What does having heart failure mean? [Music playing] Gail Hogan: About 6 million American adults have heart failure. Expert, Dr. Sakima Smith, is here to tell us what that is and why expertise is critical. [Text on screen: The Ohio State University Wexner Medical Center Gail Hogan] Gail Hogan: First, Dr. Smith, what is heart failure? [Music fades] [Text on screen: The Ohio State University Wexner Medical Center Sakima Smith, MD Transplant Cardiologist] Sakima Smith, MD: So heart failure is simply, the heart is no longer able to meet the body's demands, it's not able to pump blood efficiently to the rest of the body to meet the daily needs of the body. So whether it's getting up to go to the restroom, your heart is no longer able to meet the needs to do something that's what we would perceive as a simple activity. Gail Hogan: It's a scary term, heart failure. And I think many people think, "Well, that's it. I'm done." There are treatments, right? Sakima Smith, MD: Correct. And personally, I do not like the term heart failure. The societies are working on trying to come up with more innovative ways to really convey that message, because failure has a negative connotation. When I see patients in clinic, I try to avoid the term failure, I don't even bring it up. I'm focused on what can we do to improve your quality of life and improve your heart function. I don't like to use the terminology, failure. Gail Hogan: What are some of the symptoms? Sakima Smith, MD: So there are a lot of symptoms, some that are subtle, some that are not so subtle. So symptoms of heart failure can be something as simple as you're short of breath with your normal activities. Going to the grocery store and just not having the energy or the wind. Noticing swelling in your legs and feet despite trying to lose weight with health and exercise, and you notice that you're still gaining weight and swelling. Being short of breath when you're in bed and when you shouldn't be short of breath. Sometimes it can be chest pain or your thoughts are a little cloudy and you're not able to think straight because you're not pumping enough blood to your brain and you're kind of cloudy and foggy in your thought. It could be low blood pressure. Those are some of the symptoms that we see and that we try to advise our patients look for. Rapid weight gain, despite not really eating a lot of food, is really one of the key red flags that we tell our patients to keep an eye out for. Gail Hogan: Is there treatment? Sakima Smith, MD: Thankfully, we do have treatment, great treatments, in fact. We have treatments that help get rid of the extra water weight that can accumulate. We have medical treatments that can improve the strength of the heart. Our goal is always to maximize our medical therapy and improve heart function. Now, some patients, 10 to 15% of patients, unfortunately, despite our best efforts, over time, the medical therapy by itself is no longer efficient or effective to where they can lead a healthy life or a quality of life that's satisfactory to them. So then we look at what we call advanced therapies, and that would be heart transplantation or a mechanical heart, essentially. Those are our kind of options for end-stage heart disease. Gail Hogan: What causes heart failure? [Text on screen: The Ohio State University Wexner Medical Center Sakima Smith, MD Transplant Cardiologist] Sakima Smith, MD: Heart failure is complex. It could be acquired via genetics. It could be environmental exposure to toxins. It could be due to coronary heart disease or having a heart attack and blockages and causing your heart muscle to be weak. It can be secondary to, unfortunately, anti-cancer treatment sometimes, that can lead to it. So there's a lot of different things that can lead to the heart muscle not being as effective or weak, not to use the term heart failure, there are a lot of different things that could lead to that outcome. Gail Hogan: We've mentioned treatments, but can heart failure be reversed? Sakima Smith, MD: Thankfully, it can be. I have a lot of patients in my clinic and as well as other providers here at Ohio State who have had good outcomes and have a good quality of life. Now, it means that these individuals typically are adhering to a good diet, they're exercising, they're taking their medications, they're coming in as scheduled. So there are opportunities and a lot of patients can do well, but the reality is it's a tough diagnosis, and not everyone has that outcome. And we have to always be prepared to look at more advanced options, which, thankfully, we have the ability to offer those advanced offers here at Ohio State with respect to heart transplantation and mechanical hearts if necessary. Gail Hogan: If a person has symptoms, the sooner, the better? You can get this under control early? Sakima Smith, MD: Absolutely. Just like if you're having a heart attack, the sooner that you notice that you have those symptoms and you can seek medical care, the better. Heart attack, sometimes, is subtle, just like heart failure may be subtle. So I think, being mindful of a change in your weight and nuance, that shortness of breath, cloudy