Mayo Clinic Q&A podcast: Reducing the risk of heart failure
Mayo Clinic Q&A podcast: Reducing the risk of heart failure
Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
“The most recognized, the most common symptom of heart failure is breathlessness,” says Dr. Gosia Wamil, a cardiologist at Mayo Clinic Healthcare in London. “And the type of breathlessness that patients would describe most often is the inability to lie flat, waking up in the middle of the night or gasping for air.”
Heart failure is often thought to be a disease of advanced age, but it can actually develop at any time in life. In many cases, heart failure can be prevented or treated if people are aware of the risk factors and warning signs.
Coronary artery disease is the main cause of heart failure. Stiffening of the heart muscle is mostly a result of poorly controlled hypertension or diabetes. Proper treatment can improve the signs and symptoms of heart failure and may help some people live longer. Lifestyle changes — such as losing weight, exercising, reducing salt (sodium) in your diet and managing stress — can improve your quality of life.
“All the risks of developing heart attack, if we reduce those risks, we improve their lifestyle,” explains Dr. Wamil. “If we reduce the risk of diabetes, hypertension, stop smoking, this will reduce the risk of heart attacks, but at the same time, will reduce the risk of heart failure.”
Dr. Wamil’s research efforts include studies aimed at understanding the connection between diabetes and heart disease and using novel medical imaging techniques to identify heart failure early on. Other research underway at Mayo Clinic includes the use of artificial intelligence and machine learning tools to detect heart failure early.
“An area of research interest at Mayo Clinic is the use of large databases, such as randomized controlled trials, electronic health care records, and applying not only statistical methods but also AI, machine learning models and algorithms to try to identify how we can detect early signs of heart failure risks,” explains Dr. Wamil.
On the Mayo Clinic Q\u0026A podcast, Dr. Wamil, discusses warning signs of heart failure and advances in early detection of heart disease.
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Content
1.23 -> Narrator: Coming up on Mayo
Clinic Q&A,
3.66 -> Dr. Malgorzata Wamil: There are
many causes of heart failure,
6.09 -> and unfortunately, the most
common cause of heart failure
8.94 -> and heart attacks and coronary
artery disease. We have also
12.36 -> learned that other diseases such
as diabetes, obesity, heart
16.47 -> failure can pose a problem with
stiffening of the heart muscle,
19.5 -> and therefore, heart failure.
21 -> Narrator: Heart failure,
sometimes known as congestive
23.67 -> heart failure, occurs when the
heart muscle doesn't pump as
26.58 -> well as it should. Proper
treatment and a healthy
29.16 -> lifestyle can improve the
symptoms of heart failure, and
32.1 -> may help some patients live
longer.
34.59 -> Dr. Malgorzata Wamil: So we can,
with good lifestyle changes —
38.13 -> reducing the body weight, having
a good diet, exercising
42.99 -> regularly — we can train our
body to reduce the risk of
46.65 -> diabetes, high blood pressure
heart attacks, and therefore,
49.86 -> decrease our risk of developing
heart failure. And that's
52.92 -> something that we can all work
on.
54 -> Dr. Halena Gazelka: Welcome,
everyone to Mayo Clinic Q&A. I'm
57.33 -> Dr. Halena Gazelka. You may
think of heart failure as a
61.02 -> disease of advanced age, but it
can actually develop at any time
64.86 -> in life. In many cases, heart
failure can be prevented or
68.67 -> treated. But there are risk
factors and warning signs people
72.51 -> might not be aware of. Here with
us to discuss is Dr. Gosia
76.8 -> Wamil, a cardiologist at Mayo
Clinic Healthcare in London. I'm
81.48 -> so delighted to have you here
today. Can you first tell us
85.74 -> what is heart failure?
88.44 -> Dr. Malgorzata Wamil: That's a
good question. So heart failure
90.33 -> is the inability of a heart to
pump blood efficiently. So the
94.95 -> main function of the heart as a
pump is to deliver the oxygen
100.77 -> and nutrients to all the cells
and organs. And in heart
104.1 -> failure, the heart cannot do it
in an efficient, normal way.
109.14 -> Heart failure can result either
from the problem with weak
113.82 -> pumping function, and we call it
then heart failure, reduced
117.6 -> ejection fraction. And the other
type we frequently encounter is
121.65 -> heart failure preserved ejection
fraction, when actually the
125.43 -> pumping is within normal limits,
but the heart is very stiff and
131.1 -> there is a problem with
relaxation between contractions.
