Carlos Mercado was settling in for a night of television in 2022 when his heart suddenly began racing, pain gripped his chest and he broke into a cold sweat—symptoms that were all too familiar from a dozen years earlier when a bout of chest pain at the gym landed him in the emergency room (ER). Within days of that initial incident, he was undergoing heart bypass surgery to treat blockages in his arteries.
The recovery from heart bypass, says Mercado, now 55, was brutal. “I was put on life support and there were a lot of complications,” he says. “I was determined to lose weight and get healthy.” And he did, cutting back on rich foods, getting serious about exercise and dropping 40 pounds from a starting weight of 340 pounds.
Over time, though, he fell back into his old habits. Worse, when those troubling heart symptoms began to return, he ignored them. “I told myself it was because I’d regained some weight or that it must be heartburn,” he says. “The truth is, I was afraid to get checked.”
On that night in 2022, however, his symptoms were too intense to ignore. Another trip to the ER revealed that he’d had a mild heart attack. What’s more, the coronary artery disease he’d been diagnosed with years earlier had now progressed to full-blown congestive heart failure, a condition in which the heart muscle is no longer strong enough to pump sufficient blood and oxygen throughout the body. In other words, no longer capable of doing its job.
The most common cause of heart failure is coronary artery disease, followed by high blood pressure, diabetes, obesity and smoking. “But heart failure can also occur as a result of problems with the heart valves, abnormal heart rhythms or a genetic issue with the heart muscle,” says Bobbi Bogaev Chapman, M.D., FACC, FACP, Vice President, Heart Failure, at Abiomed, a division of Johnson & Johnson MedTech.
In spite of its dire-sounding name, heart failure doesn’t mean the heart has stopped working completely. While there is no cure for the condition, it is possible to recover from the debilitating symptoms and lead a full, active life. “Our goal is to look for reversible causes, then address those causes with the right treatment, whether it’s medication or surgery, as well as lifestyle changes,” says Dr. Chapman.
That’s what ultimately happened with Mercado, who, 12 years after his first heart incident, was relieved to discover that there are now treatments that can spare patients like him from an invasive bypass surgery or a heart transplant.
Keep reading to learn more about those treatments, as well as four things we now know about heart failure.
1.
While heart failure occurs most commonly in people over age 65, smoking cigarettes, consuming a high-fat diet and conditions such as obesity, hypertension and diabetes can also increase the risk in younger people. Indeed, a 2023 study published in the Journal of Cardiac Failure found that one in four Americans will develop heart failure in their lifetime. Each of those cases, however, may look very different.
Heart failure often progresses in four stages, starting with an elevated risk for the condition (Stage A), due to comorbidities like diabetes or a family history. Stage B—known as pre-heart failure—occurs when changes can be seen in the structure or workings of the heart, though no symptoms are present. Symptoms such as fatigue, rapid heartbeat, coughing, swelling, a change in weight and shortness of breath start to occur during Stage C. These symptoms may progress and interfere with the ability to live a normal life without treatment, which is known as advanced heart failure or Stage D.
But heart failure can also occur more suddenly. “When someone has an acute heart attack, they can go into cardiogenic shock, which is when the heart suddenly can’t pump enough blood and oxygen to meet the body’s needs,” says Dr. Chapman. “When the heart’s pumping function is severely impaired, blood pressure drops dramatically and vital organs—such as the kidney, liver and brain—don’t receive enough oxygen-rich blood. This can also occur as a result of a condition known as myocarditis (inflammation of the heart muscle) or during the third trimester of pregnancy as a result of peripartum cardiomyopathy.”
Acute heart failure is also associated with the virus that causes COVID-19. In a 2022 study of nearly 600,000 hospitalized patients, those with COVID-19 had a 45% higher risk of developing heart failure in the following year compared with people who didn’t have the virus. Mercado was hospitalized with COVID-19, not once but twice. “At the beginning of the pandemic, I would deliver bags of food, soup and aspirin to people around the neighborhood who were sick, which may have contributed to my contracting the virus,” he explains.
2.
“One problem with heart failure is that people often attribute their symptoms to gaining weight or getting older,” so they don’t necessarily feel the need to see their healthcare provider, says Dr. Chapman. What’s more surprising, she adds, is that doctors don’t always screen patients with tell-tale symptoms for coronary artery disease.
