Heart failure explained

To better understand heart failure, we sat down with Dr. Michele Bertelli, a clinical fellow in Calgary’s Advanced Heart Failure program to learn more about this often-misunderstood condition. Dr. Bertelli is an Italian-trained cardiologist on a one-year fellowship to learn more about heart failure.  

What is heart failure? 

Heart failure is an umbrella term that defines any condition in which heart function is unable to meet the body’s needs. There is a spectrum of severity, ranging from outpatients managed with oral medications to those requiring urgent intervention. 

There are two main categories of heart failure: one is characterized by a faulty pump function (HFrEF – heart failure with reduced ejection fraction), the other by a problem with the heart’s ability to relax adequately (HFpEF – heart failure with preserved ejection fraction).

What are the symptoms of heart failure? 

Heart failure commonly presents with reduced exercise tolerance and shortness of breath. However, other non-specific symptoms may occur, including fatigue, nausea, and bloating.

What causes heart failure? 

There are many underlying causes of heart failure. Broadly speaking, they can be classified as being linked to blockages in the coronary arteries (i.e. ischemic cardiomyopathy) or dysfunction in the heart muscle itself (i.e. non-ischemic cardiomyopathy). The latter is more prevalent in young people developing heart failure and is often linked to underlying genetic variants. 

How is heart failure diagnosed?

Heart failure is diagnosed based on symptoms, blood biomarkers, and imaging tests such as echocardiogram and cardiac MRI.

Are there any common myths or misconceptions about heart failure you’d like to clear up?

The term itself is not particularly helpful in characterizing what is going on in the heart or predicting patient outcomes. If you are diagnosed with heart failure, it doesn’t necessarily mean your heart will fail, it just means the heart isn’t able to meet your body’s demands and that further testing/treatment is needed. 

Tell us about the latest research and innovations in heart failure. 

There are numerous exciting advances in the field of heart failure. These range from medications, which are backed by rigorous clinical research and have dramatically improved long-term outcomes, to a durable heart pump called left ventricular assist device (LVAD) allowing long-term support in patients with advanced heart failure.

For chronic patients with recurrent heart failure episodes, a relatively new device measuring pressures in the lung vasculature, CardioMEMS, allows us to predict heart failure episodes thereby reducing hospital readmissions. 

How can patients and their medical team manage heart failure? 

First of all, it’s important to establish a clear diagnosis of the cause of heart failure, as this is what determines the required interventions and treatment. In terms of prevention, maintaining a healthy diet and active lifestyle is important; however, some types of heart failure are related to genetics and may not be preventable. 

For those with an established heart failure diagnosis, physicians often recommend watching fluid and sodium intake. Open communication with your health care team is also important in helping optimize medication regimen. Generally, accessing the right support and following your doctor’s advice is critical. 

What makes Calgary’s Advanced Heart Failure program unique? 

There are a lot of opportunities in Calgary. It has an excellent program both from a training and research standpoint with amazing support by the fellowship’s Program Director, Dr. Kristin Lyons. I am particularly impressed by the finetuned multidisciplinary organization of both the LVAD and  heart transplant programs in Alberta, which have managed to achieve outstanding patient outcomes despite the province’s challenging geography. 

Are you involved in any research projects? 

One of the projects I am contributing to involves genetic testing in heart transplant recipients with a prior diagnosis of non-ischemic cardiomyopathy. These patients are at the very extreme of the heart failure spectrum and we are finding that a lot of them have an underlying genetic variant as a cause of their heart failure. This project is being conducted with the Broderick Cardiomyopathy Program, led by heart failure and genetic cardiomyopathy specialist, Dr. Omid Kiamanesh.