134.91 -> So that's a different, second
type, a main type of heart
138.42 -> failure. Initially, when there
is a problem with pumping
142.71 -> function of the heart, the body
tries to compensate. So there
146.94 -> are different mechanisms that
can be applied. And so the heart
151.68 -> stretches, becomes enlarged, the
heart can also increase its
157.23 -> muscle mass, so become thicker.
Another very common mechanism is
164.07 -> that the heart speeds up, so the
pulse increases. And all those
168.6 -> are temporary measures. But that
does explain why some patients
174 -> may have heart failure, but
actually they do not present
176.82 -> with any symptoms in that
initial phase. This cannot last
182.25 -> forever, unfortunately. And
eventually it leads to
185.49 -> development of symptoms. And
this is when we diagnose heart
189.48 -> failure.
191.07 -> Narrator: When you were
describing the two types of
192.99 -> heart failure, it reminded me
that in medical school, I think
196.71 -> we call those right and
left-sided heart failure. True?
200.52 -> Dr. Malgorzata Wamil: So right
and left-sided heart failure, so
204.15 -> focuses our attention on the on
where pumping problem is. It
209.19 -> could be either in the main
chamber of the heart, so the
211.8 -> left ventricle, or the right
side of the heart. And then this
215.55 -> may be secondary to a problem,
for example, in the lungs,
218.16 -> rather than in the heart. So
heart failure both reduced
221.97 -> ejection fraction, preserved
ejection fraction, so looks at
225.51 -> something different. So it looks
at the cause of heart failure.
230.31 -> So is there a problem with the
pumping function? Or is there a
233.31 -> problem with relaxation? That
type of terminology looks at the
240.12 -> at the actual mechanism of
developing those symptoms.
243.81 -> Dr. Halena Gazelka: Well, that's
a great segue to my next
245.64 -> question, I wanted to ask you
what causes heart failure?
250.89 -> Dr. Malgorzata Wamil: There are
many causes of heart failure.
253.47 -> Still, unfortunately, the most
common cause of heart failure
257.1 -> are heart attacks and coronary
artery disease. And we have also
262.29 -> learned that other diseases such
as diabetes, obesity, heart
268.2 -> failure can pose a problem with
stiffening of the heart muscle
271.71 -> and, therefore, heart failure.
There are other causes, so a
276.93 -> problem with a valve. Either
narrowing or leaking valves can
281.85 -> cause heart failure. Problems
with rhythm. So abnormal, faster
286.2 -> rhythm of the heart can cause
heart failure symptoms as well.
289.92 -> There are other treatments, for
example, treatment of cancers
295.29 -> that can as a result, lead to
the development of problems with
299.31 -> a pumping function of the heart.
But there are also rarer causes
303.66 -> of heart failure. We call those
cardiomyopathies. Either
307.14 -> inherited, associated with
inheritance of abnormal spelling
312.51 -> mistakes in our DNA. Or
acquired, which can be
316.53 -> associated with actually a
systemic disease that just
319.98 -> happened to affect the heart as
well. So there is a long list of
324.21 -> causes of heart failure. And our
role as cardiologist is to try
328.05 -> to diagnose heart failure first,
but then to understand the
332.76 -> etiology, and maybe find the
cause that could be treated at
337.05 -> its roots and improve the
symptoms of patients.
340.5 -> Dr. Halena Gazelka: Gosia, we
mentioned in the intro, that
342.936 -> there are some risk factors for
heart failure that patients and
346.935 -> individuals might not even be
aware of. What are the risk factors?
351.78 -> Dr. Malgorzata Wamil: So this
relates to the causes of heart
355.56 -> failure. So all the risks of
developing heart attack, well,
362.55 -> so if we reduce those risks, if
we improve their lifestyle,
367.08 -> reduce the risk of diabetes,
hypertension, stop smoking, this
371.88 -> will reduce the risk of heart
attacks, but at the same time,
377.07 -> will reduce the risk of heart
failure. There are also causes
381.96 -> and other causes of heart
failure, such as, for example, a
384.75 -> viral infection that leads to
myocarditis. So inflammation in
389.94 -> the heart muscle. So trying to
reduce the risk of infection. So
394.05 -> we just went through the COVID
pandemic, so reducing the risk
398.1 -> of developing COVID infection,
other viral diseases by using
402.96 -> vaccination can also reduce the
risk of heart failure.
