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Advanced Heart Failure

What is advanced heart failure?

Heart failure is a condition that is evaluated based on stages. Advanced heart failure is considered Stage 4. In this stage, patients’ symptoms are severe and persistent, and conventional therapies are no longer effective in managing symptoms. Patients with advanced heart failure feel shortness of breath even when resting.

What are the symptoms?

Patients with advanced heart failure may experience the following symptoms:

  • Shortness of breath/troubvle breathing
  • Persistent cough
  • Fatigue
  • Swollen feet, ankles, lower leg and abdomen
  • Weight gain
  • Loss of appetite/nausea
  • Waking up to urinate
  • Increased heart rate
  • Confused thinking

How is it diagnosed?

Your doctor will begin with a physical exam, checking for risk factors, reviewing your symptoms and listening for signs of lung congestion and abnormal heart sounds. Blood tests will be ordered, along with any or all of the following:

  • Chest X-ray to view heart and lungs
  • ECG to check for heart rhythm problems and any damage to the heart
  • Echocardiogram to check the size and shape of the heart and how well it is pumping
  • Stress test to see how well your heart functions with exertion
  • CT scan, MRI or coronary angiogram to view the heart
  • Myocardial biopsy to test small samples of heart muscle tissue for diseases that cause heart failure

How is it treated?

Advanced heart failure is a chronic disease that cannot be reversed but can be managed. Medications such as ACE inhibitors, beta blockers, diuretics, digoxin and inotropes may be prescribed to help control heart failure and its symptoms. You may need to use supplemental oxygen at all times. Some major interventions that may be an option at this stage include:

  • Open heart surgeries, including coronary artery bypass graft, valve surgery and pericardiectomy
  • Percutaneous interventions, or non-surgical procedures, accessed through a small opening in the groin may be considered if the patient isn’t a surgical candidate which can include percutaneous valve intervention and percutaneous coronary intervention/angioplasty
  • Pacemaker implantation
  • Implantable cardioverter defibrillator
  • Temporary mechanical support devices, including intra-aortic balloon pump, LVAD, etc.
  • Heart transplant
Previous Page Last Review Date: May 20, 2019