thoughts and not able to just have your normal mentation, things of that nature can trigger rapid heart rates, things that just seem out of the ordinary. I think it's always better to err on the side of caution. If you're not certain, to seek medical help, because the sooner that we can address some of these issues, whether it's someone whose heart is getting weak or someone who's having a heart attack, the sooner we can intervene, the data clearly shows, the better outcomes you will have. Gail Hogan: Okay. It's confusing, heart failure, heart attack, cardiac arrest. People are always confused by all of these. Can you sort of straighten out in just a few sentences some of the differences in those? [Text on screen: The Ohio State University Wexner Medical Center Sakima Smith, MD Transplant Cardiologist] Sakima Smith, MD: That's great. So with respect to when your heart stops, that's cardiac arrest. That's an episode where the electrical components of the heart stop working, the mechanical and the way the heart functions and squeezes stop working, and you need someone to administer CPR as soon as possible for resuscitation. So that is the situation where the heart actually stops beating and stops working. A heart attack is the heart is still working and beating, but one of your three main arteries that feed blood to the heart so it can receive its nourishment is acutely blocked by a clot. That's typically what we call a heart attack. And someone needs to quickly come in for medical care, to see an interventional cardiologist or someone of that nature to pop open, essentially, with a stent and balloon and break open that clot to stop that heart attack. And then, heart failure, again, is a term where it tends to be more of a chronic situation where, for whatever reason, whether it's genetic or it could be the long term effects of having a heart attack or it can be environmental, it can be a lot of different things, but essentially, the heart is no longer able to meet the day-to-day needs of the body because it's not working effectively as a pump to get blood to the body, to your brain so you can think, to your gut so you can eat, to your legs so you can walk. And that's heart failure. Gail Hogan: The symptoms are vague, they're vague for heart attack, they're vague for... I always say to people, this is just me, "You know your body." But what do you tell patients? How do they know when they're in trouble? Sakima Smith, MD: I think the biggest red flag that I try to tell individuals or patients with respect to heart failure, I think it's the rapid weight gain. Weight can fluctuate here and there, but a rapid accumulation of weight, five pounds in two days or 10 pounds over a week, and you really haven't changed your diet, is a big red flag. Or all of a sudden, you're so short of breath, you're not able to get out of bed, you're not able to go to the grocery store and walk around, those are red flag signs. Now, they may not necessarily be heart failure, but they do indicate that something is going on that warrants medical attention, and it could be a thyroid issue, it could be a rheumatologic issue, but you need to be seen to help decipher that out because it could be the first signs and your first presentation of heart failure. Gail Hogan: Why should someone come to Ohio State if they're suffering from heart failure? [Text on screen: The Ohio State University Wexner Medical Center Sakima Smith, MD Transplant Cardiologist] Sakima Smith, MD: Someone should come here to The Ohio State University in the Ross Heart Hospital if they have heart failure because we're the only hospital here in Central Ohio that offers heart transplantation, which is the gold standard for end-stage heart failure. Gail Hogan: If you could list them, in a way, what does Ohio State offer that others don't, either physicians, collaborative care, research? Can you just kind of list it? Sakima Smith, MD: Yeah. Here at Ohio State, what we have that others don't, with respect to innovation and taking care of patients who have heart disease and heart failure, is that we have heart transplantation, which is the gold standard for end-stage heart failure. We have innovative research. We have basic scientists, translational scientists, doing very cutting edge, novel, breakthrough research every day to improve the lives of patients. We have innovative clinical trials that are going on. We're enrolling patients on a constant basis, one of the largest clinical trial programs in the country, trying to come up with the next stage of innovative care that could be quickly applied to patients. Gail Hogan: Just kind of give me an example of what would they be looking at. [Music playing] Sakima Smith, MD: We have over 30 active trials in heart failure alone that are investigating new therapies, new ways of administering the therapies, different new techniques and procedures to improve the quality of life of patients with heart failure. So it's really remarkable just the breadth and depth of things that are occurring on a daily basis that only Ohio State can offer. [Text on screen: Ohio State Health & Discovery health.osu.edu] [Music fades]