407.61 -> Decreasing the amount of alcohol
that we drink, stopping using
413.01 -> anabolic steroids. So those are
things that we know that may
417.45 -> influence our future and reduce
the risk of developing symptoms
422.49 -> of heart failure. In patients
with cardiomyopathy, so
426.54 -> especially inherited type of
heart failure, heart muscle
430.53 -> disease, it's very important to
seek medical attention early if
435.9 -> there are cases of heart failure
in the family. Because we can,
440.85 -> these days, offer not only
genetic tests, but also a
444.54 -> comprehensive scans and
investigations that will try and
448.86 -> we can apply some preventive
measure to reduce the risk of
454.35 -> future problems.
456.78 -> Dr. Halena Gazelka: How
interesting, you had mentioned
458.76 -> earlier that symptoms may be
delayed due to the type or how
463.53 -> the heart tries to compensate.
So in medicine, we often talk
466.71 -> about symptoms, which have a lot
to do with what patients can
470.19 -> feel and sense, and then signs,
which are things that we as
473.22 -> clinicians can see or measure.
What are some of the symptoms of
477.36 -> heart failure that individuals
might experience, even before
481.29 -> they're diagnosed?
483.15 -> Dr. Malgorzata Wamil: So we
probably, the most recognized is
485.82 -> the most common symptom of heart
failure is breathlessness. And
490.59 -> the type of breathlessness that
patients would describe most
493.71 -> often, is inability to to lie
flat. Waking up in the middle of
499.92 -> the night or gasping for air.
People will describe swelling
505.5 -> that developed around their
ankles and in the lower limbs.
509.7 -> Very frequently, patients will
also notice that their abdomen
514.95 -> got distended, they lose
appetite. The tummy feels very
519.75 -> bloated. So those are probably
the most common symptoms that
525.21 -> patients will report. But there
are there are other symptoms
529.92 -> that are less frequent. Patients
eventually will also develop
535.74 -> some fatigue, tiredness, and may
complain of low mood and
540.87 -> depression. And those can also
be the early signs of heart
545.55 -> failure. In myocarditis, so
inflammation of the heart
549.12 -> muscle, we frequently see as an
early sign, palpitations, so
553.29 -> irregular fast heartbeats. And
again, it's very important for
558.24 -> the patients to report those
symptoms to us before it is too
562.77 -> late and before we need to deal
with a very serious
565.62 -> complication. So, there are
different presentations. And
570.54 -> unfortunately, in some cases, we
diagnose heart failure at a very
574.83 -> late stage when they already
developed significant problems
579.72 -> and they present in an acute
phase. So some patients will
583.29 -> present with pulmonary edema, so
they come to the hospital with
589.68 -> acute breathlessness. They
produce lots of sputum which may
593.82 -> have a pink discoloration. They
are very, very unwell. So there
599.28 -> is a whole range of symptoms
that patients can present with.
602.73 -> Dr. Halena Gazelka: So edema is
excess fluid. So that would be
605.64 -> excess fluid in the lungs?
607.44 -> Dr. Malgorzata Wamil: That's
right. Yeah.
609.54 -> Dr. Halena Gazelka: Gosia, how
do you diagnose heart failure if
612.12 -> it's suspected?
614.37 -> Dr. Malgorzata Wamil: Very good
question. Um, so we all over the
618.87 -> world, we use a very simple test
called ECG. At Mayo Clinic,
623.58 -> researchers have been
developing, researching and
629.07 -> investigating the possibility of
applying AI algorithms to a
633.99 -> simple ECG and spotting early
signs of heart failure. So this
640.23 -> has been a very successful
project and colleagues at Mayo
645.75 -> Clinic showed that using AI may
be better and may spot early
651.72 -> signs, those that may not be so
obvious for a human eye. So ECG
657.45 -> is the first, the cheapest, the
most available type of test. The
661.44 -> gold standard remains
echocardiogram. So that's an
665.25 -> ultrasound of the heart. An echo
is a very versatile imaging
671.52 -> technique. So it is able to not
only distinguish between
675.33 -> different types of heart
failure. So we talked about the
678.21 -> right, left ventricular failure.
Heart failure with reduced,
682.68 -> preserved ejection fraction. So
Echo can give us a clue about
686.61 -> all those subtypes. It can also
sometimes described very
691.29 -> specific features that will
point towards a specific
695.73 -> diagnosis such as, for example,
hypertrophic cardiomyopathy, or
701.1 -> cardiac amyloidosis. So it gives
us lots of lots of information.
