Stages of Heart Failure
Stages of Heart Failure
What are the stages of heart failure and what are the symptoms and treatment? Dr. Nikolas Krishna, cardiologist and medical director for the Advanced Heart Failure Clinic at Chippenham Hospital, explains how heart failure patients are assessed.
Content
3 -> - [Stages Of Heart Failure, Nikolas
Krishna, MD, Director of the Advanced
Heart Failure Clinic]The different
stages of heart failure are four stages:
5.64 -> Stage A, B, C, and D.
7.71 -> And it progressively gets worse.
10.05 -> Stage D by definition is
end stage heart failure,
13.38 -> and it carries with a very high mortality.
15.66 -> Stage A is essentially
kind of pre-heart failure.
18.93 -> So this is a group, this is a population
21.27 -> where they are at risk.
23.4 -> So as we know, chemotherapy, it's toxic.
25.607 -> That's how it works.
27.18 -> But the heart can sometimes go down
28.77 -> as an innocent bystander.
30.06 -> So patients who've received chemotherapy,
32.52 -> they have cancer, they
received chemotherapy,
34.44 -> these are people who are at risk.
35.88 -> They don't have heart failure,
but they're at risk for it.
38.4 -> Diabetics, people with
uncontrolled hypertension.
41.76 -> So peripartum cardiomyopathy,
43.68 -> sometimes when there's a lot of stress
46.74 -> within the few months of having a baby,
48.51 -> and people can develop a
weak heart, young mothers.
51.18 -> So there are people
who are at risk for it,
54.03 -> but they don't quite have it yet.
55.47 -> Stage B are folks that have a weak heart.
59.67 -> The function of the heart
is actually going down.
61.44 -> The squeeze of the heart's
typically between 50 to 70%.
63.99 -> And if you wanna narrow it,
most people are about 55 to 60%.
67.47 -> But once the heart starts getting weaker,
70.32 -> they are automatically Stage B.
72.3 -> They don't necessarily
have the symptoms yet.
74.43 -> They're not short of breath.
75.51 -> They don't have swelling
in the legs or the belly.
77.13 -> They're not gaining fluid weight.
78.9 -> They are not tired; they
don't have that fatigue.
81.645 -> But they may develop it.
84.21 -> The heart's already weak.
85.32 -> So that's called structural heart disease.
87.15 -> Stage C is when you have the symptoms.
89.4 -> So the heart's weak now,
and they're symptomatic.
92.04 -> And people can be in that
stage for many, many years.
94.26 -> And the medicines now are tremendous.
96.48 -> You talk about, essentially,
97.65 -> four pillars of heart
failure medical therapy,
99.63 -> four main categories of drugs.
101.67 -> We try to get everybody
on those drugs as a goal.
104.91 -> And that's what guideline-directed
medical therapy is,
107.16 -> is the highest doses that
these patients can tolerate.
110.04 -> We push 'em as high as we can,
111.636 -> right up until they get dizzy,
113.46 -> and then back off a little bit.
115.83 -> And we push them very aggressively
117.21 -> 'cause we know that
there's a survival benefit.
118.98 -> There's an incremental survival benefit
120.84 -> of the addition of every
additional medicine.
122.76 -> That's how important medicines are.
124.89 -> And people can stay in Stage
C for a very long time.
129.36 -> And then because heart failure
kind of works as a spectrum,
133.89 -> a big part of my job and my staff
135.75 -> is figuring out where
136.89 -> in this spectrum of
heart failure are they.
139.95 -> Are they right here,
kind of in the middle,
142.23 -> and they've got years of great
quality and quantity of life,
145.74 -> and then down the road, we'll
keep an eye out for them?
148.2 -> Are they right here at Stage D?
150.57 -> Are they already there by the
time that I'm seeing them?
153.24 -> We screen them regularly
154.56 -> with these tests called
cardiopulmonary stress tests
156.93 -> on a bicycle or a treadmill.
158.16 -> It measures their breathing
and what's going on.
160.62 -> Their metabolism.
162.09 -> And gives me a little clue
163.56 -> into saying where they
are in that spectrum.
166.2 -> We do procedures in the cath
lab called right heart caths,
168.78 -> where we measure, really,
170.55 -> how many liters of blood is
the heart actually pumping?
173.04 -> Is the pump failing?
174.39 -> Is it failing their body?
176.46 -> And also gives us a sense
177.84 -> of how much fluid they're carrying.
179.13 -> So that's very important information.
181.02 -> I use those tests to help me
risk stratify these patients.
185.309 -> And because heart failure
doesn't have a cure,
188.04 -> many patients do, naturally,
189.99 -> the natural course of it
is to go to end stage.
192.66 -> So if we can catch them early,
193.8 -> we can catch them end of that window,
195.15 -> we can help them.
196.8 -> Often, we tend to catch them
on the way to the hospital.
201.15 -> The hospitalization is
when we really find that,
204.06 -> okay, you're approaching Stage D,
205.53 -> because in a sense,
206.363 -> that's how their body declared themselves.
207.96 -> If they were feeling fine,
they'd stay at home, right?
210 -> So by nature of coming to the hospital,
212.61 -> or being hospitalized,
or having EMS bring you,
215.13 -> I catch them by the time
they come to the hospital.
Source: https://www.youtube.com/watch?v=XYQPtN_LCZE