FAQS

Heart Failure

What is heart failure?
Heart failure, or congestive heart failure (CHF), occurs when your heart cannot pump enough blood because the chambers of the heart cannot fill up with enough blood or the heart itself cannot pump blood with enough force.

What causes heart failure?
Conditions that damage, stress or weaken your heart — coronary artery disease, heart attack, high blood pressure (hypertension) — are potential causes of heart failure.

What are the symptoms of heart failure?
Heart failure may present itself in early stages through such symptoms as shortness of breath, a persistent cough, general fatigue, nausea, mental confusion, lack of appetite or swelling in the feet, ankles, legs or abdomen.

What tests are used to diagnose heart failure?
To determine if you are experiencing heart failure, our team may recommend blood tests, a chest X-ray, an electrocardiogram (EKG) and echocardiogram, a stress test, a CT or MRI scan, an angiogram (cardiac catheterization) or scans using radioactive substances.

How is heart failure treated?
The course of treatment our physicians will recommend depends on the severity of your condition. The treatment plan may include lifestyle changes, medication, bypass surgery, angioplasty, pacemaker or a heart transplant.

How will I know if I need a heart transplant?
If your condition does not improve and we have exhausted all possible treatments for heart failure, our team will discuss the possibility of a heart transplant. We will explain the entire procedure and will assist you in finding a donor. Physicians and surgeons at the Houston Methodist J.C. Walter Jr. Transplant Center are leaders in the field of transplantation.

How do I care for myself when I go home from the hospital?
Before you go home from the hospital, our team will explain how to care for yourself and how to monitor your condition. We will also set a schedule for check-ups and will be available for any questions you might have.

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Heart and Vascular Disease

What is heart disease?
Heart or cardiovascular disease is a term that describes a range of conditions that affect your heart, whether it involves the heart itself or the blood vessels leading to the heart. It may include blood vessel diseases (coronary artery disease), angina, irregular heart rhythm (arrhythmias) and defects from birth (congenital heart defects). In the United States, the most common heart disease is coronary artery disease.

What is vascular disease?
Vascular disease is defined as a condition that affects your circulatory system. Examples of vascular diseases include peripheral artery or vascular disease (PAD/PVD), aneurysms (weakening or ballooning of the artery wall), renal artery disease, Raynaud's disease, Buerger's disease, varicose veins and venous blood clots.

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Valve Diseases

What is a heart valve?
At the exit of each of the four chambers of your heart is a set of flaps; these are known as heart valves. The primary purpose of a heart valve is to keep the blood flowing in the correct direction. If a valve does not seal properly, blood may backflow into the heart. If a valve does not open properly, it may reduce the amount of blood flowing through the heart.

What causes valve disease?
Valve disease may be caused by a condition that is congenital (exists since birth) or acquired (develops over time). Congenital defects may include valves that are malformed or the wrong size; a common cause of acquired valve disease occurs when the valve’s leaflets deteriorate with age.

What tests are used to diagnose valve disease?
To determine if you have a valve disease, our team may recommend a chest X-ray, an electrocardiogram (EKG), a transthoracic echocardiogram (TTE), a transesophageal echocardiogram (TEE), a Doppler echocardiogram, a 3-D echocardiography, a 3-D TEE or a cardiac magnetic resonance imaging (C-MRI).

What is the aortic valve?
The aortic valve is the valve located between the heart’s left ventricle and the aorta, the largest artery in the body.

What is aortic stenosis?
Aortic stenosis occurs when the aortic valve passage narrows, causing the heart to have to pump harder to push oxygenated blood into the aorta. Medications can be used to manage symptoms, but the only way to treat the condition is by repairing or replacing the valve through open-heart surgical valve replacement, balloon valvuloplasty or a transcatheter aortic valve implantation/replacement (TAVI/TAVR).

What is aortic regurgitation?
When the leaflets of the aortic valve do not close properly, it allows blood to backflow into the heart. This is known as aortic regurgitation. If the valve is allowing large amounts of blood to backflow, this can cause the heart’s left ventricle to have to work harder to pump blood. If the leaky valve is causing no symptoms or only mild symptoms, we may suggest monitoring your condition with regular echocardiograms. For more serious symptoms, we may treat you with certain medications or with surgery to repair or replace the valve.

What is mitral valve stenosis?
The mitral valve controls the blood flow between the left atrium and the left ventricle in your heart. Mitral valve stenosis occurs when the mitral valve does not open easily; this causes high pressure in the left atrium which can affect the lungs and make you feel short of breath. To treat mitral valve stenosis, our team will recommend a catheter-based procedure using a balloon to enlarge the valve opening or surgery to replace the valve.

What is mitral valve regurgitation?
If your mitral valve does not close properly, blood may flow backward into the left atrium; this can cause shortness of breath, fatigue and heart palpitations. For severe cases, we will recommend mitral valve repair surgery; this involves repositioning the leaflets to correct the leak.

What is mitral valve prolapse?
Mitral valve prolapse is a common condition and occurs when the leaflets in the mitral valve do not close properly. They may bulge backward into the left atrium. Most patients with this condition are only mildly affected, show no symptoms and don’t need treatment.

