Heart Failure + Heart Transplant

Heart failure happens when the heart can’t pump enough blood to keep your body working the way it should. Treatments for advanced heart failure might include medications, devices to help the heart work better, an LVAD (a device that helps with blood flow) or even a heart transplant. A heart transplant, where a sick heart is replaced with a healthy donor heart, can sometimes be the best way to improve heart function and help you feel better.

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Navigating heart failure + heart transplants with expert care

Since our first heart transplant in 1985, we’ve helped many people manage heart failure. For some, heart transplant surgery may be recommended, offering a fresh start with a new heart. A heart transplant can give you more energy and help you feel better when other treatments aren’t working.

Heart failure is different for everyone. Conditions like coronary artery disease, diabetes, high blood pressure, or being overweight can weaken your heart over time. That’s why it’s important to stay on top of your heart health.

Your care will be personalized just for you, focusing on what’s best for your health and well-being, including the potential for a heart transplant if necessary.

Katrina Landaverde, CCMA and Bernanie St. Juste, MA (both medical assistants at Tufts Medical Center) testing a heart patient at a cardiovascular appointment.

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Conditions

Nearly 1 in 4 adults in the United States will develop heart failure during their lifetime. While lifestyle factors like obesity can also lead to heart failure, certain conditions can weaken the heart, too. For example:

Cardiac amyloidosis

Cardiac sarcoidosis

Coronary heart disease

Diabetes

Dilated cardiomyopathy

Heart attack

Hypertension

Hypertrophic cardiomyopathy (HCM)

Sleep apnea

Valvular heart disease

Heart failure symptoms vary based on your underlying condition and stage of heart failure. Common symptoms include:

Fatigue and weakness
Shortness of breath with activity or when lying down
Struggling with exercise
Rapid weight gain
Swelling in the legs and/or abdomen
Loss of appetite or nausea
Confusion or difficulty concentrating
Persistent cough or wheezing
Arrhythmia (rapid or irregular heartbeat)

Types of heart failure

While there are many causes of heart failure, there are 2 primary categories. Knowing which type you have helps us create the most effective care plan for you.

Heart failure with reduced ejection fraction (HFrEF) happens when the heart's main pumping chamber, the left ventricle, doesn't pump blood well. In this condition, the ejection fraction (EF), which measures how much blood the heart pumps out with each beat, is 40% or less. This means the heart is too weak to pump blood effectively throughout the body.
Heart failure with preserved ejection fraction (HFpEF) happens when the heart is stiff and has trouble relaxing, even though its pumping function (ejection fraction) is normal.

Stages of heart failure

Heart failure is a chronic condition that becomes more serious over time, and in some cases, may ultimately require a heart transplant.

The process of understanding the extent of your heart failure is called staging, and it helps us design the most effective care plan for you, including whether a heart transplant might be needed. There are 4 stages of heart failure:

Stage A: When a person is at high risk for heart failure and doesn’t have structural heart disease or obvious symptoms.
Stage B: When a person has a heart disease, but isn’t experiencing obvious symptoms.
Stage C: When a person has a heart disease, and is experiencing heart failure symptoms.
Stage D: Also known as advanced heart failure, a person with Stage D heart failure is not tolerating or not responding well to standard medications and may be offered advanced treatments or surgeries.

Testing

Everyone’s journey to better heart health starts with a careful check-up. Your doctor and cardiologist will use the latest tools to understand how your heart is doing. These might include:

Blood tests
Echocardiogram (a heart ultrasound)
CT scan of the chest
Cardiac stress test
MRI of the heart
Left heart catheterization
Right heart catheterization

Your doctor may also send you to a special facility called a catheterization lab (cath lab). It has special equipment to help check serious heart and blood vessel problems. In the cath lab, you might have:

Left heart catheterization (coronary angiography): This looks at the blood vessels that supply blood to your heart.
Right heart catheterization (Swan-Ganz catheter): A small tube is used to check your heart's pressure and blood flow.

Treatments

Treatments for heart failure depend on how serious the condition is. For early-stage heart failure, simple lifestyle changes and medications can help manage the condition. For end-stage heart failure, treatment becomes more involved and may include a device placed in your chest to help your heart or a heart transplant.

For early-stage heart failure

For people living with Stage A or Stage B heart failure, our top priority is getting you on the path to better health before symptoms begin to show. For many people, that starts with making heart-healthy lifestyle choices, like exercising more, managing your weight and having less salt in your diet.

Stopping smoking and cutting back on alcohol use does your heart a big favor, too, but that’s not always easy to do on your own. There are resources and support available to help, and we’re always here to listen if you need to talk.

Your doctor may also prescribe medication — like beta-blockers or diuretics — to slow or stop the progression of heart failure. You can learn more about heart failure medications with our guide, "How to Take Your Heart Failure Medicines."

For end-stage heart failure

For people living with Stage C or Stage D heart failure, also known as advanced or end-stage heart failure, we focus on:

Managing symptoms
Preventing further complications
Helping you enjoy a comfortable quality of life

We always prefer to start with minimally invasive treatments, such as lifestyle changes and medications, for heart failure. However, if these strategies are not sufficient, we will consider more advanced options like mechanical circulatory support or a heart transplant.

Ventricular assist devices (VAD) + mechanical circulatory support

People with advanced heart failure may require a mechanical device to help their hearts pump enough blood. This approach is called mechanical circulatory support, and it uses a group of ventricular assist devices (VADs) to help the heart pump blood.

A VAD is a mechanical pump that’s surgically implanted into the chest when a person’s heart function is severely impaired. VADs are powered by an electricity source (batteries or AC power) from outside the body. Most often, VADs are implanted in the left ventricle (LVAD), which is the main pumping chamber of the heart.

Heart transplant surgery

A heart transplant is a surgery where a weak heart is replaced with a healthy one. Heart transplants are a big step, but it’s done to help you feel better and live a healthier life. The process of a heart transplant includes waiting for a donor heart and taking time to recover afterward.

We understand that hearing you need a transplant can feel overwhelming, but you're not alone. At Tufts Medicine, we are here to support you every step of the way. We are one of the top health systems in the country for heart transplants, and you’ll be in great hands. When you're ready for a second chance at heart health, we’ll be right here with you.

Who qualifies for a heart transplant or LVAD?

Deciding to have a heart transplant or an LVAD is an important choice, and you’ll make it with your doctor and the people who support you. You might be a good candidate if:

Your heart has trouble pumping enough blood to keep you feeling healthy.
Your body is ready to handle the surgery and the recovery that comes after.

Deciding whether to move forward with a heart transplant or an LVAD is a big decision, and it’s important to take your time and think about all the options. Here are some steps to help you make the right choice:

Talk to your care team: They’ll explain your options and help you understand the benefits and risks.
Ask questions: Don’t be afraid to ask about the surgery, recovery and how it affects your life.
Involve your support team: Talk with family and friends to get their thoughts and support.
Consider your health: Think about how well your body can handle surgery and recovery.
Think about your future: Consider how the treatment might improve your life in the long run.
Take your time: This is an important choice, so make sure you feel ready and comfortable with your decision.

Your doctor, support team and loved ones will be there to guide you every step of the way.

I can't say enough for the care that I received from the whole [heart failure + transplant] team. From day one of the evaluation I have felt so supported. I am where I am today because of my donor family and the Tufts Medical Center team’s support and care.

Tufts Medical Center

Read Ann's story