Advanced Heart Failure

Heart failure is typically considered advanced after:

• Conventional treatments stop working
• Symptoms occur with minimal or no activity
• Repeated hospitalizations
• Evidence of other organ damage due to heart failure
• Inability to handle recommended heart failure medications
• Heart disease without other medical or surgical intervention options
  
  

A person does not have to be sick in the hospital with heart failure for it to be considered advanced heart failure. In fact, many times individuals are not hospitalized, but instead are struggling at home.

Advanced heart failure symptoms include:

• Progressive breathlessness occurring either at rest, while eating, taking a shower or talking on the phone
• Worsening fatigue
• Reduced blood pressure
• Inability to tolerate standard heart failure medicines
• Persistent angina, without any options to improve blood flow to the heart’s arteries
  
  

Heart failure can have many causes, including:

• Restrictive cardiomyopathy – when the ventricles become rigid and restrict filling
• Dilated cardiomyopathy – when the heart muscle becomes abnormally enlarged, thickened or stiff because of a variety of diseases
• Cardiac amyloidosis – when there are deposits of abnormal proteins (amyloids) in the heart tissue
• Hemochromatosis – a genetic condition that causes an iron overload that poisons organs, including the heart
• Sarcoidosis – in which there is growth of inflammatory cells in different parts of the body, including the heart
• Ischemic cardiomyopathy – weakening of the heart muscle that can occur as a result of coronary artery disease
• Heart valve disease – when one or more of your heart’s valves, which facilitate blood flow, fail to open or close properly
• Arrhythmia – an irregular heartbeat, particularly one that is hard to control
  
  

If your doctor suspects heart failure, he or she may use the following tests to determine a diagnosis:

• Blood tests
• Cardiac catheterization
• Cardiac stress testing
• Echocardiography
• Cardiac MRI
• Nuclear imaging
  
  

If heart failure has progressed into advanced-stage heart failure, several treatment options can be considered, including:

• Close monitoring and adjustment of medications
• Optimization of your defibrillator or pacemaker
• Consideration of a percutaneous valve, if a valve problem exists
• Consideration of using open heart surgery to open blocked arteries
• Mechanical heart, via a left ventricular assist device (LVAD) or artificial heart
• Heart transplant, as well as multi-organ transplant when needed
• Supportive palliative care, which provides relief from symptoms, pain and the mental and physical stress associated with a serious illness
• Hospice care