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How To Manage Heart Failure

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Dr. Starling shares tips for patients on ways to better manage heart failure. Dr. Mark Starling is currently the Chief Medical Director at Banner Heart Hospital in Mesa, Arizona.

Dr. Starling:
One of the most common questions I have when patients come into the hospital or they come into the office, particularly the hospital because they come in acutely deteriorated, they come in with shortness of breath, they are scared, they’re anxious, they don’t know what’s going on, and they are now put in the hospital, which is a very unfamiliar place for them to be and they want to know, “What’s the problem?” And more importantly, “What can I do to manage it?”

Now the problem is usually structural heart disease of some form. It’s usually because of their shortness of breath, it’s usually a fluid overload so they’ve ingested way too much salt so that, you know, potato chips at the side of the bed is not a good strategy for managing heart failure, but my goal with them is to begin to teach them that you can live with heart failure, that you can manage it and what you are trying to manage is taking control of what you can take control of to optimize your quality of life.

People have different expectations in what they want out of their life, what they expect to do. For example, an older patient can come into my office, 78 years old, retired, and the question is, “Am I going to leave my husband behind, and when am I going to do that?” And my counter back to them is not for a while because we can manage this and my question to them is, “What do you want to do? What do you want to be capable of doing?”

Now she wants to go to her book club and she wants to go to the knitting club and she wants to play bridge with other couples down and go to places. It’s pretty simple things. It’s not that ‘I want to go run a marathon’. So what you have to manage is, “How do we get her capable managing to allow her to do those things that she perceives are the quality issues in her life?” We can do that, but as physicians we need to listen to that and make sure that we understand that expectation.

On the other hand you’ll take somebody, say a young person who is in their 40s, maybe a divorced woman with two kids that’s got a job. She is working 60 hours a week or two to make ends meet. Well she has got a whole different set of expectations around what it is she needs to be capable of doing for her quality of life. So she needs to make sure that “I don’t have symptoms. I got two kids to take care of. I am running two jobs. Fix me!”

And so you sometimes are more aggressive with that and have to teach them how to manage things. Fast foods out, you know, there are certain things that are out and you try to advise them about how to change their lifestyle and make sure they are on the right medicines at the right doses, they are having the right response, and those kinds of things and actually be able to direct them as, “This is what your exercise limit is so here’s where you are and this is what you can do within that,” and have that very candid conversation around, “What can I really do?” And it may not be what she is doing at the moment, but something close and it’s a physician’s obligation to get them there to that point so that they understand that.

The elderly women, you know, it’s easier. They are sometimes much easier and particularly if they come in early so then you can say, “Well, you are going to live longer. You are going to be around for a while. You and your husband are going to be around for a long time playing, so you better go to bridge.” Over here, it’s just survival; taking care of the kids. This is a very different kind of scenario and sometimes it’s much tougher to be able to help people through.

About Dr. Mark Starling, M.D.:
Dr. Mark Starling graduated from the University of Washington, B.A. Degrees, cum laude, History and Literature. After a studying French Language and Literature at the University of Paris in France, Starling returned to Washington to study medicine at the University of Washington School of Medicine. He graduated in 1974 with honors. Over the years, Dr. Starling has been that Associate Professor of Medicine in the Departments of Internal Medicine and Cardiology Division at both the University of Texas and the University of Michigan.

Conditions: Heart Failure, Heart Disease, High Blood Pressure,

Related Terms: Shortness of Breath, Ejection Fraction, Edema, Exercise Intolerance, Fatigue, Echocardiogram, Electrocardiogram, Weak Heart Muscle

Expert: Dr. Mark Starling, Dr. Mark Starling, M.D., Doctor Starling, Chief Medical Officer Mark Starling, Women's Heart Health Specialist Cardiologist Dr. Mark Starling

Expertise: Peripheral Artery Disease, Heart Disease Risks, Heart Disease Management, Cardiac Metabolic Syndrome, Heart Disease Prevention, Blood Pressure Testing, Cholesterol Testing, Robotic Catheter Ablation, Coronary Artery Disease, Heart Failure Warning Signs, Heart Failure Prevention

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