• When the Heart Needs Help to Pump

     
     
     
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    Concern about the condition of country music artist Randy Travis has brought attention to a widespread and urgent public health problem: heart failure. Whether your own life has been touched directly, indirectly, or not at all by heart failure, you may be surprised to know that, according to the American Heart Association 5.7 million Americans are living with heart failure, and 10 percent of these patients have an advanced form of heart failure.

    In Mr. Travis’s case, news reports have suggested that a viral infection caused a condition called cardiomyopathy, which then led to heart failure.

    Read on to learn more about viral cardiomyopathy, heart failure, and heart failure treatment options—including the tiny pump that was inserted into Mr. Travis’s heart in an attempt to treat his heart failure.

    What Is Cardiomyopathy?

    The term cardiomyopathy describes disease of the heart muscle. If the heart muscle is thickened, the condition is referred to as hypertrophic cardiomyopathy. However, if the muscle is stretched thin, it is called dilated cardiomyopathy.

    Viral cardiomyopathy is a form of dilated cardiomyopathy that occurs when a virus that might, for example, typically cause a respiratory infection or gastrointestinal illness infects the heart muscle and causes inflammation. The heart muscle becomes less able to pump oxygen-rich blood to the body, so the chambers of the heart expand in an effort to push more blood through the arteries. Viral cardiomyopathy on its own is treated with medications.

    What Is Heart Failure?

    Heart failure is a condition where the heart muscle can no longer pump enough oxygen-rich blood to meet the body’s needs. The term heart failure gives the impression that the heart can no longer function at all, but that is not the case. In fact, people can live for years with heart failure, depending on the severity.

    You may also hear the term congestive heart failure. This term refers to the weakened pumping action of the heart, which results in blood “backing up” in the lungs and vessels that carry blood to the heart, causing them to become congested. As the heart becomes less efficient as a pump, it grows larger so it can hold more blood—and it begins to wear out. To help compensate for the heart’s inability to circulate the blood as it should, other body tissues begin to hold on to fluid, increasingly becoming congested. The lungs can fill with fluid, the legs and abdomen can swell and get puffy, and the liver can enlarge. Serious, progressive heart failure is eventually fatal.  

    Heart failure can be caused by many factors, including, for example, long-term high blood pressure, damage to the heart muscle from a heart attack, exposure to toxins, and heart defects. Conditions such as diabetes also raise the risk of heart failure.

    How Is Heart Failure Treated?

    Mild cases of heart failure can sometimes be reversed with medications that reduce the workload on the heart by lowering blood pressure and reducing fluid retention. Lifestyle changes such as limiting sodium intake and following a doctor’s physical activity recommendations also contribute to healing. Moderate heart failure requires the same treatments on a more aggressive scale, with a goal of long-term management of the condition.

    In the past, patients with serious heart failure could only do their best to manage the condition and would eventually require hospitalization. A heart transplant was the only source of hope for many of these patients.

    Today, exciting avenues in treatment are opening up, and stand to be revolutionary in their ability to treat patients who previously did not have many options. For example, medical researchers have developed tiny pumps, such as various Impella models, which can be inserted by an interventional cardiologist, who makes a small puncture site in the skin and threads the pump through a flexible tube (a catheter) to the heart. The pump is then placed in the main pumping chamber of the heart (the left ventricle). Another device, the Tandem Heart, draws oxygenated blood directly out of the heart and pumps it back into the aorta to be delivered to the rest of the body.

    These implanted devices take over some of the heart’s job of moving blood through the heart, allowing the heart muscle to “rest.” While these devices are in place, the patient recovers in the hospital. Although artificial pumps do not work for everyone, their ability to allow the heart to rest appears to be capable of reversing heart failure for some patients.

    These innovative devices are often used to stabilize patients who are also receiving other treatments. For patients with advanced disease, the pump serves as an effective bridge while waiting for a heart transplant or for the heart to fully recover. Those who are ineligible for a transplant may receive a surgically implanted left ventricular assist device (LVAD). These LVADs totally replace the pumping function of the heart, so that patients may recover to leave the hospital. These pumps may increase longevity and quality of life for patients who are not candidates for heart transplant.

    Insertion of the pump, like any medical procedure, carries risks. Stroke is one of these risks, but heart failure itself is also a risk factor for stroke.

    Looking to the Future

    Treatment of heart failure is an emerging area of medical research with much uncertainty,  but it is exciting because of the potential to restore heart health to some patients with mild heart failure and offer hope to thousands of patients with serious heart failure who have had few options in the past.