Heart Failure Care in Katy & Sugar Land, TX

Common Signs and Symptoms of Heart Failure

Shortness of breath

Breathlessness may occur during exercise, walking or other daily activities. As heart failure progresses, some people experience difficulty breathing while resting, lying flat or sleeping.

Swelling and fluid retention

Fluid can accumulate in the feet, ankles, legs or abdomen. Shoes or clothing may feel tighter, and body weight may increase over a relatively short period.

Fatigue and reduced stamina

When the heart cannot meet the body’s demands efficiently, everyday tasks may require more effort. Patients may notice difficulty walking through a store, carrying groceries, climbing stairs or completing routine household activities.

Persistent cough or wheezing

Fluid congestion may contribute to coughing or wheezing. A cough producing pink, frothy or blood-tinged material requires immediate medical attention.

Rapid or irregular heartbeat

The heart may beat faster in an attempt to meet the body’s needs. Some patients also have atrial fibrillation or another rhythm disorder that contributes to or worsens heart failure.

Appetite and concentration changes

Some people experience nausea, reduced appetite, abdominal fullness, confusion or difficulty concentrating, particularly when heart failure becomes more advanced.

Report new or changing symptoms to your healthcare team. Severe or sudden symptoms may require emergency evaluation.

What Causes Heart Failure?

Heart failure can result from any condition that damages, weakens, stiffens or places excessive strain on the heart.

Common causes and contributing conditions include:

• Coronary artery disease
• A previous heart attack
• Long-standing high blood pressure
• Cardiomyopathy or heart-muscle disease
• Heart-valve disease
• Atrial fibrillation and other rhythm disorders
• Congenital heart conditions
• Diabetes
• Chronic kidney disease
• Obesity
• Sleep apnea
• Inflammation or infection affecting the heart
• Certain medications, toxins or excessive alcohol use
• Pulmonary hypertension and some lung conditions

Some patients have more than one contributing cause. For example, high blood pressure, diabetes and coronary artery disease may occur together and progressively affect heart structure and function.

Our evaluation is designed to identify both the heart-failure syndrome and the conditions contributing to it. Treating those underlying problems is an important part of the long-term care plan. The NHLBI notes that heart failure may be associated with coronary disease, hypertension, cardiomyopathy and other conditions that affect heart function.

Understanding the Different Types of Heart Failure

Your cardiologist may describe heart failure according to the heart’s structure, the side affected or its ejection fraction.

Heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction, or HFrEF, occurs when the main pumping chamber does not contract strongly enough. It is generally associated with a left-ventricular ejection fraction of 40% or lower.

Heart failure with mildly reduced ejection fraction

HFmrEF is generally used when the ejection fraction falls between approximately 41% and 49%. Treatment is individualized based on symptoms, medical history and the conditions contributing to heart failure.

Heart failure with preserved ejection fraction

In HFpEF, the percentage of blood pumped from the left ventricle may remain within a preserved range, but the heart muscle may be stiff and unable to fill normally. A preserved ejection fraction does not by itself rule out heart failure.

Heart failure with improved ejection fraction

Some patients who previously had a reduced ejection fraction improve after treatment. Continued medical follow-up is still important because stopping effective therapy may allow the condition to worsen again.

Right-sided heart failure

Right-sided heart failure can cause swelling in the legs or abdomen and may be associated with left-sided heart failure, pulmonary hypertension, valve disease or certain lung conditions.

Current ACC classifications distinguish reduced, mildly reduced, preserved and improved ejection-fraction categories.

How Heart Failure Is Diagnosed

A heart-failure diagnosis is based on your symptoms, medical history, physical examination and appropriate testing. No single symptom or test should be considered in isolation.

Medical history and symptom review

Your cardiologist may ask about:

• When symptoms started
• Which activities cause shortness of breath
• Whether breathing is more difficult when lying flat
• Recent weight changes
• Swelling in the legs or abdomen
• Previous heart attacks or heart procedures
• High blood pressure, diabetes or kidney disease
• Family history of heart disease or cardiomyopathy
• Recent hospitalizations
• Current prescription medicines, over-the-counter products and supplements

Physical examination

The examination may include checking your blood pressure, pulse, oxygen level and body weight, listening to the heart and lungs, and looking for signs of fluid retention or circulation problems.

Electrocardiogram

An EKG records the heart’s electrical activity. It may identify a previous heart attack, an abnormal heart rhythm or another finding that warrants additional evaluation.

Echocardiogram

An echocardiogram uses ultrasound to evaluate heart structure and movement. It can help assess:

• Ejection fraction
• Heart-chamber size
• Heart-muscle function
• Valve function
• Filling patterns
• Pressure estimates
• Fluid around the heart

Laboratory testing

Blood tests may be used to evaluate kidney function, electrolytes, liver function, thyroid function, blood counts and biomarkers associated with cardiac stress, such as BNP or NT-proBNP.

Additional testing when clinically appropriate

Depending on the patient’s symptoms and initial results, further evaluation may include:

• Chest imaging
• Stress testing
• Coronary CT or coronary angiography
• Cardiac MRI
• Holter or event monitoring
• Cardiac catheterization
• Evaluation for sleep apnea
• Genetic evaluation in selected cardiomyopathies

Not every patient needs every test. Testing should be selected according to symptoms, risk factors, prior results and the question the cardiologist is trying to answer.

Personalized Heart Failure Treatment

Heart-failure treatment depends on the cause, symptoms, ejection fraction, blood pressure, kidney function, potassium level, other medical conditions and the patient’s individual goals.

