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that pot ent i a l ly i nd icat e hea r t fa i l- u re. T hese w ide -ra n g i n g s y mpt om s a r i s e f r om t h e h e a r t 's i n a bi l it y t o pump adequate blood t h roug hout t he body 's orga ns. Sy mptoms t hat may indicate hea r t fa i lure include t he fol low ing: Coughing that is persistent . The patient 's cough may or may not produce white or blood-sta ined mucus. Edema in the abdomen or lower extremities. Swelling in the feet, legs or a n k les a nd subsequent weig ht ga in is a tel lta le sig n of hea r t fa i lure. Feeli n g breat h le s s , of t en w it h activ ity. This lack of ox ygen ca n a lso occur when at rest or whi le sleeping. It may force a n indiv idua l to sit upr ig ht i n b ed i n t he m idd le of t he n i g ht t o improve breat hing. Feelings of fatig ue. Wa l k i ng a nd exercise ca n become d i f f icu lt due to hea r t fa i lure. Such tiredness compli- cates t he patient 's abi lit y to per for m activ ities of da i ly liv i ng a nd reduces overa l l qua lit y of life. L o s s of a p p e t it e . He a r t f a i lu r e patients of ten str uggle to eat. This may be due t o feel i n gs of f u l l ness, wh ich may be accompa nied by nausea . Menta l acuity def icits. Hea r t fa i l- ure ca n reduce a n indiv idua l's menta l s t r en g t h a n d s t a m i n a . W it h he a r t fa i lu re, t he pat ient m ay ex per ience at y pica l memor y dif f icu lt y, conf usion a nd ot her menta l impa ir ments. Pa lpitating hear t. A fa iling hea r t is consta nt ly at tempting to catch up a nd per form its dut y properly, compensat- ing for the hea r t 's lost pumping abi lit y. A s it does t his, t he patient may ex pe- r ience a noticeably rapid hea r t rate. S h ou l d s u c h s y mp t om s b e pr e s - ent , a n i n- dept h ex a m i n at ion helps det er m i ne t he pre senc e or a bsenc e of hea r t fa i lure. Fol low ing a physica l exa mination a nd discussion of medica l h istor y, t he cl i n icia n may per for m a ser ie s of a nci l l a r y t e s t s t o u nc over hea r t fa i lure. A n c i l l a r y t e s t s f o r h e a r t f a i l - u r e i n c l u d e b l o o d t e s t s , c h e s t r a d i o g r a p h y, e l e c t r o c a r d i o g r a p h y a n d e c h o c a r d i o g r a p h y. T h r o u g h t hese t es t i n g moda l it ies, cl i n icia n s ca n identif y congestion in t he lung or heart or a cardiac gallop due to abnormal function of the heart. A n a bnor m a l ele c t ro c a rd iog r a m is a lso diag nostica lly sig nif ica nt, as it may suggest a previous myocardia l infarction. Additional testing, such as Connecting COVID-19 and Heart Failure SINCE THE BEGINNING of the pandemic, the medical community has quickly developed an understanding of COVID-19, how it spreads and how to avoid and treat it. Despite this, "We don't know everything about COVID-19," says Felix Oviasu, MD, FACC, FACP, FCCP, board-certified cardiologist at Garden City Heart and Diplomate of the American Board of Internal Medicine and Nuclear Cardiology Board. What Dr. Oviasu does know is that patients with COVID-19 may present with cardiac conditions, including myocarditis. In some cases, those presentations are significant enough to require hospitalization. Heart failure can also occur as a COVID-19 complication. Determining who will experience COVID-19-induced heart failure is no easy task, as it sometimes affects those who do not require hospitalization. This increased incidence is not unexpected, Dr. Oviasu notes. As a virus, COVID-19 can directly affect the heart muscle. It can also set off an immune response that ultimately affects the heart muscle. This inflammation of the heart causes myocarditis. When severe, myocarditis can result in the development of a low ejection fraction and ultimately heart failure. While anyone can experience such complications, certain individuals are at higher risk. "Those with comorbidities are more likely to succumb to COVID-19 [and heart failure brought on by COVID-19]," Dr. Oviasu says. "And those with preexisting heart failure have an increased risk of mortality when infected with the virus." With this information, clinicians ought to be particularly protective of their patients with preexisting conditions, encouraging them to exercise extra caution to avoid infection. Yvonne Kowalczyk, a certified echocardiography technologist, performs an echocardiography. M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 0 7