Heart Failure and Transplant Cardiology

Heart failure means the heart cannot pump enough blood, or can do so only at high filling pressures, causing breathlessness, fatigue and fluid retention. Heart failure cardiology is the subspecialty that diagnoses its cause, builds up the medicines that prolong life, selects patients for devices, and looks after those with advanced disease who may need a mechanical pump or a transplant.

Modern treatment has changed the outlook: four classes of medicine together roughly halve mortality in heart failure with reduced ejection fraction. The difficulty is delivery. Doses must be increased step by step over weeks with blood tests, which requires continuity of care close to home.

Conditions this service looks after

• Heart failure with reduced ejection fraction
• Heart failure with preserved ejection fraction
• Dilated, ischaemic and inherited cardiomyopathies
• Heart failure from valve disease or long-standing high blood pressure
• Cardiac amyloidosis and sarcoidosis
• Chemotherapy-related heart dysfunction
• Peripartum cardiomyopathy
• Advanced heart failure with repeated admissions
• Care before and after ventricular assist device or heart transplant

Tests you may be offered

• Natriuretic peptides (BNP or NT-proBNP): A blood test that supports or excludes heart failure and tracks severity.
• Echocardiography: Ejection fraction, valve function and filling pressures; the core test.
• ECG: Rhythm and QRS width, which determines suitability for resynchronisation therapy.
• Cardiac MRI: Identifies the cause by showing scar, inflammation or infiltration.
• Coronary angiography or CT: Looks for coronary disease as a treatable cause.
• Cardiopulmonary exercise test: Peak oxygen uptake, used to judge prognosis and timing for advanced therapies.
• Right heart catheterisation: Pressures and cardiac output, essential in transplant and LVAD assessment.
• Blood tests: Kidney function, potassium, iron studies, thyroid and liver tests.

Treatments available

• The four foundation medicines: An ARNI or ACE inhibitor, a beta blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor, started early and titrated to target doses.
• Diuretics: Relieve fluid overload; dose adjusted to weight and symptoms.
• Intravenous iron: Improves symptoms and reduces admissions in iron deficiency.
• Devices: ICD to prevent sudden death; cardiac resynchronisation therapy for those with left bundle branch block.
• Treating the cause: Revascularisation, valve repair or replacement including transcatheter mitral repair, rhythm control and ablation of atrial fibrillation.
• Left ventricular assist device (LVAD): A surgically implanted pump for advanced failure, as a bridge to transplant or as long-term therapy.
• Heart transplantation: For selected patients with end-stage disease; limited by donor availability.
• Self-care education, rehabilitation and palliative support: Daily weights, fluid and salt guidance, exercise training and symptom-focused care when needed.

When to ask for a specialist opinion

• You are breathless on mild exertion or when lying flat, or your ankles swell
• You have been admitted to hospital with heart failure
• Your ejection fraction is below 40 percent and you are not on all four foundation medicines
• Your symptoms are worsening despite treatment
• You have been told nothing more can be done and want a specialist review

Travelling to Türkiye for this care

A visit can provide a full work-up of the cause in 3 to 5 days, a second opinion on whether therapy is optimal, and planned procedures such as CRT or ICD implantation, valve intervention or ablation. It cannot provide the months of titration and monitoring, which need a local team. Heart transplantation is not available to medical travellers in practice: donor hearts are allocated through the national waiting list, Turkish law permits living donation only between relatives with ethics committee approval, which does not apply to hearts, and no agency can arrange a donor. Do not fly while decompensated; breathlessness at rest needs local hospital care.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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