705.69 -> We spoken also about the most
common cause of heart failure,
710.01 -> so coronary artery disease. So
it's very frequent that patients
713.85 -> who present with heart failure
will also have another test
716.64 -> called an angiogram, so either
invasively or in a non-invasive
722.52 -> way more often these days. So we
check for the presence of
727.65 -> narrowing the coronary arteries.
And out of all those tests,
732.03 -> probably the most comprehensive
type of scan that we offer to
735.6 -> our patients is called cardiac
MRI scan. And on top of all the
740.58 -> information about the function,
the size of chambers of the
744.33 -> heart, it can also offer tissue
characterization. So it can give
749.49 -> us information that, these days,
we can compare to a previously
754.59 -> used and non-invasive way of
taking a tissue biopsy. So
758.7 -> biopsying the myocardium, and
muscle. So it can tell us a lot
763.38 -> about the presence of swelling
in the heart muscle, the
768.54 -> presence of scarring, or
inflammation. So that's
773.01 -> fascinating what we can do with
those images these days.
777.18 -> Dr. Halena Gazelka: That really
is fascinating. I want to go
779.76 -> back to what you said about AI,
or artificial intelligence as it
785.34 -> relates to EKGs. What I
understand is that the way that
790.08 -> this works is they have done so
many EKGs and measured so much
793.95 -> on them that a computer
algorithm is able to make
798 -> comparisons between disease
states and what you see in an
801.39 -> EKG and what you don't is that
right?
804.36 -> Dr. Malgorzata Wamil: That's
correct. So with using machine
808.83 -> learning algorithm, so the idea
is that you need to have a very,
812.55 -> very large database. And that is
what is available in Mayo
817.89 -> Clinic. So we then apply
algorithms that are comparing
826.59 -> the observations against the
outcome, and the gold standard
831.9 -> outcome is the result of an
echocardiogram with a diagnosis
836.49 -> of impaired pumping function of
the heart. And those algorithms
842.28 -> can be trained and detect signs
that we cannot even as
848.22 -> cardiologists, detect those
early signs. And we've seen
852.27 -> similar examples in other
pathologies. So for example, AI
858.33 -> algorithms these days can detect
very subtle abnormalities that
863.82 -> relate to a level of potassium
in the blood, in the blood of
870.24 -> the patient. And similar
technology has been applied to
874.44 -> identify those early signs and
detect signs of heart failure.
880.02 -> Dr. Halena Gazelka: Very
interesting. How do you treat
881.94 -> heart failure?
884.43 -> Dr. Malgorzata Wamil: So we have
been observing a revolution in
888.51 -> the heart failure field over the
last decade. We have got lots of
894.42 -> treatments these days for our
patients and this has changed.
897.99 -> And so for heart failure reduced
ejection fraction, we've got
902.58 -> five different pharmacotherapies
that have been shown to not only
908.76 -> to improve symptoms, but also
reduce frequency of admission to
914.73 -> the hospital with heart failure
and prolong patient's life,
918.9 -> which is the most important. We
have also more interventional
924.54 -> type of treatments. So devices
such as CRTs, are a special type
929.25 -> of pacemakers. In certain groups
of patients with heart failure,
933.78 -> we use defibrillators. In those
patients that had evidence of
940.26 -> abnormal fast, sinister type of
abnormal rates. And we sometimes
944.91 -> may also use surgery to improve
the survival of patients with
949.53 -> heart failure. And those
patients the this will be in the
954.63 -> group of patients that have a
problem with a valve. So we
957.48 -> repair or replace the valve, or
often even a bypass surgery to
961.86 -> improve that pumping function of
in our patients. So there are
967.41 -> many different options. What is
the most exciting for me as a
971.85 -> cardiologist works in the heart
failure field is that for the
975.6 -> first time, we have new
treatments for patients with
978.81 -> stiff heart muscle, so those are
the patients with diabetes and
983.52 -> high blood pressure, who develop
symptoms of heart failure. And
986.97 -> those are SGLT two inhibitors.
So for the first time, we can
990.63 -> offer them, that group of
patients that is increasing in
994.05 -> numbers, a treatment that will
prolong their life. And that's
997.53 -> extremely exciting for me.
999.48 -> Dr. Halena Gazelka: Very
exciting. Can heart failure be
1002.78 -> prevented?
