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October 19, 2004
By Jen Christensen
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Heart failure is the inability of the heart to pump enough blood to meet the demands of the body. In systolic heart failure, the heart muscle is weakened. Blood flowing out of the heart slows, causing the pumping chambers to thin and enlarge. In addition, blood coming back to the heart starts to back up in the veins, causing swelling of the tissues (most notably the legs and ankles). Patients with another form of heart failure, diastolic heart failure, have stiff heart muscle. The heart muscle is able to pump normally, but can't relax enough to fully fill with returning blood, causing fluid build-up in the tissues. Patients with heart failure experience shortness of breath and fatigue during exercise, difficulty breathing while lying down, persistent cough or wheezing, swelling of the ankles, weight gain from excess fluid and nausea or lack of appetite.
According to the American Heart Association, nearly 5 million Americans have some degree of heart failure. About 550,000 new cases are diagnosed every year. The condition is more common in patients with coronary artery disease, prior heart attack, high blood pressure, heart valve disease, congenital heart defects and infection or damage to the heart muscle. Heart failure contributes to about 300,000 deaths/year in the U.S.
There are several treatments for heart failure. Lifestyle changes may help alleviate symptoms and slow progression of the disease. Doctors may recommend stopping smoking, losing excess weight, following a low-fat/low-sodium diet, avoiding alcohol and caffeine, a program of regular exercise and stress reduction. Medications can be prescribed to improve the heart's ability to pump, expand the blood vessels and/or eliminate excess fluid. Control of underlying medical conditions, like coronary artery disease, heart rhythm abnormalities or diabetes, is also important.
When lifestyle and medications no longer help and symptoms greatly impair quality of life, doctors may recommend a heart transplant. In a heart transplant, the diseased heart is replaced with a healthy heart from a deceased donor. The United Network for Organ Sharing reports 2,057 heart transplants were performed in the U.S. last year. However, the number of available donor hearts falls far short of the need. As of September 17, 2004, more than 3,400 people were on the waiting list for a heart transplant.
People who are waiting for a donor heart often face a long wait for a suitable donor organ. Those with failing hearts may be able to buy some time with a left ventricular assist device (LVAD). An LVAD is a surgically implanted battery powered pump. The device takes over the pumping action of the left ventricle (the main pumping chamber of the heart), pulling blood from the left ventricle and pushing it into the aorta (then on to the rest of the body).
Studies have shown an LVAD can be an effective device to relieve symptoms and "bridge" the time until an acceptable donor heart becomes available. However, doctors have found that after a period of LVAD implantation, some failing hearts begin to improve and patients eventually get better. The rest period provided by the LVAD appears to allow the weakened heart muscle to heal and recover function. In these patients, a transplant is no longer necessary and the LVAD can ultimately be removed.
At the University of Rochester, scientists are trying to determine why some hearts recover after LVAD implantation while others still require a transplant. Investigators are using gene profiling to study heart muscle tissue of heart failure patients. Two tissue samples are obtained - one at the time of LVAD implantation and one at the time of transplantation or (for those not needing a transplant) removal of the LVAD. The tissue samples will be compared with samples from healthy donor hearts that were deemed unsuitable for transplant (i.e., because the donor had hepatitis).
The researchers hope to uncover clues about why some hearts recover while others continue to fail. Eventually, the information gained in the study may one day lead to better heart failure treatments and earlier diagnosis of the condition.
For information on heart failure or LVADs:
For information on heart transplantation:
Copyright © Barrington Broadcasting.
This article posted November 20, 2004.