Learn the next step in heart failure treatment when medications and lifestyle changes aren’t enough.
The term “heart failure” is a bit misleading. It doesn’t mean your heart has stopped working, per se. “It’s a misnomer,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City. “Heart failure is treatable.” In fact, more than 6 million Americans are living with heart failure.
Heart failure occurs when the heart muscle has become weak and can’t pump blood well enough to meet the body’s needs. Basically, it can’t keep up with its workload. Here’s more about what happens to your heart during heart failure.
After you’re diagnosed with heart failure, your doctor will likely suggest a heart failure treatment regimen, which may include a series of lifestyle changes, heart failure medications, or, depending on the severity, devices or surgery.
“After you’ve been on a series of medications, [we’ll check] to see if the pumping of the heart improved,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. If the heart muscle still remains weak, your doctor may then suggest surgical treatment options, she says.
How Doctors Treat Heart Failure with Surgery or Procedures
“The first and foremost thing we have to always do is make sure that the heart failure is not due to coronary artery disease or a heart attack, because we’d want to open the arteries so that the muscle can get blood and can get stronger,” says Dr. Bhusri.
To open the arteries up, doctors may suggest putting in a stent. A stent is a small mesh tube that’s placed in the artery to improve blood flow and help prevent the arteries from bursting.
If the heart muscle is still weak after lifestyle modifications and medications, it puts your heart at risk for an arrhythmia (abnormal heart rhythm), which can be life-threatening. In this case, doctors may then recommend a device such as an implantable defibrillator. “What [the defibrillator] does is, if your heart were to go into an abnormal rhythm, it would ultimately shock you out of it and ultimately save your life,” says Dr. Bond.
Left Ventricular Assist Device (LVAD)
Sometimes, despite doctors’ best efforts to treat heart failure with medication, lifestyle changes, and device therapy (like defibrillators), patients are still hospitalized for their heart failure. “Patients find that their heart failure is really limiting their quality of life,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “In those situations we tend to escalate care. For example, we start to evaluate patients for more aggressive therapies like a left ventricular assist device (LVAD), or in certain situations a heart transplant.”
An LVAD is a special type of machine, a heart pump, that is implanted into the heart in an open heart surgery, to help the heart pump blood to the rest of the body, says Dr. Bloom. LVAD therapy is characterized as either bridge to transplant or destination therapy.
Bridge to transplant: These patients will receive an LVAD, but there will be a plan in place to offer those patients a heart transplant when a heart becomes available after they wait on the waiting list, says Dr. Bloom.
Destination therapy: These patients will receive an LVAD with the intention of living with it for the rest of their lives.
The success of heart failure treatment greatly depends on your commitment to managing the condition by following your doctor’s recommendations and making the necessary changes in diet, exercise, and lifestyle to give you the highest possible quality of life.
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The most common cause of heart
failure is coronary artery disease.
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If you have blockages in the arteries, and
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you're not getting enough blood supply to
the muscle of the heart, you can imagine
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that overtime that heart doesn't relax
well and it doesn't contract well.
00:00:19,759 --> 00:00:24,784
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I always tell patients
that if it's not that,
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then there is an entire laundry list
of other things that can cause it.
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For example, a patient that has
a problem with their valves.
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A patient that has a problem with
the arrhythmias, abnormal heart rhythm.
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The first and foremost thing we have to
always do is make sure the heart failure
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is not due to coronary artery disease or
a heart attack, because we
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wanna open the arteries so that the muscle
can get blood, and get stronger.
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Stenting is the first
thing we look for, whether or
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not we need to stent the patient.
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When we talk about stenting, we're talking
about coronary artery disease, and
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opening that blocked artery so
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we can get blood to that muscle, so that
that muscle can heal and get stronger.
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If we notice that the muscle still
remains weak, you are putting yourself
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where your heart is at risk of
this abnormal rhythm of happening.
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And on that situation,
we may suggest that you need a device.
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This device is called a defibrillator, and
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what it does is if your heart were
to go into an abnormal rhythm,
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it would ultimately shock you out of it,
and ultimately save your life.
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despite our best efforts there's a small
subset of patients they still continue
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to have symptoms, they still continue to
get hospitalized with heart failure, and
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they find that their heart failure is
really limiting their quality of life.
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In those situations, we start to evaluate
patients for alternate therapies.
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One of those therapies is a left
ventricular assist device,
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which is a special type of machine,
a pump, that is implanted into the heart,
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in an open-heart surgery to help the heart
to pump blood to the rest of the body.
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Without that therapy,
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we characterize into either destination
therapy, or bridge to transplant.
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In a bridge to transplant population,
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those are the patients where we implant
a left ventricular assist device, but
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with a plan in place to offer that patient
a transplant when a transplanted heart
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after they wait on the waiting list.
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And the other group of patients that we
call destination therapy, we will implant
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an LVAD with the intention that
the patient will live with that LVAD for
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the remainder of their life.
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Stents. National Heart, Lung and Blood Institute. (Accessed on June 8, 2018 at https://www.nhlbi.nih.gov/health-topics/stents)
Ventricular Assist Device. National Heart, Lung and Blood Institute. (Accessed on June 8, 2018 at https://www.nhlbi.nih.gov/health-topics/ventricular-assist-device)
What is Arrhythmia? Answers by Heart, American Heart Association. (Accessed on June 8, 2018 at http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300290.pdf)
Devices and Surgical Procedures to Treat Heart Failure. American Heart Association. (Accessed on June 8, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Devices-and-Surgical-Procedures-to-Treat-Heart-Failure_UCM_306354_Article.jsp#.WxqTgZPwY5g)