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EFFECTIVE THERAPIES FOR HEART FAILURE Today, a number of medical therapies are available to effectively manage heart failure. This is a great advance from years past. When Dr. Oviasu began practicing three decades ago, there were limited options. At t hat time, diuretics a nd digitalis were the treatments of choice. In fact, they were the only approved treatments for managing heart failure. Thir t y yea rs ago, accepted best prac- tices recommended aga inst the use of beta blockers for hea r t failure. Medica l schools actively taught against using the medication, as the resea rch of that day suggested beta blockers exacerbated hea r t fa ilure symptoms. A few yea rs later, g roundbrea k ing re sea rch fou nd t he e x a c t opposit e . I n s t ea d of worsen i n g hea r t fa i lu re, b et a blocker s were fou nd t o h ave a positive effect. Researchers determined beta blockers improved the two major benchmarks of medica l care: morbidity and morta lity rates. Their use has since become sta nda rd practice within the hea r t fa ilure patient population. Soon a f ter beta blockers beca me a s t a nda rd of ca re, la nd m a rk s t ud ies found benef it in a nother medication: angiotensin-converting enzyme (ACE) in hibitors. Resea rch found t hat t his medication helps people with fully devel- oped hea r t fa ilure or post-myoca rdia l infa rction with low ejection fraction. T h o s e p r e s c r i b e d A C E i n h i bi t o r s enjoyed longer sur v iva l. A ng iotensin receptor blockers were a lso shown in studies to improve heart failure patient outcomes. A s resea rchers continued developi n g new t reat ment opt ion s , patients benef ited. " With time, there have been sig nif- ica nt improvements in the treatment of hea r t fa ilure," Dr. Oviasu says. "ACE inhibitors have been key in terms of the improvement they 've provided." However, he is quick to admit that the overa ll improvement in outcomes for those with hea r t fa ilure is not due to a single adva nce. Rather, "It 's due to a combination of these medications." Diagnostic Order of Operations AT GA RDEN CIT Y Heart, a suite of diagnostic tests provides a full picture of a patient's heart health and helps detect heart failure. Patients who come to Garden City Heart may undergo the following procedures: Electrocardiogram. This test shows the heart's rhythm and electrical activity, which may indicate a previous heart attack, arrhythmia or thickened left ventricle. Echocardiogram. This standard ultrasound test reviews the heart's ability to pump blood through the body. It is the most accepted manner of assessing the heart's ejection fraction, which helps identify the presence of heart failure. Nuclear exercise stress test. With this test, clinicians seek for ischemia, which may suggest the cause of a patient's heart failure in terms of ischemic heart disease. Holter monitor. This device provides evidence that a patient is experiencing the persistent rapid heart rate of atrial fibrillation, which can contribute to heart failure, or an irregular heart rate, such as tachycardia, which can be the result of heart failure. Though these tests are typically performed in succession, they are not always indicated. "If someone presents with unstable angina — they're having chest pain at rest and it is progressively worsening — you may suspect that individual has significant ischemic heart disease," 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. In that case, he says, "You may go directly to a coronary angiogram without undergoing a stress test or other tests, because you believe the risk of noninvasive testing will be too high." Patients are monitored during a cardiac rehab session at Garden City Heart. 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 9