The Medical Minute: Modern heart failure therapies improving life

By John P. Boehmer

Heart failure is a common medical condition. In fact, it is the most common cause of hospitalization for people over the age of 65. The very name is frightening — heart failure sounds as though someone may die at any moment. Indeed, the risk of dying from it was high in the past. But medical and surgical advances over the past 20 years have changed the nature of heart failure treatment from simply trying to slow progression of the disease to one where we can actually improve the heart’s condition. Today, heart failure is a chronic disease that people can live with for many years while maintaining a good quality of life.

Heart failure defined

A normal heart fills with blood, and then squeezes to force the blood through the circulatory system. In heart failure, either the heart is too weak to provide enough force to drive the blood flow, or it must be extra full in order to generate this force. The increased filling creates a backpressure that causes swelling in veins. In the body, this typically is seen as swelling of the feet or belly. In the lungs, it feels like shortness of breath. If the heart cannot generate enough blood flow, a person might feel weak and tired.

Medical therapy

In the early 1980’s, heart failure was a disease with a grim prognosis. Doctors simply tried to slow the progression of the disease and relieve symptoms. But modern medical therapy has revolutionized treatment of heart failure. Medications can make a weak heart stronger, relieve symptoms and improve a patient’s ability to be active, avoid hospitalizations and live longer with good quality of life.

Implantable Cardioverter Defibrillator (ICD) therapy

The risk of death due to a sudden, unexpected cardiac arrest increases as heart failure worsens. Many strategies have been studied to prevent these deaths, including medicines designed to stabilize heart rhythm. However, the most effective therapy to prevent sudden death is the implantable cardioverter-defibrillator, or ICD. This device is like a pacemaker, but pacemakers are designed only to stimulate the heart to force it to begin to squeeze. A defibrillator can deliver a shock—just as a rescue team does with electrical paddles—to stop a potentially lethal heart rhythm.

Pacing therapy

A special type of pacemaker, called a biventricular pacemaker, works on both sides of the heart to keep it in a normal rhythm. It synchronizes the right and left chambers (ventricles) of the heart and keeps them pumping together. This is called cardiac resynchronization therapy and is designed to improve the function of a failing heart.

Artificial heart pumps

For patients with end-stage heart failure, their only option for survival may be a ventricular assist device (VAD), or some other form of mechanical circulatory support. Penn State Milton S. Hershey Medical Center has a Joint Commission-certified VAD program that provides patients access to a broad spectrum of artificial heart pumps that can be surgically implanted to support their failing heart. The Medical Center also has the capability of implanting a total artificial heart in patients that meet specific criteria. These various pumps are typically used to support patients while they await heart transplantation or recover from an acute cardiac injury. Penn State Hershey Heart and Vascular Institute is also the only group in the area with Medicare approval for the Thoratec Heartmate device for permanent support of patients with failing hearts who are not candidates for heart transplants.

Heart failure seminar

Anyone interested in learning more about heart failure and the various therapies should attend a free seminar entitled Update on Heart Failure Treatment and Research. This event will be held February 3, 7-9 p.m. in the University Conference Center adjacent to Penn State Hershey Medical Center. Free parking is available near the entrance. Space is limited. Register by calling the Medical Center CareLine at (800) 243-1455.

John P. Boehmer is a professor of medicine, Penn State College of Medicine, and medical director of the Heart Failure Program within Penn State Hershey Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center.

Contacts: 
Last Updated March 19, 2009