Meet the Cardiologist: Heart Failure
Dr. Luanda Grazette is a board-certified cardiologist with Keck Medicine of USC. In our “Meet the Specialist” series, we highlight the perspectives of various medical specialists on the types of patients they see and what they find rewarding and challenging in their daily practice.
I have been a cardiologist for about 20 years. Even as a child, I was fascinated by science and medicine. Throughout my education, I was especially captivated by the way science presents a way to untangle and solve real-world problems. Now, as a cardiologist, it’s especially fulfilling for me to have tools and a logical approach to solving real problems for real people. With cardiology, many things can be counted, measured, and calculated. And the solutions or treatments we find for these problems are life-changing for many people. It’s important for me to make a real impact, and cardiology allows me to do that.
Understanding Heart Failure
I am personally not a big fan of the term “heart failure.” I think the term can be cruelly misleading to patients, especially early in the diagnosis. I can’t count the number of patients who, once they hear those words, think they’re dying and there’s no hope. However, it’s really quite the opposite—for the majority of patients, heart failure is a chronic condition that can be managed and patients can live with it for many years. There are all sorts of historical reasons why we continue to use the term heart failure, but my personal preference is the terminology most commonly used in Europe: cardiac insufficiency. In heart failure or cardiac insufficiency, the cardiovascular system is not capable of meeting the body’s metabolic needs—its actions are insufficient. This can result from a problem with the heart itself or it can be a problem with the “pipes” leading to the heart, the blood vessels that make up the circulatory system. Or, most commonly, heart failure is caused by a combination of the two. There are lots of different things that can lead to cardiac insufficiency, which also means there are a lot of levers we can manipulate to try to stop or reverse the process.
There is a wide range of treatments for heart failure, and new therapies offer exciting options. I want patients to know heart failure doesn’t mean they have failed or their bodies have failed. They just need to make adjustments, like taking prescribed medications as ordered and maintaining a healthy lifestyle in which they exercise and eat well.
What Patients Should Know
When a patient has just received a diagnosis, or is early on in the treatment process, I try to emphasize to them that this is a journey with multiple steps. There will be hills where they feel well and there will be valleys where they don’t. Our combined goal is to maximize the number of hills and minimize the number of valleys. The way to do that is take it step by step and be honest and open with your doctors and caregivers. If you’re experiencing side effects from medications, I want to know about it so we can make changes. If you’re having trouble taking all your medications as prescribed, talk to your doctor so you can find a solution together. Additionally, exercise is especially important, not just for your physical health, but also your mental health. The diagnosis of heart failure can leave people feeling like they don’t have control of their lives anymore, but exercise can help them re-engage with their bodies in a positive way. I’ve never had a patient who didn’t experience a positive impact from adding moderate exercise, such as walking, to their life. Most of all, patients should know this isn’t a death sentence. Things can get better.
Finding the Right Cardiologist
In order for your health to improve, it’s crucial to find the right cardiologist and care team. Look for someone who is comfortable explaining things to you. You want to feel comfortable asking questions and ideally, your cardiologist and team will be happy to give you the answers in language you can understand, not just hand you a printout of clinical information. Ask questions: What will I experience? What happens to other people in my condition when they take this drug or do this therapy? What are some of the side effects I should expect? If you don’t feel confident in your doctor’s ability or willingness to answer your questions, try to find someone who will better meet your needs.
My favorite part of my job is encountering a patient who, for whatever reason, has lost hope that things can get better—and helping them realize that’s not necessarily the case. There is hope with heart failure, and with the right care, you can live your life in a healthy and fulfilling way.