“Too often they are looking for chest pain as opposed to shortness of breath, fatigue or extra fluid in the legs and abdomen,” she says, echoing the results of a 2021 review of studies in the Journal of Cardiac Failure, which found that rates of heart failure misdiagnosis ranged from 16% to more than 68%. “Women, especially, don’t always present with chest pain, but instead might have jaw pain, anxiety and even burning in their stomach.”
3.
Like many other illnesses, outcomes for people with heart failure (and their risk of getting it in the first place) are linked to factors such as race and income. Case in point: Black people under age 50 have a 20-fold higher incidence of developing heart failure than white people their age, according to a 2021 report in Current Opinion Cardiology. And despite advances in medicine and technology, premature deaths in Black patients with heart failure, ages 15 to 44, increased nearly three-fold from 2012 to 2019.
The reason is linked to underdiagnosis. “Studies have shown that people of color are less likely to be diagnosed with heart failure in an outpatient setting,” says Dr. Chapman. Those delays matter. “By the time many Black and lower-income people finally do get a diagnosis, their symptoms are more likely to be out of control.”
As research shows, a number of factors fuel these disparities, including barriers to medical care access, fewer referrals to specialists and lack of adequate insurance. Issues such as lack of trust and poor doctor-patient communication also keep patients from getting the care they need.
4.
The second time Mercado landed in the ER because of his heart, the news wasn’t good, at least not at first. He was in Stage D of heart failure. “My doctor told me that I had multiple blockages in my arteries and that my case was high risk,” Mercado recalls. He was relieved to learn that instead of surgery, he might be a candidate for a minimally invasive cardiac catheterization procedure to unblock his arteries with the help of an Impella heart pump.
While some people with heart failure can be treated with medications that can slow a too-rapid heart rate, control blood pressure and reduce fluid in the body, “not all patients can tolerate these prescriptions because their blood pressure may be too low, or their kidney function might be compromised,” says Dr. Chapman. Others may be too sick to make them good candidates for surgery if they have multiple blockages or comorbidities such as obesity or diabetes.
In the past, the only option for these high-risk patients was to get on a waiting list for a heart transplant. But recent studies, including one in the International Journal of Cardiology, suggest that patients who receive the Impella heart pump before procedures such as cardiac catheterization—as opposed to during or after—have significantly lower short-term and mid-term mortality rates. One reason is that the Impella heart pump assists the heart and decreases its workload while maintaining blood pressure, allowing the heart to rest and recover and making it possible for doctors to perform procedures earlier.
“Think of it like having a twisted ankle—in order to heal, you need to rest and not put weight on it,” says Sonya Bhavsar, Ph.D., Director, ECP and Pediatric Platforms, Abiomed. “Similarly, your heart is a muscle that is always working. When it is injured or compromised, it’s not able to rest because your body depends on it,” she adds. “Impella is like crutches for the heart—it takes the load off.”
And unlike older, bulkier heart pumps, which can potentially damage the heart muscle, “the Impella pump is inserted during a minimally invasive procedure,” explains Bhavsar. “The pump is inserted percutaneously, meaning through the skin, using a small puncture to reach a large blood vessel in your leg. It is similar to when a technician uses a needle when you are giving blood. Once in position, the pump sits across the aortic valve, pushing blood through the valve in synchrony with the heart, working with it hand in hand.”
The Impella can remain in the body for just a few hours, as was the case for Mercado, while his doctor unblocked his arteries, or for up to 14 days as the patient continues to receive treatment.
Looking back, Mercado says the difference between his treatment experience in 2010 and 2022 was dramatic. “The first time, my chest was open, and there was mesh in there,” he says. “This time, I was awake during the whole procedure, and my doctor even showed me images of my arteries as he was removing the blockages. I was home from the hospital in two days.”
Today, he is back to working out again and enjoying the things that make him happy, like spending time with his family and dancing. He’s also down 70 pounds from his high of 340 and is mindful that he needs to stay tuned into his body’s signals. “I know how important it is to get checked if you feel symptoms,” he says. “The worst thing to do is to wait until the last minute.”
