Demystifying heart failure: A Q&A with Gabriel Sayer, MD

Jeevanandam heart failure

Millions of people in the United States currently deal with issues related to heart failure. While the name of their condition might sound dire, many heart failure patients actually have a great quality of life for the long term. They’re able to do this in part because of dietary and medical therapies and, sometimes, surgery. In short, a diagnosis of heart failure means the heart isn’t pumping like it should.

UChicago Medicine heart failure expert Gabriel Sayer, MD, explains some of the key things he addresses with patients.

What are some symptoms or signs I may be experiencing heart failure, and when should I see a doctor?

Sayer: The most common symptom of heart failure is shortness of breath. Additionally, if someone has swelling in their legs, or has a bloated or distended abdomen, they should get evaluated by a physician. One of the main problems with heart failure is the retention of fluids in the body, which causes this swelling. In addition, if someone experiences shortness of breath when they lie down or a cough when they lie down, that is another sign that should be evaluated.

What are common questions patients ask you after being diagnosed?

Sayer: People always are interested to hear how serious it is. What does it mean for them in terms of how sick they are, and how is it going to affect their quality of life and survival? I think the first visit we spend a lot of time talking about what we can do to get heart failure better — what is the expectation, and when we’d expect some kind of results.

Does all heart failure look the same?

Sayer: We see a huge range of patients. Heart failure is more common in older patients, but it’s one of the diseases that can really affect a person at any age. We also see a huge range of causes. In older people, we see more patients who come in with heart failure due to a heart attack or blockages in coronary arteries. In younger people, we see heart failure related to a viral infection or high blood pressure or sometimes following pregnancy.

While the range of patients varies, most of their symptoms are the same. The primary symptom we see is shortness of breath with exertion — when they walk or do something strenuous like climbing a hill, they’ll get tired very easily. People can also develop fatigue, cough, nausea and loss of appetite.

How is it treated?

Sayer: There are three general types of treatment: lifestyle modifications, medical therapies and surgical interventions. In terms of lifestyle modifications, all heart failure patients are told to reduce the amount of salt they take in, limiting it to about two grams of salt per day. Too much salt causes the body to hold onto too much fluid, which gets into heart and lungs and makes them short of breath. We also counsel patients about not drinking too much fluid, and we counsel people on stopping the use of alcohol and tobacco as quickly as possible.

In terms of medication, one of the primary issues for patients is that they’re holding on to too much fluid. To help with this, we give diuretics, which are aimed at getting rid of fluid through the kidneys. Other medications help the heart get stronger over the long term. Most of the medications we use are not designed to change symptoms acutely, but help over time.

Medical therapies are the mainstay, and the vast majority of patients remain on medications throughout their lives. About 5 percent of heart failure patients progress to advanced heart failure. For those patients, if they are eligible, we can offer them surgical therapies like heart transplantation or the placement of a mechanical assist device to help their heart pump correctly.

What are some common misconceptions people have about heart failure?

Sayer: I think people hear that their heart is failing and think that it is irreversible, but that’s not true. I always try to stress to them that many patients respond well to medications, such that they can lived a long time with heart failure. I try to encourage people not to be discouraged and to make sure they will comply with medical therapy, giving them the hope for the long term.

Anything else people should know?

Heart failure is a chronic disease. In most cases, once you’re diagnosed with it, you’ll be managing it for the rest of your life.

Heart Failure

Heart failure is a serious and often complex condition, affecting more than 5 million Americans with 825,000 new cases are diagnosed each year.

Learn more about how we treat heart failure