If you receive a heart failure diagnosis, Mount Sinai Heart's multidisciplinary heart failure team works together to design a comprehensive, personalized treatment plan to improve and closely manage your heart's overall function.
We conduct a thorough medical history and physical exam, and provide a treatment plan often including both medication and lifestyle modifications. If the disease continues to progress we may explore other advanced treatment options including surgery and transplant. We focus on all patients, whether you have no symptoms at all, or are facing end-of-life issues.
At Mount Sinai Heart, we offer a variety of services including case management, information on heart failure clinical trials, education and disease management strategies, nutritional assessments, exercise programs, counseling, and evaluations for heart transplant.
At Mount Sinai Heart, our cardiologists use the best evidence-based medicine available and partner with you to identify the most appropriate personalized medication therapy for you. We also help you better understand and organize your regimen. The following are some of the types of medications we use most often:
Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers
Angiotensin coverting enzyme inhibitors (ACE-I) and Angiotensin II Receptor Blockers (ARBs) are two different types of medications that work in very similar ways. They both help your heart by relaxing its blood vessels, which can lower blood pressure and allow it to pump more easily. Both types of medicine also help prevent or correct changes in the shape of the heart that can occur because of heart failure. We usually prescribe an ACE-I first. If you experience side effects and cannot tolerate an ACE-I, we may switch you to an ARB medication.
ACE-I side effects may include dizziness, non-productive cough, or in rare occasions swelling of your face, lips, or throat. Consult your doctor if you have decreased blood pressure, feel dizzy or faint, experience weight gain, have a persistent cough, have swelling of the face, or if you become pregnant. ARB side effects may include: diarrhea, dizziness, headache, or fatigue.
If you are taking either of these medications, your doctor may need to monitor your blood pressure, kidney function, and potassium levels regularly.
Beta Blockers are medications designed to slow the heart and lower blood pressure, which makes the heart’s job easier. Side effects can include fatigue, dizziness, lightheadedness, fainting, or swelling of the face, lips, or throat.
Diruretics, commonly called water pills, help you eliminate excess fluid and salt (sodium) making breathing easier. When you have heart failure your body retains extra fluid, usually in your lungs, legs, and abdomen. The most common side effects of diuretics are increased urination, weakness, dizziness, headache, upset stomach, mild skin rash or itching, muscle cramping, or dry mouth.
Aldosterone Receptor Antagonists
Like diuretics, aldosterone receptor antagonists help your body get rid of excess water and sodium. They also assist in retaining potassium, an electrolyte that helps your body and heart function properly and help you feel better. Side effects include weakness, dizziness, headache, upset stomach, mild skin rash or itching, muscle cramping, or dry mouth.
Nitrates and Hydralazine
When taken together, nitrates and hydralazine help your heart's blood vessels relax and expand to open wider. The combined actions allow your heart to pump blood much more easily and we often use these types of medications with patients who cannot tolerate an ACE-I. We may prescribe these combination medicines in two separate pills or in a single pill. Possible side effects include headaches and nausea.
Digoxin, also known as Digitalis, helps your heart pump with more force, which may also reduce some symptoms of heart failure. Side effects of Digoxin can include nausea, vomiting, headache, dizziness, changes in mental health, slow heart rate, vision changes, and electrolyte disturbances. These side effects can be dangerous and lead to toxicity.
Statins aid in cholesterol control, which helps avoid plaque build-up in your arteries. For some people, changing their diet may not be enough to reduce cholesterol or cardiovascular disease risk. When diet alone is not an option, combining nutritional changes with statins can be very effective in treating high cholesterol.
Antiplatelet therapy helps prevent clots from forming and blocking your arteries. Platelets are small particles in the blood that assist in clot formation to stop bleeding. If your arteries aren’t healthy or if you have a lot of cholesterol plaque built up, the platelets can pool, forming clots and blocking your arteries.
Changing your lifestyle plays an important role in managing heart failure symptoms and maintaining your overall cardiovascular health. It also puts you–should the need arise–in a better position to receive an implantable device or heart transplant procedure.
At Mount Sinai Heart, we work with every patient and caregiver to discuss lifestyle modifications that can help improve your heart health including:
- Exercise: Increase exercise. Physical activity has a number of benefits including weight loss, aerobic training for the heart, stress release, endorphin release ("happy" hormone in the brain), and improved sleep. As little as 30 minutes of exercise, three times a week, can improve heart health and overall well-being. Your health care provider can outline the right exercise program for you.
- Dietary Changes: Changing your diet can make a big difference, but only if you can stick with it. A number of "fad" diets invade the media routinely; many which offer short-term weight loss. We recommend a diet that is high in fruits, vegetables, lean grains, and proteins, as suggested in the United States Department of Agriculture MyPlate program. Cutting out all fatty foods or sugars is not realistic, but maintaining a modest intake can have a large effect on your overall health. Limit your salt intake to less than 2,000 mg a day.
- Quit Smoking: Avoid tobacco, which damages the blood vessels throughout your body, allowing plaque to form and accelerating heart and vascular disease. Stopping use of tobacco includes cigarettes, cigars, pipes, and chewing tobacco products. Research shows that immediately after you stop using tobacco, your risk of heart attack, stroke, and death decrease substantially.
Mount Sinai Heart offers cardiac resynchronization therapy for patients with congestive heart failure who also have a heart rhythm disorder such as an arrhythmia.
This therapy uses a minimally invasive procedure to implant a small, specialized device on your heart called a biventricular pacemaker. The device resynchronizes your heart's beating by triggering the left and right ventricles to contract simultaneously to pump blood more efficiently, and improve your heart's function. Sometimes we combine this device with an implanted cardioverter defibrillator (ICD) to help shock the heart to a normal rhythm. The ICD transmits information about your heart directly to our computers, so we can make the most educated, up-to-the-minute care decisions or changes. We can calibrate your biventricular pacemaker to meet your individual needs and provide maximum benefit.
At Mount Sinai Heart, we use left ventricular assist devices (LVAD) when a patient’s heart’s left lower chamber (ventricle) is no longer working. An LVAD does not replace the heart, but can help pump blood through the heart and rest of the body. We have one of the largest LVAD programs in the country and implant more than 50 LVADs each year.
The latest generation of LVADs are smaller and lighter than ever before, about the size of a smart phone; they easily fit in your front pocket and provide the power your heart needs to pump blood throughout your body. The device’s size and power enables us to discharge you from the hospital after surgery with fewer heart failure symptoms and greater daily activity.
We use LVADs as short-term assistance for patients with acute (sudden) heart failure, those waiting for a transplant, and open-heart surgery patients in need of emergency support. LVADs are also used as a "destination therapy" for patients in need of permanent support to extend their survival.
Living with an LVAD and adjusting to the post-transplant lifestyle can cause stress for both you and your loved ones. Our LVAD/Heart Transplant Support Group provides a safe forum to share your stories and learn from others who have been through similar experiences.
The support group meets monthly, generally on the second Wednesday. We welcome all LVAD and heart transplant patients and their caregivers, as well as those considering advanced therapies. Meetings are held at The Mount Sinai Hospital, 1468 Madison Avenue, Annenberg Building, Room 206B.
Please contact Social Workers Julie Resnik (212-241-2938) or Elyse Palumbo (212-241-3159) for further information about the support group.