1004.61 -> Dr. Malgorzata Wamil: Yes, in
the same way as we can prevent
1007.37 -> heart attacks and development of
serious infections in the heart
1014.45 -> muscle. So we can with a good
lifestyle changes. So with
1021.17 -> reducing the body weight, having
a good diet, exercising
1026.09 -> regularly, we can train our body
to reduce the risk of diabetes,
1030.41 -> high blood pressure, heart
attacks, and therefore, decrease
1033.5 -> our risk of developing heart
failure. So that's very
1037.43 -> important. And that's something
that we can all work on. In
1041.48 -> families of patients, where
there are cases of inherited
1046.91 -> cardiomyopathy, so certain
groups of heart failure, we can
1051.8 -> also these days, offer some
genetic tests try to figure out
1057.5 -> who are the members of their
relatives who may be at major
1062.99 -> risk of developing heart
failure. So there are lots of
1065.69 -> things that we can offer our
patients these days.
1069.26 -> Dr. Halena Gazelka: What about
tobacco use?
1073.01 -> Dr. Malgorzata Wamil: So smoking
can obviously increase the risk
1077.51 -> of coronary artery disease and
therefore, lead to heart attacks
1081.56 -> and scarring in the heart
muscle. And this remains to be
1086.09 -> one of the main causes of heart
failure. So by stopping smoking
1091.4 -> and applying healthy changes in
our lifestyle, we can reduce the
1097.82 -> risk of heart failure.
1099.5 -> Dr. Halena Gazelka: I had to ask
you Gosia, because pretty much
1102.594 -> everyone that we interview on
Q&A says that you would be
1106.603 -> healthier if you didn't smoke!
Seems universal. So I thought
1110.894 -> I'd give in there.
1112.52 -> Dr. Malgorzata Wamil: That's
very important and applies to
1115.04 -> many pathologies that we treat
in medicine.
1118.85 -> Dr. Halena Gazelka: Right?
Gosia, I understand that heart
1120.858 -> failure is an area of interest
for you. Can you share with us
1124.135 -> what it is that you study?
1126.8 -> Dr. Malgorzata Wamil: I have a
particular research interest in
1129.8 -> the link of diabetes, high blood
pressure, insulin resistance and
1134.57 -> heart failure. There are two
interests within my research. So
1141.38 -> one is the use of large
databases, such as randomized
1145.58 -> controlled trials, electronic
healthcare records, and applying
1150.77 -> statistical methods, but also
the new AI, so machine learning
1156.32 -> models and algorithms, and
trying to identify with AI new
1162.74 -> ways, and how we can detect
early signs of heart failure
1168.74 -> risks for our patients with
diabetes and hypertension and
1172.79 -> prevent them in future. So
that's one. The second area of
1177.71 -> my interest is, as you probably
would guess, is the use of
1182.81 -> multimodality cardiac imaging.
So echocardiography, cardiac
1187.79 -> computer tomography and cardiac
MRI, and new techniques within
1194.27 -> the new modalities that allow us
to find new imaging markers that
1200.75 -> will help us in future to screen
asymptomatic patients for early
1204.5 -> signs of heart failure. And so
that is the area that I'm very
1209.27 -> passionate about. And we have
observed lots of new, novel
1214.52 -> innovations in that side. That's
wonderful.
1218.3 -> Dr. Halena Gazelka: We're so
glad that you are working on
1220.832 -> this topic. It affects a lot of
people. Thanks for being here
1224.963 -> today, Gosia.
1226.61 -> Dr. Malgorzata Wamil: Thank you
so much for inviting me.
1229.4 -> Dr. Halena Gazelka: Our thanks
to cardiologist Dr. Gosia Wamil
1232.081 -> for being here today to talk to
us about heart failure. I hope
1236.009 -> that you learn something. I know
that I did. And we wish each of
1240.062 -> you a wonderful day.
1241.61 -> Narrator: Mayo Clinic Q&A is a
production of the Mayo Clinic
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1247.61 -> to your favorite podcasts. To
see a list of all Mayo Clinic
1251.09 -> podcasts, visit
NewsNetwork.MayoClinic.org. Then
1255.71 -> click on podcasts. Thanks for
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1260.54 -> you'll offer a review of this
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1263.06 -> option is available. Comments
and questions can also be sent
1268.67 -> to
[email protected].
Source: https://www.youtube.com/watch?v=hBsJ9kY943o