medication and lifestyle changes to help get, and keep these things under control.
Doctors will likely order cholesterol and C-reactive protein (CRP) blood tests and may also order chest x-rays and/or electrocardiogram tests to confirm this diagnosis. Because patients do not show any symptoms yet at this stage, seniors can continue to maintain an active lifestyle. Becoming more physically active (as they are able), quitting smoking, and lowering or discontinuing alcohol use may help to slow the disease’s progress.
Class B
With a class B diagnosis, there is some evidence of cardiovascular disease. The patient shows mild symptoms and some slight limitations during ordinary activities but is comfortable at rest.
Doctors will want to continue monitoring blood pressure carefully. Additional chest x-rays, electrocardiograms, blood tests and/or echocardiograms may be conducted to determine the stage. Stress tests, MRIs or CT scans may also be required to diagnose this stage.
More aggressive medications may be prescribed to keep blood pressure and cholesterol in check, including ACE-inhibitors and beta blockers. Doctors may also discuss possible surgical options for coronary artery repair and valve replacement or repair.
Seniors with class B heart failure can still be fairly active. They may find they experience shortness of breath more frequently than before, so they should be mindful to not over-exert themselves. When done responsibly, moderate activity at this stage can still help slow the disease’s progression.
Class C
A patient with class C HF shows increasing evidence of moderately severe cardiovascular disease. Generally at this stage, the patient has obvious limitations in their routine activities due to their symptoms. Less than ordinary activities can result in fatigue, heart palpitations or labored breathing, and the patient is typically only comfortable while resting.
The same diagnostic tests used for classes A and B may be used to diagnose this class of HF. Doctors may also request coronary angiograms and/or myocardial biopsies. These tests can diagnose certain types of heart muscle diseases, allowing doctors to treat the patient more effectively. In addition to the treatment options described above for patients in classes A and B, doctors may also consider cardiac resynchronization therapy (a pacemaker) and implantable defibrillators.
Those in class C often find they are unable to be very active because of their symptoms, and should discuss safe exercise options with their doctors.
Class D
A patient with class D heart failure shows objective symptoms of severe cardiovascular disease and is severely limited in their activities. Unlike the previous stages, they will continue experiencing symptoms even while at rest.
Treatment options for advanced heart failure are growing and may include such things as implantable defibrillators, which shock a “fluttering” heart back into normal action, or mechanical heart pumps, which can relieve shortness of breath and other congestion-related symptoms. However, there are risks associated with these options that may outweigh the potential benefits for some seniors. For example, heart pumps, also called “left ventricular assist devices,” may increase the risk of stroke, internal bleeding or infection.
Different types of open heart surgery are also considered for treating some class D heart failure patients, but this type of invasive treatment comes with a lot of risk. Unfortunately, many seniors are not good candidates for this option. Patients in this advanced stage may also receive continuous medication through the use of IV drips and may need palliative or hospice care to achieve comfort.
Commonly Prescribed Medications for Heart Failure
ACE (angiotensin-converting enzyme) inhibitors, beta blockers and diuretics are commonly associated with the treatment of heart failure. As a loved one’s HF progresses, they may be given more medications to help improve and regulate the function of their heart and circulatory system. Nitrates, statins and blood-thinners may also be added to their regimen to manage chest pain, cholesterol levels and blood clotting respectively.
While you and your loved one should speak extensively with their health care team in detail about the medications that are added to their regimen, there are a couple of important things to know about a few of the above drugs.
ACE Inhibitors can interact with other medications, like NSAIDs (nonsteroidal anti-inflammatory drugs) and antacids, and result in kidney injury, especially for those who already have compromised kidney function. These drugs can also cause hyperkalemia, or an elevated level of potassium in the blood.
Common side effects of beta blockers include cold hands and feet, fatigue, dizziness and dry mouth. The results of a recent study also suggest that taking beta blockers can potentially affect a patient’s mental state and mood as well.
Since diuretics help the body to eliminate excess water and salt through urination, it comes as no surprise that some important minerals can be depleted during this course of treatment. This class of drug also affects blood-potassium levels. If your loved one is taking a diuretic and an ACE inhibitor, for example, this is something that their doctor should carefully monitor. Dizziness and dehydration can also be more serious side-effects.
These medications are prescribed to reduce overall stress on a person’s heart, but certain combinations of these and others can result in a slowed heart rate (bradycardia), a drop in blood pressure (hypotension), and irregular heartbeat (arrhythmias). If your loved one experiences any of these symptoms, it is wise to contact their physician immediately.
How to Track Symptoms and Treatments Through the Stages
Blood pressure and heart rate can be monitored at home with a blood pressure cuff purchased from a drugstore or other retailer. Keep track of these changes, weight changes, and changes in physical activity level/ability. Doing so will help the patient’s physician better diagnose and treat the appropriate stage of heart failure.
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