Heart Failure Program

John Muir Health provides ongoing education, support, and management to patients who have been diagnosed with heart failure from inpatient consultations to our outpatient heart failure resource centers.  Heart failure patients receive assistance through every phase of cardiac care. Our highly skilled team includes cardiologists, hospitalists, clinical nurse specialists, dietitians, physical therapists and cardiovascular nurses.

What Is Heart Failure?

If you have been diagnosed with heart failure or know someone who has, you're not alone. Nearly five million Americans of all ages are currently living with this condition, with over 900,000 new cases diagnosed each year. Although there is no known cure, new treatments are helping patients with heart failure to live full, enjoyable lives.

Heart failure is a common, progressive condition in which the heart's pumping power weakens, slowing the flow of blood throughout the body. Heart failure doesn't mean that the heart has stopped working but rather that it has become inefficient. The condition increases pressure inside the heart and lungs, which can result in a buildup of fluid in the feet, ankles, legs, and lungs.

Heart failure's many causes include:

• Coronary artery disease
• Scar tissue from past heart attack
• High blood pressure
• Heart valve disease
• Infection of the heart valves and/or heart muscle itself

The most common symptoms of heart failure are shortness of breath, swelling in legs and feet, fatigue, weight gain, and sometimes faster and irregular heartbeats. Heart failure is a serious problem that needs to be evaluated by a specialist. Untreated, heart failure will continue to worsen, damaging other vital organs.

Heart Failure Resource Centers

Located in Walnut Creek and Concord Medical Centers, these resource centers are managed by cardiac nurses certified in heart failure care. The heart failure nurses follow patients while in the hospital and then as outpatients via phone calls and resource center appointments. The resource center offers medication reconciliation, education and symptom management in consultation with the patient’s referring physician. The more your patients understand their disease, the better prepared they will be to manage it. Our heart failure program includes intensive patient education designed to help patients understand their disease and proactively manage their symptoms.

CardioMems Heart Failure Program

Our heart failure nurses follow patients who have been implanted with the CardioMEMS Heart Failure System. This system non-invasively measures pulmonary artery systolic, diastolic and mean pressures from a sensor implanted into the pulmonary artery and allows cardiologists to adjust treatment before the patient feels a worsening of their heart failure symptoms.

Treatment Options

Heart failure has no known cure, but new treatments are helping patients live full, enjoyable lives. The goals of treatment include:

• Identifying and treating any underlying cause of heart failure
• Managing and improving symptoms
• Improving the quality of life
• Slowing the progression of heart failure

A detailed medical history and physical examination will help identify the need for additional tests or procedures, which may include:

Electrocardiogram (EKG)

This test provides a graphic measurement of the heart rate and rhythm.

Chest X-Ray

A chest x-ray provides information about the size of the heart and the condition of the lungs.

Echocardiogram

Sound waves reveal information about the size and function of the heart, including problems with muscle contraction and heart valves.

Nuclear Scan

A radioactive substance is injected into a vein and then tracked by a nuclear camera. The scan shows how well the heart is pumping blood.

Cardiac Catheterization

A small, flexible tube is inserted into an artery in the groin or arm. After a special dye is injected, moving pictures trace the dye as it travels through the heart arteries. The images identify narrowed or blocked arteries and illustrate heart muscle movement.

Heart Failure Treatment

Heart failure patients can make many healthy choices to improve their symptoms and increase life expectancy. Regular contact with a doctor, including blood pressure checks, is paramount. A healthy diet, weight control, and limited salt intake are essential. Exercise can also have a positive impact.

Heart failure usually requires a treatment program that includes:

• Rest
• Proper diet
• Modified daily activities
• ACE inhibitors
• Beta blockers
• Digitalis
• Diuretics
• Vasodilators

ACE inhibitors and vasodilators expand blood vessels and decrease resistance, allowing blood to flow more easily and making the heart's work easier or more efficient. Beta blockers can improve the function of the left ventricle. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water.

Cardiac Resynchronization Therapy

More than 40 percent of patients with heart failure have an arrhythmia that decreases the heart's ability to beat properly. Cardiac resynchronization therapy (CRT) can relieve heart failure symptoms by improving the coordination of the heart's contractions. CRT uses technology found in pacemakers and implantable cardioverter devices. CRT devices also protect an individual from slow and fast heart rhythms.

The ideal candidate for a CRT device is someone with:

• Moderate to severe heart failure symptoms, despite lifestyle changes and medication
• A weakened and enlarged heart muscle
• A significant electrical delay in the lower pumping chambers

Some CRT candidates have a high risk of sudden cardiac death from rapid irregular heart rhythms. For these patients, a special CRT device can stop potentially life-threatening rapid heartbeats with a jolt of electricity that restores the heart's normal rhythm. This device incorporates a standard implantable cardioverter defibrillator (ICD) with a CRT pacemaker, creating a "CRT-D" device. (The "D" refers to defibrillation.)