The objectives may include:

• Relieving congestion and shortness of breath
• Improving the ability to perform daily activities
• Protecting heart function
• Addressing the underlying cause
• Reducing the risk of worsening symptoms or hospitalization
• Supporting quality of life
• Identifying when advanced treatment should be considered

Guideline-directed medical therapy

For eligible patients with heart failure and reduced ejection fraction, contemporary guideline-directed treatment commonly draws from four foundational medication groups:

1. A renin-angiotensin system medication, such as an ARNI, ACE inhibitor or ARB
2. An evidence-based beta blocker
3. A mineralocorticoid receptor antagonist
4. An SGLT2 inhibitor

Other medications may be appropriate depending on symptoms, heart rhythm, blood pressure, kidney function and the underlying cause. Diuretics, sometimes called water pills, may be prescribed to reduce fluid congestion and relieve swelling or breathlessness.

Treatment for preserved or mildly reduced ejection fraction is also individualized. It may include controlling congestion and blood pressure, considering appropriate evidence-based medication, and treating associated problems such as atrial fibrillation, coronary disease, diabetes, obesity, kidney disease and sleep apnea.

The ACC and AHA emphasize guideline-directed treatment for patients with current or previous heart failure, with medication selection based on the individual clinical situation. Updated ACC pathways also address treatment optimization for both reduced and preserved ejection-fraction heart failure.

Important: Do not start, stop or change a heart-failure medicine without speaking with the prescribing clinician. Several medicines require monitoring of blood pressure, kidney function and electrolytes.

Treating the underlying cause

Medication is only one part of heart-failure care. Your plan may also address:

• Uncontrolled high blood pressure
• Blocked coronary arteries
• Previous heart-muscle damage
• Atrial fibrillation or another arrhythmia
• Heart-valve disease
• Diabetes
• Kidney disease
• Sleep-disordered breathing
• Thyroid disease
• Lifestyle factors affecting cardiovascular health

Devices and procedures

Selected patients may benefit from a cardiovascular procedure or implanted device. Depending on the diagnosis, options may include:

• Implantable cardioverter-defibrillator evaluation
• Cardiac resynchronization therapy
• Pacemaker treatment
• Coronary angiography or revascularization
• Heart-valve intervention
• Treatment of an important rhythm disorder
• Mechanical circulatory-support evaluation
• Heart-transplant evaluation

These options are not appropriate for everyone. The decision depends on the heart-failure type, severity, test results, response to medication and overall health.

Living Well With Heart Failure

Heart-failure management continues between office visits. Your care team may recommend a personalized plan that includes the following.

Take medicines exactly as prescribed

Keep an updated medication list and tell your healthcare team about over-the-counter medicines, vitamins and supplements. Some products may affect blood pressure, kidney function, fluid retention or prescription medications.

Monitor your weight

When instructed, weigh yourself at the same time each day using the same scale and similar clothing. Contact your healthcare team when your weight changes beyond the threshold in your personal care plan.

Track symptoms

Record changes in breathing, swelling, fatigue, heart rate, blood pressure and activity tolerance when requested. Early recognition of worsening congestion may allow treatment to be adjusted before symptoms become severe.

Follow an individualized sodium and fluid plan

Reducing excess sodium may help limit fluid retention, but the appropriate amount varies. Some patients also need individualized fluid guidance. Follow the instructions provided by your clinician rather than applying a generic restriction.

Stay active safely

Regular activity may be beneficial for many medically stable patients. Ask your cardiologist what type and amount of activity is safe before beginning or intensifying an exercise program. Some patients may benefit from cardiac rehabilitation.

Manage related health conditions

Good control of blood pressure, diabetes, cholesterol, kidney disease, weight and sleep apnea can be an important part of heart-failure care.

Avoid tobacco

Smoking damages blood vessels and increases cardiovascular risk. Ask your healthcare team for help developing a cessation plan.

Keep follow-up appointments

Heart-failure medicines may need to be introduced or adjusted gradually. Follow-up allows the clinician to review symptoms, blood pressure, laboratory results and treatment tolerance.

AHA patient guidance recommends monitoring symptoms, weight, blood pressure and other measures selected by the care team. NHLBI guidance also emphasizes individualized sodium, activity and weight-management recommendations.

Advanced Heart Failure and Transplant Cardiology

Some patients continue to have significant symptoms despite appropriate treatment. Advanced heart failure may be considered when a person has:

• Repeated heart-failure hospitalizations
• Severe limitations during routine activities
• Symptoms while resting
• Increasing need for diuretic treatment
• Difficulty tolerating recommended medicines
• Low blood pressure that limits treatment
• Worsening kidney or liver function
• Progressive weakness or unintended weight loss
• Serious rhythm problems
• Ongoing symptoms despite optimized therapy

Early specialist assessment can help determine whether additional treatment, closer monitoring or evaluation for advanced therapy is appropriate.

Dr. Khalid’s training in Advanced Heart Failure and Transplant Cardiology supports evaluation of complex heart-failure cases. When services such as transplant assessment or mechanical circulatory support are appropriate, care can be coordinated with the necessary hospital-based or advanced-treatment program.

This section must not imply that a transplant or ventricular-assist-device program operates inside either outpatient office unless that is factually correct.

Why Choose Advanced Cardiology for Heart Failure Care?

Relevant specialist training

Dr. Adnan Khalid has training in cardiovascular disease, interventional cardiology, advanced heart failure and transplant cardiology.

Individualized treatment

Heart failure affects people differently. Recommendations are based on the type of heart failure, symptoms, contributing conditions, test results and treatment goals.

Care for related cardiovascular conditions

The practice also evaluates conditions that frequently contribute to heart failure, including coronary artery disease, hypertension, heart-rhythm disorders and valvular heart disease.

Clear patient education

Patients receive an explanation of their diagnosis, test results, medication plan, follow-up needs and warning signs to monitor at home.

Convenient Katy and Sugar Land locations

Patients can request cardiology appointments at two Greater Houston-area locations.