What nonsurgical options are available for my heart failure symptoms?
When I first see new patients with heart failure, I make sure their standard medical therapy is maximized.  Often, I find room for improvement.  Standard therapy includes a beta-blocker, an ACE (angiotensin receptor blocker), and an aldosterone antagonist. These therapies all have data supporting their use and increase the chance for survival in heart failure. 

What implantable devices can I look into that can treat my heart failure?
Many patients have Implantable Cardioverter Defibrillators (ICD).  These devices have been shown to improve survival in most types of heart failure where the heart muscle is weak.  I make sure my patients who qualify have one.  If the patient uses this device as a pacemaker as well as a defibrillator, the pacing of the heart can lead to dysynchrony of contraction. This means one part of the pumping chamber starts to contract long before the other part of the heart, which is very inefficient. The ICD can be upgraded to a biventricular pacemaker-ICD (BiV-ICD) which will pace the left and right ventricle more synchronously to make it more efficient.  Sometimes I see patients who have a BiV-ICD, but the device has not been optimized.  We do this in our office, and it is quick and painless.  We time the firing of the three leads in the pacemaker so they fire in the most efficient sequence to make each individual heart perform as good as possible. This is like tuning a race engine before the Indy 500! 

What can I do to personally improve my heart failure symptoms?
I encourage my heart failure patients to lose weight.  If their weak heart has to carry an extra 50 to 80 pounds around with them every day, it puts additional stress on it. This means patients need to alter their lifestyle by diet and exercise.  I also make sure they do not have any sleep-disordered breathing which could contribute to heart failure, risk of heart attack, and rhythm disturbances.  We routinely check the patients for lipid abnormalities which could impact the risk of future heart attacks and/or strokes. 

“When I first see patients with heart failure, I make sure their standard medical therapy is maximized. Standard therapies all have data supporting their use and increase the chance for survival in heart failure.”

If medication doesn’t work for my heart failure, what other options will I have?
When standard therapies are exhausted, we must go down a pathway for less-used advanced heart failure therapies.  It should be understood that the natural history of the failing heart, in most cases, is progressive deterioration, even in the best of hands. For most of the advanced therapies, a decision must be reached as to whether or not the patient qualifies for a transplant. Most transplant patients are younger, have less or no co-morbid disease, and have both family and financial support.  If they cannot qualify for transplant, we evaluate the patient for Destination Therapy (DT) Left Ventricular Assist Device (LVAD).  An LVAD is an implantable mechanical pump, which helps the left ventricle (the main pumping chamber of the heart) to pump. This pump is actually implanted in the chest and/or upper abdomen, and the patients can walk around and do their daily activities. The patient carries changeable batteries to power the pump on a vest or belt. This allows them to feel better, have fewer symptoms, and perform daily tasks. It also prolongs survival in patients with advanced heart failure due to a weak heart. Medical City Dallas Hospital currently has two different types of pumps. While waiting for a transplant or LVAD, we often send the patient home on intravenous milrinone that helps the heart pump better and keeps the patient out of the hospital. I have several patients who have been on this medication continuously for more than five years.  

Dr. Eric Eichhorn is an interventional cardiologist at Medical City Dallas and at Baylor Regional Medical Center in Plano. He is board certified in cardiovascular medicine and internal medicine with a specialty in cardiovascular disease and in interventional cardiology. He has special interests in interventional cardiology (congestive heart failure) and in cardiovascular research. He is an author and co-author of 100 articles and 50 abstracts for such journals as The New England Journal of Medicine, Circulation, Journal of the American College of Cardiology, and American Journal of Cardiology. He is also on the editorial board for many of these publications and serves as a reviewer for several other medical journals.

dallascardiovascular.com 

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