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Heart Failure: Which Questions Should A Woman Ask?

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Dr. Starling shares how a woman with heart failure can begin to discuss her new diagnosis with her cardiologist. Dr. Starling is currently the Chief Medical Director at Banner Heart Hospital in Mesa, Arizona.

Dr. Starling:
You know, when patients come to me, not uncommonly, they are actually a bit fearful about talking or asking questions about heart failure, their heart, structural heart disease. “Am I at risk? What should I be doing?” Those kinds of things, and I think it’s easier for cardiologists to be able to have that discussion because obviously you’ve potentially have been sent to a cardiologist because of some suspicion.

And as a woman, I think the first question out of your mouth to a cardiologist ought to be, “Do I have structural heart disease? How do I know if I have it or if I don’t, and what do I need to do about it to minimize my risk for developing symptoms of heart failure or worsening structural heart disease that would potentially limit my quality of life?” Those questions are kind of more and more in the daily lexicon of the medical world, almost expected.

People own their medical history. They own their problems and they need to understand how to manage them. So my encouragement, to women in particular, where sometimes they are, that might be just shunned off as, you know, inconsequential or something like that, is ask. For example, patients come in to see me. They almost universally they’ll get an electrocardiogram. Not uncommonly we do an echocardiogram in the office and off of that echocardiogram the cardiologist can tell you a lot of information, provide that to you. For example, they can tell you, “Do you have structural heart disease?”

“What did my echocardiogram show? Do I have structural heart disease?” The second question you should ask off right away is, “What is my ejection fraction?” Now what is an ejection fraction and why is it critical? An ejection fraction is the amount of blood that your heart ejects each beat. It’s the percentage that it ejects so it fills and then ejects.

What percentage of blood does it eject each beat? It should be around 55%. If it’s 40%-45% it begins to tell you that not only do you have structural heart disease, but your real risk for potentially developing heart failure goes up because now you have structural heart disease. So you need to ask about it. Questions around things such as “What’s my blood pressure? Is it normal range? What should I be doing to affect it?”

Remember we talked earlier about those risks for developing structural heart disease, well if you do have it then you’ve got to be more aggressive about managing those risk factors. So things like that.

The primary care community-based physician generally doesn’t have that information unless it’s sent to them; if you’ve seen a cardiologist and had an echocardiogram done or an electrocardiogram done or those kinds of things, but if you have then your community-based physician should be… you should be asking the same questions. They should be providing you the same data.

Treatments change. For example, if you do have structural heart disease then there are very specific therapies that you should be on to prevent further progression and you need to understand that in discussion with your physicians and ask those questions. “Should I be on therapy for this if I have this?” And that will help guide the conversation and I think will make you feel more comfortable about managing the process itself.

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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