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Host (Mark Houston): Welcome to Doc Talk, a weekly podcast featuring Monument Health physicians addressing medical topics. Tune in to your health with Monument Health.
Hello, my name is Mark Houston, and welcome to this edition of Doc Talk with Monument Health. Joining me today is Dr. Luis Hernandez. He is a physician here in Rapid City who specializes in general cardiology, with an interest in heart failure.
He belongs to the American Medical Association, the American College of Physicians, the American College of Cardiology, and the Heart Failure Society of America. That’s a lot, doctor.
Dr. Hernandez: It sounds like a lot when you say it like that.
Host: It really does. Thank you for being here.
Dr. Hernandez: Thank you, Mark. I appreciate it.
What Is Heart Failure?
Host: When I saw today’s topic—heart failure—I thought this could easily be a 14-part series. I think a lot of people hear “heart failure” and assume it means everything is wrong with their heart. That’s not necessarily true, right?
Dr. Hernandez: Correct. That’s one of the reasons we chose this topic. When people hear “heart failure,” they often get scared and think their heart is completely failing.
In reality, there are different types of heart failure. Most of the time, it means the heart is either not pumping enough blood or the heart muscle is stiff and not relaxing properly.
It doesn’t mean the heart has completely failed. In some cases, the heart may actually be normal in strength but stiff. In others, the heart muscle is weakened.
So, the term can sound alarming, but with proper education and treatment, patients can live normal lives. That’s always my goal.
How the Heart Works
Host: Let’s step back for a moment. Can you explain how the heart works in simple terms?
Dr. Hernandez: Of course. The heart has four chambers—two on top and two on the bottom. The lower chambers are responsible for pumping blood.
The left side of the heart pumps blood to the rest of the body. That’s typically where heart failure develops.
If the left side is weak and doesn’t pump enough blood, we call that systolic heart failure, or heart failure with reduced ejection fraction.
If the heart pumps normally but is stiff and doesn’t relax properly, we call that diastolic heart failure, or heart failure with preserved ejection fraction.
Symptoms of Heart Failure
Host: What symptoms should people watch for?
Dr. Hernandez: Symptoms are generally similar in men and women, with some variation.
Common symptoms include:
Shortness of breath, especially with minimal activity
Sudden weight gain due to fluid retention
Swelling in the legs or ankles
Difficulty lying flat due to breathing issues
Fatigue and low energy
In more severe cases, patients may even experience confusion.
Host: You mentioned weight gain—why does that happen?
Dr. Hernandez: That’s due to fluid buildup. When the heart isn’t pumping effectively, fluid backs up into the lungs, abdomen, and legs.
The lungs are usually affected first, which is why people feel short of breath—especially when lying flat. As the condition progresses, fluid can accumulate in the abdomen and legs.
What Is Ejection Fraction?
Dr. Hernandez: Let me explain ejection fraction briefly.
A normal ejection fraction is about 52% to 75%. Many people assume it should be 100%, but that’s not correct.
If someone is told their heart function is 30%, that’s 30% compared to the normal range—not 30% out of 100%. That distinction is important.
We measure ejection fraction using an ultrasound of the heart, called an echocardiogram. It tells us how effectively the heart is pumping blood.
How Urgent Is It to See a Doctor?
Host: If someone notices these symptoms, how quickly should they seek care?
Dr. Hernandez: They should make an appointment as soon as possible. If they can’t see a cardiologist right away, they should start with a primary care provider.
Early evaluation is important so we can identify the cause and begin treatment.
Causes of Heart Failure
Host: What are the most common causes?
Dr. Hernandez: The most common cause is coronary artery disease, including heart attacks.
Other causes include:
High blood pressure
Abnormal heart rhythms (arrhythmias)
Less commonly, genetic conditions such as familial cardiomyopathies
Familial causes are not the most common, but we consider them in younger patients with a strong family history of heart disease or transplant.
Can Heart Failure Be Prevented?
Host: What can people do to reduce their risk?
Dr. Hernandez: Heart failure is increasing, unfortunately. After age 40, about 1 in 5 Americans will develop it.
Prevention focuses on managing risk factors:
Control blood pressure
Manage diabetes
Maintain a healthy weight
Exercise regularly
Stay consistent with primary care visits
Prevention is critical.
Is There a Cure for Heart Failure?
Host: Is there a cure?
Dr. Hernandez: Currently, there is no cure. However, we have very effective treatments. With the right medications and medical care, patients can live normal, full lives. That’s always our goal.
Testing for Heart Failure
Host: How is heart failure diagnosed?
Dr. Hernandez: The primary test is an echocardiogram, which is an ultrasound of the heart. It is:
Non-invasive
Cost-effective
Highly reliable
From that test, we determine the ejection fraction and identify the type of heart failure, which guides treatment.
Interestingly, women tend to have more diastolic heart failure, while men more often develop systolic heart failure, largely due to differences in heart attack rates.
Care at Monument Health
Host: Can patients receive full treatment here in Rapid City?
Dr. Hernandez: Yes. I always tell my patients that we have everything here at Monument Health. I trained at the Cleveland Clinic, and the level of care we provide here is comparable. Patients can receive comprehensive heart failure care locally.
Host: You’re originally from Honduras, correct?
Dr. Hernandez: Yes.
Host: And you’ve been in the U.S. for about seven years and one year here in Rapid City?
Dr. Hernandez: That’s correct.
Host: And you like the cold?
Dr. Hernandez: I do. I love it here.
Host: Do you have hobbies?
Dr. Hernandez: I enjoy hiking. I also have an English bulldog, so I prefer trails with water since he doesn’t tolerate heat well.
Host: We’re looking forward to continuing this conversation in future episodes, including discussing COVID and heart failure.
Dr. Hernandez, thank you for your time.
Dr. Hernandez: Thank you, Mark. I appreciate being here.
Host: Thanks for listening to Doc Talk.
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