The clinical evaluation aims to assess ventricular function, meaning the way the heart muscle is working. The first test done is a chest x-ray which provides us with some important but limited information, the gold standard to diagnose heart failure is the echocardiogram. The echocardiogram allows is to evaluate alterations of disorders of the segmental mobility of the heart, it also allows us to observe if there is heart dilation, if there is dilation it allows to measurement of the disorder, what we call the “ejection fraction”. The ejection fraction value is very important, it should remain at 70%, that means the heart ejects a steady and sufficient amount of blood to the body with each heartbeat.
Another evaluation that gets done with an echocardiogram is the functioning of the heart valves, it helps identify any damage done to the heart valves (the flaps that allow entry and exit of blood through the heart).
If the echocardiogram shows that the root of the cause of heart failure is coronary artery disease, then the patient will need to undergo a cardiac catheterism.
It is well known that the ideal treatment approach for heart failure consist of several lifestyle adjustments such as; healthy weight management, weight loss, salt intake reduction, implementing a Mediterranean style diet, medication such as; diuretics, potassium sparing diuretics, ACE inhibitors, beta-blockers, and digoxin. This treatment approach has shown to improve the quality of life of the patient, improving the functional class of HF, reducing the number of hospitalization and reducing mortality rates.
It is imperative that the cause of HF is fully corrected, meaning once the reason is identified the treatment is aimed at the resolution of the disorder, for example revascularization in the case of coronary artery disease, or heart valve replacement with a prosthetic heart valve when a damaged valve is identified.
There’s other sub-group of patients that suffer greater deterioration and worsening of functional class, those with complete block of the left bundle branch of the bundle of his (LBBB), another with reduced ejection fraction (less than 40%), most these patients would benefit from medical devices that improve contractility and improve the pumping function of the heart through electrical stimulation (cardiac synchronization) or tri-chamber pacemaker.
Other treatment options such as stem cell implantation (CED340) obtained through bone marrow aspiration has shown to be effective and effective at improving ejection fraction (effectiveness of the heart as a pump) by 10-15%. This alternative treatment is usually reserved for patients that do not respond to pharmacological treatment and were not the candidates for a tri-chamber pacemaker.