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Aortic Conditions

What is an aneurysm?
An aneurysm occurs when a portion of the wall of a blood vessel dilates or bulges outward like a small balloon. Aneurysms can cause clots, aortic dissection or can rupture, making them serious health risks.

What is an aortic aneurysm?
An aortic aneurysm occurs in the aorta, the body's largest artery. A thoracic aortic aneurysm (TAA) appears in the chest portion of the aorta; it can be identified with a chest X-ray or CT scan and may not cause symptoms. An abdominal aortic aneurysm (AAA) appears in the abdominal portion of the aorta, usually near the kidneys; they are usually discovered by CT scans performed for other medical conditions.

What causes aortic aneurysms?
Several factors can contribute to aortic aneurysms:

• Aging
• High blood pressure or hypertension
• Atherosclerosis 
• Inflammation of the arteries
• Syphilis
• Smoking
• Genetic abnormalities
• A previous aortic dissection
• Congenital conditions such as bicuspid aortic valve, Marfan syndrome, Ehlers Danlos syndrome and Turner syndrome

Who is at greatest risk for aortic aneurysms?

The factors that put you at greatest risk of developing an aortic aneurysm are being a white male age 60 or over, having high blood pressure or atherosclerosis, being a cigarette smoker and having a family history of aneurysms. 

Why are aortic aneurysms so dangerous?
Aortic aneurysms are dangerous because they often do not present symptoms until a rupture, internal tear (dissection) or clotting occurs.

How can I find out if I have an aortic aneurysm?
If you are 55 or older and have a family history of aneurysms, discuss this with your doctor so you can be screened. Aneurysms are often discovered when having medical imaging for other conditions.

How will my doctors determine if or when I need surgery?
Depending on the location of the aneurysm, how quickly it is growing and your age and health will be the determining factors your physician will evaluate to decide whether your aneurysm has grown large enough to recommend surgery.

What is "monitoring" for an aortic aneurysm?
With small aneurysms, cardiovascular surgeons generally monitor their growth with an ultrasound examination every six months. While you are being monitored, our team may suggest lifestyle changes, such as quitting smoking, controlling your blood pressure and engaging in mild exercise to improve your health; we may also recommend some medications which have shown to slow the growth of aneurysms.

What are the risks of surgical repair?
If you do not have a history or signs of heart disease, you will probably do very well with aneurysm repair surgery. If you have coronary artery disease, your physician will suggest performing a detailed examination to determine your fitness for surgery.

What do you use to replace the part of the aorta with the aneurysm? How long does the replacement part last?
The damaged section of the aorta is replaced with an artificial tube of Dacron® or Gore-Tex® fabric; it will last for the rest of your lifetime.

How long does it take to recover? What is the likelihood of returning to a normal life?
Following surgery, the average hospital stay is between 5 to 10 days; it will likely take you about 6 weeks to recover in order to return to work. Most people return to their normal lives.

Can the aneurysm come back if I have surgery to fix it? Will I still need to take medication after surgery?
When a segment of aorta is excised to fix an aneurysm, the weakened section is removed so the chance of an aneurysm reoccurring is almost zero. However, if the aneurysm was caused by a systemic condition (such as atherosclerosis or Marfan syndrome), an aneurysm occurring in another part of the aorta is a distinct possibility. In this case, we would probably recommend medications such as those to help control blood pressure to reduce the chance of another aneurysm. In either case, we will probably recommend imaging scans to monitor for other possible aneurysms.

What is an aortic dissection? How is it different from an aneurysm?
When the interior lining of the aorta tears away, this is known as an aortic dissection; it is a life-threatening condition. It may begin as a tear in the inner lining which allows blood to pool between the outer and inner surfaces of the aorta. Some people may have an aneurysm along with dissection, but not everyone will; conversely, not everyone with an aortic aneurysm will go on to develop a dissection.

What are the symptoms of an aortic dissection?
An acute aortic dissection causes a person to experience a severe, sudden sharp or stabbing pain in the chest, neck, back, abdomen or legs, depending on what section of the aorta the dissection is located. There may be some overlap with the symptoms of a heart attack, but most of the symptoms are different. The sooner an aortic dissection is diagnosed and treated, the better the chances for survival.

What is Marfan Syndrome?
An abnormality in the gene that forms fibrillin-1, a structural component of elastin fibers that give the aorta its strength, causes Marfan syndrome, a disorder that contributes to the formation of thoracic aortic aneurysms. The defect in fibers makes the aorta weak and susceptible to stretching. If you have Marfan syndrome, you are at greater risk for both aortic aneurysms and aortic dissection.

What is a bicuspid aortic valve?
A bicuspid aortic valve is a congenital defect in which the aortic valve only has two leaflets (cuspids) instead of three. This defect may function relatively well, but often aortic stenosis occurs (the valve is narrowed) or the valve leaks. People with this condition usually experience higher rates of premature valve degeneration and can have abnormal aortic tissue structure susceptible to a faster aneurysm growth rate.


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