Heart Failure: Getting in Sync
By Dr. Glenn Brammer
More than 4.6 million people suffer from congestive heart failure, with 450,000 new cases a year.
Congestive heart failure is a condition that occurs when the heart is too weak to pump blood throughout the body. The heart can be weakened or damaged by many causes. Reduced blood flow to the heart muscle, due to clogged arteries or coronary artery disease, is the most common cause. Other causes include:
Regardless of the cause, symptoms are about the same.
Symptoms of Congestive Heart Failure
Patients with congestive heart failure suffer from symptoms related to the weak pump:
- Shortness of breath
- Swelling in their legs
- Sleeping problems
As the condition worsens, they are unable to do many of life’s daily activities. Walking up steps, around the neighborhood, or even to get the mail can be too challenging for a weak heart.
In addition to symptoms caused from a weakly pumping heart, patients with congestive heart failure are at risk for a condition that can strike without warning. Once the heart has been damaged, it contains scar tissue, which can cause the heart to go into a very fast and lethal rhythm. This lethal rhythm that can strike without warning is called sudden cardiac death, SCD. The heart beats so fast that it can’t pump blood, resulting in death.
Over time, patients with congestive heart failure experience more changes. The heart stretches, losing its natural conical shape and taking on more of a round, ball shape. This makes a weak heart even weaker. The round shape interferes with the heart’s pumping chambers, so that instead of squeezing at the same time, they squeeze at different times, out of sync. Patients feel worse and worse. Many end up in the hospital, often several times a year, for irregular heart rhythm, severe shortness of breath and other complications.
Treating Congestive Heart Failure
Medications and lifestyle changes make a big impact in the treatment of congestive heart failure. Patients now live longer and can have reduced symptoms. However, in some patients medications alone are not enough. As a cardiac electrophysiologist, that is when I get involved.
To me, nothing is as fascinating and exciting as the heart’s electrical system, the signals that drive the pump. In my practice, I treat patients with abnormal heart rhythms: both too fast and too slow. A major part of that involves implanting electronic devices called pacemakers and defibrillators.
- A pacemaker is a device implanted just beneath the skin that contains wires that connect to the heart and prevent the heart from pumping too slowly.
- Defibrillators, or ICDs, are similar electronic devices that have all the functions of the pacemaker but also have special features that treat dangerously fast rhythms. Defibrillators also treat and prevent sudden cardiac death by immediately detecting and treating dangerous heart rhythms.
Patients with congestive heart failure have a high risk of death from these fast, lethal rhythms. It has been known for some time that defibrillators help patients with congestive heart failure live longer by preventing these rhythms. However, it wasn’t until lately that devices, called biventricular defibrillators, were developed that not only prevent sudden death, but also help patients feel better.
About Biventricular Defibrillators
The biventricular defibrillator has wires connected to both of the heart’s pumping chambers. This allows the heart’s chambers to squeeze at the same time, which in turn helps the heart regain its natural shape and become stronger. With more efficient pumping, patients feel better. Some return to work. Others tell me they can walk around the neighborhood again and play with their grandchildren.
Even these improved defibrillators didn’t work in all patients. At Wake Forest Baptist Medical Center, we were the first in North Carolina and the entire Mid-Atlantic region to implant the newest generation of biventricular defibrillators. The device allows us to fine-tune the way we stimulate the heart electronically, so that we better regulate heart rhythm and the heart’s pumping performance. Now we can more consistently reach and stimulate the areas of the heart that have been proven most beneficial in treating failing hearts, in less time and without the need for repeat operations.
The device, which has four leads instead of two, was approved by the FDA last November and so far I have implanted over a dozen. My youngest patient was 33 years old and is doing great, and in fact is scheduled to go back to work. Another patient, a man in his mid 80’s, is back on his feet, walking with more energy than he’s had in years. His heart is responding. And as importantly, he hasn’t been re-admitted to the hospital for heart failure.
As these new devices become more commonly used by cardiologists, it’s my hope that they will help reduce hospital stays and repeat procedures throughout the region for patients with congestive heart failure. With the right combination of proven medications and implantable device technology, patients with congestive heart failure will feel better and stay healthier longer than ever.
Dr. Glenn Brammer is an assistant professor of cardiology at Wake Forest Baptist Medical Center.