HERSHEY, Pa. — Anyone who saw Stephen McNamara on the tennis court today would never guess he has heart failure. Yet in 2023, the active 56 year old started experiencing symptoms that were hard to ignore — getting tired easily, shortness of breath, gastrointestinal pain and extreme trouble sleeping. After seeing his doctor and getting blood work, he was scheduled for a stress test and chest X-ray the following Monday.
His doctor told him to go to the emergency department immediately if he felt dizzy. Following a weekend of sleepless nights, the Lancaster resident woke his wife and asked her to drive him to Penn State Health Lancaster Medical Center.
“After running several tests, they told me I had chronic heart failure and blood clots in my heart and lungs,” McNamara said. “They did an echocardiogram and determined that my ejection fraction was 17. A normal ejection fraction is 55 to 65. I was in transplant range.”
Recognizing heart failure symptoms
Nandini Nair, a cardiologist and medical director of the Ventricular Assist Device and Heart Transplant programs at Penn State Health Heart and Vascular, explained that ejection fraction measures how much blood the heart pumps out with each contraction. It is one of several factors used to evaluate heart failure.
“Heart failure is when the heart isn’t providing enough circulation or enough blood to the other organs,” Nair said. “It can be due to a squeeze problem where the function is going down, or it can be that the walls of the heart are stiff — they’re not relaxing, and so they’re not filling enough.”
McNamara experienced some of the warning signs of heart failure: shortness of breath and overall fatigue. The American Heart Association says patients may also experience:
- Coughing or congestion
- Swelling in the legs, feet, ankles or belly
- Confusion
- Sudden weight changes
- Heart palpitations
- Lack of appetite or nausea
Heart failure can result from three common types of heart disease, Nair said, including coronary artery disease, which can lead to heart attacks, heart rhythm disorders and cardiomyopathy, a condition that weakens the heart muscle. Some people are genetically predisposed to heart disease, but high stress leading to high blood pressure and lifestyle factors like smoking, drinking excessive amounts of alcohol, an unhealthy diet and lack of exercise can increase the risk. Viral infections can also cause it, which McNamara believes was most likely the case for him.
Heart failure treatment options
Although heart failure is a serious condition, Nair said many patients can improve their health and quality of life with a combination of medication, lifestyle changes and, in some cases, surgery.
“Heart failure is no longer a death sentence the way it was in the past, especially if you catch it early,” Nair said.
After his diagnosis, McNamara wore a LifeVest, a cardioverter-defibrillator that continuously monitors heart rhythm, for several months before receiving an implantable cardioverter-defibrillator (ICD) in 2024. The device coordinates the heart chambers to pump blood more efficiently and can deliver an electrical shock to restore a normal rhythm if it detects a life-threatening arrhythmia. He also takes eight medications daily to improve his heart function, reduce fluid retention and lower blood pressure.
Nair said most patients with a low ejection fraction like McNamara’s are prescribed what cardiologists call the “four pillars” of heart medications: beta blockers, ACE inhibitors, aldosterone receptor blockers and SGLT2 inhibitors. Each medication works on a different biochemical pathway, or process in the body, to help the heart function better and reduce the risk of complications.
She also prescribes lifestyle modifications, including regular physical activity such as weight-bearing exercise, a reduced-sodium diet, adequate sleep and cutting out tobacco and excessive alcohol use. Some patients need more advanced treatments, such as an ICD like McNamara’s or, for those with end-stage heart failure, a left ventricular assist device, which pump blood through the body, or a heart transplant. Nair said patients who require more invasive treatments can still have a good quality of life, particularly when they make healthy lifestyle choices.