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echocardiogram, reveals the patient's ejection fraction. At the same time, this exam can provide evidence of mitral or aortic valve regurgitation, all of which may relate to heart failure. If it 's unclea r whether the patient is ex periencing active hea r t fa i lure, Dr. Oviasu recommends caution. "If the patient is out of heart failure, you can use noninvasive tests in terms of a nuclear exercise stress test," he says. "Or you go directly for a cardiac angiogram." The decision to proceed directly to a cardiac angiogram comes with imme- diate benefit, Dr. Oviasu says. It allows the cardiologist to visualize the heart's blood vessels and determine whether the patient is experiencing significant coronar y arter y disease (CA D). If so, that CAD might contribute to a patient's symptoms. This important finding helps g uide treatment and further ensures the preservation of the patient's health and safety. THE ROLE OF HYPERTENSION A variety of lifestyle choices and genetic problems culminate in a heart failure diagnosis. Among them, one stands out. "Across the world," Dr. Oviasu says, "hypertension is one of the biggest causes of heart failure." With untreated hy per tension, the heart weakens over time. This weakened heart muscle produces a lowered ejection fraction, a primary origin of heart failure. Though hypertension is often the result of unhealthy habits, a lack of treatment for the disease, according to Dr. Oviasu, has another root. "Hypertension often goes untreated because of social issues," he says. "Some patients don't have access to care, partic- ularly within minority groups." Additionally, among those with access to care, there is some hesitancy to comply with prescribed medication for hyper- tension. One rea son is hy per tension medication comes with certain risks of its own. The most dreaded is the risk of a lowered libido. Among those with hypertension, many patients value their sexual desire over any risk of high blood pressure. Therefore, they do not ta ke medication as prescribed. Unfor t unately, t his lack of t hera- peutic management has significant complications. Hypertension can cause hypertrophy. This enlarg- ing of the lef t ventricle can lead to CA D. W hen it does, CA D may result in heart failure. In fact, hypertrophy is the most common cause of heart failure in America. ADDITIONAL RISK FACTORS: DIABETES Dangerous as it is, hyper- tension is only one risk factor for heart failure. Another cause is diabetes. With diabetes, however, diag- nosis of heart failure can be particularly difficult. Patients who have diabetes do not necessarily present with traditional angina symptoms. Therefore, they may not receive an accurate diagnosis at an early heart failure stage. As a result, many do not receive appropriate, aggressive heart care until they have experienced damage to the heart muscle. Understanding this and taking appro- priate action early may play a role in stopping heart failure from worsening over time. In some cases, recognizing the right signs may halt the development of heart failure altogether. "It's important that cardiologists treat risk factors aggressively — especia lly hypertension," Dr. Oviasu says. "They should also look for early signs that might contribute to heart failure through non- invasive testing." If a patient presents with a low ejection fraction, the cardiologist is responsible for determining whether CAD is or is not present. An ejection fraction less than 50 should raise suspicion. In most cases, hypertension, CAD or ischemic heart disease is to blame. However, other problems may be present. For instance, the patient may have abused alcohol, which can affect ejection fraction and cause heart failure. In some cases, untreated sleep apnea can lead to atrial fibrillation or heart failure. Treating the underlying condition often brings symptomatic relief for heart failure patients. Dr. Oviasu provides sensitive and thorough care for his patients in the local community. Dr. Oviasu with Ronald Bruce, a nuclear technologist, performing a nuclear stress test. 0 8❱❱❱❱❱ C O V E R F E A T U R E