The doctor’s first job is to find out why the heart is
failing. According to Jessup, there are typically four things
that cause HF — a problem with the heart valves, the heart’s
rhythm, the heart muscle or a combination of those things.
“In general, we have pretty good ways of dealing with
both valve disease and arrhythmias but fixing the heart
muscle is a lot harder,” Jessup said.
In HF caused by a muscle problem there are two major
types: Heart Failure with Reduced Ejection Fraction
(HFrEF, referred to as “hef-ref”) where the heart pumps
less blood, and Heart Failure with Preserved Ejection
Fraction (HFpEF, “hef-pef”), where the heart pumps
enough blood but has other problems, like valve disease.
Dodd’s doctor was referring to the ejection fraction
when he said her heart was pumping only 5 percent to 10
percent. Ejection fraction is an indicator of how well your
heart is pumping out blood. A normal ejection fraction
may be between 55 percent to 70 percent. Watch a video
explaining ejection fraction.
The typical patient with HF is age 75. That’s because
many of the reasons people develop HF are related to
longstanding problems with hypertension, diabetes,
obesity or lack of physical activity
or all of them combined. “About
one in five adults over the age of 40
will develop heart failure,” Jessup
said. “In the vast majority of elderly
HF patients hypertension plays a
major role. There are estimates that
if we could control hypertension, we
would reduce the incidence of heart
failure by half.” A second major
cause of HF is atherosclerosis. HF consumes more
Medicare dollars than any other diagnosis.
But not everyone with HF is elderly — children and
young adults may develop HF either through inherited
disorders of the heart, congenital heart disease or other
muscle problems in the heart. “More and more, we are
recognizing that young adults and children with HF may
also have a genetic abnormality that causes their cardiac
muscles to be weak,” Jessup said. “Now when we identify
children with HF, we screen their parents. And likewise,
when we identify young adults or middle-aged adults, we
often will screen their siblings and children.” A cause for
Dodd’s HF was never isolated.
Dr. Mariel Jessup shares hope for heart failure patients.
Dr. Mariell Jessup