This content is provided by The George Washington University Hospital.
Nearly 6 million adults in the U.S. live with heart failure, a chronic disease that occurs when the heart cannot pump enough blood and oxygen to support other organs in the body.
It’s a serious disease — data from the CDC show that one in nine deaths in 2009 included heart failure as a contributing cause. But there are ways to manage it, and some experts in our area are leading the field when it comes to care.
Three physicians from The George Washington University Hospital’s heart team recently stopped by WTOP to discuss the signs and symptoms of heart failure, plus the innovative technologies and treatments they use to care for patients in the D.C. area.
What is heart disease and how does it lead to heart failure?
Heart disease is a word many are familiar with, and generally speaking, it’s an umbrella term for conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. It can also involve valvular heart disease or weakness of the heart muscles, that ultimately lead to heart failure. With heart failure, the heart muscle may become too stiff to help the body pump enough blood, explained Dr. Gurusher Panjrath, director of the heart failure and mechanical circulatory support program and associate professor of medicine at The George Washington University Hospital.
“And because of that, people may have difficulty doing activities of their daily living or that they were used to doing. So it’s not necessarily what comes to the mind in the first instance — ‘Oh, the heart is failing and it’s going to stop’ — and I think that’s what we have to move away from,” he said.
There are multiple risk factors for heart failure, and Panjrath said two of the most common in the U.S. are blockages in the heart that lead to weakening of the muscle and high blood pressure. In the past, heart failure was thought of as a “disease of the old,” but Panjrath said it’s becoming more common in younger populations. Part of it is better diagnostics, but high blood pressure and diabetes (another risk factor) are also more common in younger individuals.
How is heart failure treated?
There are a number of treatment options to treat heart failure, ranging from medications to medical devices, and the field is continuing to evolve — especially at GW, which approaches each case with a tailored plan that gives patients easy access to the information, appropriate treatment strategy and care they need.
For patients with advanced heart failure, the GW Heart team (Advanced Heart Failure and Cardiac Surgery teams together) might use a left ventricular assist device (or LVAD), which helps the left side of the heart pump oxygenated blood to the rest of the body when it’s not able to do so on its own. LVADs are commonly used as “bridge” devices for patients awaiting a heart transplant. Not only does it help to improve the patient’s quality of life until the time of transplant, GW’s Panjrath said people who are bridged with a heart pump tend to do better after surgery. LVADs are also used in non-transplant patients as a way to prolong and improve their quality of life. The GW Heart team is unique because they offer a tailored, multi-disciplinary approach on an individual basis. They work very closely with patients and their families to provide the best care for each person.
Taking on valvular heart disease
Heart disease can also occur when the heart’s valves do not work as efficiently as they can.
When something happens to one of the heart’s four valves, it can have a major impact on the overall function of the heart, explained Dr. Farzad Najam, director of cardiac surgery and associate clinical professor of surgery at The George Washington University Hospital.
“The way that the heart was designed is that the blood has to flow in one direction. If the flow of the blood reverses direction, that leads to patients going into heart failure, not feeling well and the heart not being an efficient pump,” Najam said.
A common heart valve disease among U.S. adults is mitral valve prolapse, which can lead to progressive deterioration of the valve, causing it leak.
Najam explained that “instead of the blood going forward, the blood starts backing up into the upper chamber, and hence, indirectly backs up into the lungs, causing congestion of the lungs and ineffective pumping of the heart.”
Valve disease is something that one can be born with; it’s also something that can develop during one’s lifetime.
Devices that keep the heart going
Technology has come a long way in recent years — especially in the medical field, where things are constantly evolving and innovating. And at GW Hospital, heart doctors are using some pretty futuristic devices, both temporary and permanent, to set patients on a path to recovery.
“The patient may have had a heart attack or something terrible happen and they come into the hospital and what you’re hoping is that you can give them a device that will temporarily do the work of the heart while the physician figures out what happened to the heart and then how to treat it,” said Dr. Elizabeth Pocock, a surgeon and assistant professor of cardiac surgery at The George Washington University Hospital.
“It’s almost a bridge to get them through this very, very critical time.”
One example of a “bridge” device is ECMO, which stands for extracorporeal membrane oxygenation. It operates outside the body and oxygenates and circulates the blood (which makes its way to the machine via a large tube inserted in the patient) when the heart and lungs aren’t working. Pocock said it’s been used when the heart has been damaged after blood clots, influenza and hypothermia. Depending on the specific case, a patient can be on ECMO for days, weeks or months until the heart has recovered from the trauma.
GW Hospital is one of the leaders in cardiac devices, and even travels to other hospitals in the D.C. area to help patients who need ECMO.
“We take our entire team in an ambulance and go to a variety of hospitals throughout this region where they have critically ill patients, but not the resources to take care of them,” Pocock said.