2010-04-10 / Columnists

Medical, Surgical Advances Can Help Those With Heart Failure

Maintaining Your Health on Mackinac
By Yvan Silva, M.D.

Every year, more than half a million Americans are told by their doctors that they have, or that they are in, “heart failure.” This sounds ominous, and raises serious concerns that the heart may quit working any minute. Not true. What it really means is that the heart is not working at optimal capacity and cannot pump well enough to supply sufficient oxygen to meet the body’s needs. In current day practice, treatments have become available to enable improvement in symptoms and heart function and get patients to live relatively normal lives. In most cases, a combination of medications and clearly defined lifestyle changes constitute a treatment plan that efficiently addresses the degree of heart failure.

Heart failure is a common condition. Resulting from one or more of several diseases that affect the heart, in this chronic condition the diseased heart loses the ability to continue to pump efficiently, leading to fluid build up in the lungs and other tissues. The individual cannot be physically and fully active, and requires proper therapy to be able to function.

Heart failure among adults 65 years and older is the most common reason for admission to a hospital. Nearly 5 million Americans in this age group have heart failure, accounting for 20% of all hospital admissions. The rate of admissions has continued to climb over the past decade. The current estimate of annual deaths owing to heart failure is 300,000. However, several medical and surgical advances have been made in this area, and new and combined treatment methods are greatly reducing the morbidity of these patients and restoring function status more efficiently than ever.

Symptoms of heart failure may occur suddenly, or develop gradually. The left or right ventricular chambers, or both sides of the heart, may be involved. Shortness of breath on physical activity or while lying flat; irregular or rapid heartbeat; tiredness, weakness, dizziness, or feeling faint, and coughing or wheezing, especially while asleep, are common symptoms. Accumulation of excess fluid in the body can lead to weight gain, and swelling of the abdomen, feet, and ankles can ensue. Affected individuals may have kidney failure, which also leads to retention of fluid. They often have difficulty sleeping and difficulty concentrating or staying alert.

There are many causes of heart failure. Coronary artery disease causes narrowing of the arteries that supply the heart with blood and leads to heart attacks that permanently scar and damage heart muscle and diminish the pumping ability. High blood pressure leads to arterial damage and similarly affects the heart as well as other vital organs. Diabetes increases the risk of heart failure, especially when it is associated with obesity and high blood pressure and high cholesterol. Heart valves, when diseased, can become stiff, preventing normal pumping of blood between the chambers, or they can leak, diminishing the efficiency of the pumping mechanism. Cardiomyopathy is the term that refers to damage to the heart muscle from alcohol abuse, effects of some drugs, pregnancy, or heart muscle disease from other causes. Inflammation of the heart muscle from a virus or other inflammatory causes, abnormal heart rhythm, heart defects, and certain metabolic conditions, like an overactive thyroid, can lead to heart failure.

Treatment consists of a serious combined regimen of a balanced, low salt and nutritious diet and strict weight control; a combination of heart and blood pressure medications is essential. There is a great variety of these medications to choose from, and close follow-up with the doctor and monitoring for efficacy is very important. It is essential to stop smoking, and strictly limit the intake of alcohol. A strict diet with control of fat and cholesterol is important. Although it might seem contraindicated, regular physical exercise may well be advisable and should be approached with caution and within limits of tolerance. The goal is to optimize heart function and maintain its efficiency. Relaxation and stress control are included in the many parameters of therapy, as well as weight control. Measuring weight daily helps in assessing fluid retention, and when there is a rapid gain of three pounds or more, active reassessment of the treatment plan by the physician should be undertaken and appropriate treatment implemented.

When heart failure is advanced, hospitalization becomes necessary and removal of excess fluid build up with diuretics and other medications is undertaken. Further, strengthening of the heart muscle with medications or surgical assist devices may be indicated. In some cases, heart surgery is helpful, including coronary artery stenting or bypass surgery, or valve repair or replacement. Defibrillators may be implanted surgically. These devices are placed under the skin of the upper chest, connected internally by wires to the heart muscle, and when irregularity ensues, they can shock the muscle back into a normal rhythm. Devices combined with a pacemaker for both ventricles are used in some cases. In severe cases, other types of surgery are available; a heart pump can be implanted into the abdomen and attached to the weakened heart to help it pump. When medications and surgical devices cannot adequately manage advanced and severe heart failure, heart transplantation is an option. About 2,000 people receive a heart transplant every year, with dramatic improvement in survival and quality of life. The one-year survival rate is about 85%. The availability of suitable donor hearts is very short, however, and some candidates have to wait for long periods.

Heart failure is the end-stage of heart disease, from a number of causes. Early recognition of risk factors including diabetes, hypertension, kidney disease, obesity, smoking, and others, and a strict approach to prevention and treatment are the best preventive measures available. In the United States, primary physicians and cardiologists care for more than two thirds of patients with heart failure. Early detection and close observation on the part of the physician, and strict compliance by the patient of the management plan, will go a long way to prevent deterioration of heart function and maintenance of a good quality of life.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.

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