Congestive Heart Failure

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Many Suffer Heart Failure in US
Medications f/Heart Failure
Other Treatments for Heart Failure
LifestyleChoices f/Heart Failure
InSync Pacemaker f/Heart Failure

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Many Suffer Heart Failure in US

Many people mistake the symptoms of heart failure for natural consequences of aging, but with currently available treatment they could live more comfortable--and longer--lives, an expert on the condition said here Thursday at an American Medical Association briefing on heart disease.

"There are a lot of people with heart failure who don't know they have heart failure," said Dr. Milton Packer, director of the Center for Heart Failure Research at Columbia-Presbyterian Medical Center. "This is a huge problem. I assure you, shortness of breath is not a consequence of aging. Fatigue is not a consequence of aging." Heart failure occurs when the heart loses its ability to pump blood efficiently. This causes fluid to gather in the body, which can produce swelling of the legs and makes it difficult for people to breathe.

There are 5 million people in the US with heart failure, and an additional 15 to 20 million who have impaired muscle function of the heart and are destined to eventually develop the condition. Heart failure is responsible for 3 million hospitalizations and 400,000 deaths in the US each year, Packer said, adding that 6% to 10% of people age 65 and older have the condition. Twenty years ago, Packer noted, patients with heart failure were told to "go home and settle your affairs." But today, he explained, a combination of four medications can ease symptoms, slow the progress of disease, and extend the lives of 80% of heart failure patients.

These drugs are digitalis, diuretics, ACE inhibitors and beta-blockers.

The last two drugs block the effects of stress hormones in the blood and slow the progress of the disease. Diuretics help the body expel excess water, and digitalis strengthens heart contractions. "We think patients need to take a very activist role," Packer said. People who suffer from fatigue and shortness of breath and think they may have heart failure should see their doctor, Packer advised. Doctors diagnose the condition by taking a medical history, performing a physical exam, taking an x- ray of the heart, measuring the heart's electrical activity with an electrocardiogram, and performing a non-invasive scan of the heart such as an echocardiogram. (May 11- Reuters Health)

HeadlineWatch: Heart Failure (April, 2001):


Many recent studies have investigated treatments and other aspects of heart failure. This HeadlineWatch offers a summary of the latest findings. Since November 2000, research has revealed important findings about the following:

Medications that treat heart failure
Other treatments for heart failure
Lifestyle choices for heart failure patients

 

Medications that treat heart failure:

Researchers continue to investigate differences in how people respond to various treatments. Recent studies have shown that a person's individual pattern of Genes may predict success of heart failure drug, and that a medication called dofetilide may only be appropriate for patients with certain EKG results. Furthermore, researchers are Testing a new drug as treatment for heart failure in African Americans. Treating heart failure in African Americans is particularly important because African Americans are more likely to die of heart failure than Caucasians. If approved, the new drug (BiDil) will be the first FDA-approved drug designed to address race- specific treatment issues associated with a particular medical condition.

Well-established medications in the fight against heart failure include ACE inhibitors and beta-blockers. Recent studies suggest that ACE inhibitors may reduce post-MI risk of heart failure and that ramipril could significantly reduce the risk of heart failure in some patients. Furthermore, ACE inhibitors may reduce stroke risk in heart failure patients. Another study concluded the benefit of beta-blockers.

In addition to these findings about well-researched medications, new drugs are being tested for their safety and effectiveness as treatments for heart failure. For example, a new class of drugs called endothelin receptor antagonists is currently showing promise in improving cardiac function by improving the heart's oxygen supply. Furthermore, researchers concluded from an animal study that an experimental Drug undoes damage found in aging blood vessels. Additional research on these medications continues.

Other treatments for heart failure

Besides medications, a number of other treatments for heart failure are being investigated. First, a number of devices are being tested. These devices include permanent ventricular assist devices, biventricular pacemakers and the total artificial heart.

Second, researchers have reported promising results from the use of stem cells or skeletal myoblasts.

Third, researchers are developing a technique called therapeutic angiogenesis. This technique is designed to medically coax the body to produce its natural response of angiogenesis -- the creation of tiny new blood vessels that bring more oxygen-rich blood to organs such as the heart. Researchers in this area have recently reported that a Protein injection may be promising for heart failure and that VEGF therapy for heart failure continues to show positive results at 1-year mark.

Lifestyle choices for heart failure patients

Although previous research has suggested that antioxidants such as vitamin E might have some protective effects on heart health, a recent study concluded that vitamin E was of little benefit for patients already in advanced stages of heart failure. Recent publications in the medical literature have also pointed out that Heart failure patients should limit salt and water intake and that cancer-related Radiation treatment of the chest may affect the heart.

 


Novel Pacemaker Resynchronizes Failing Hearts

Disabled Patients Regain Function (
From WebMD)
By Peggy PeckReviewed by Dr. Charlotte E. Grayson

March 20, 2001 (Orlando, Fla.) -- A new pacemaker device that resynchronizes the beating heart so that both chambers work efficiently is the first effective treatment for a type of heart failure that affects about 750,000 Americans, according to research presented here Tuesday at the American College of Cardiology meeting.

"After just six months with the special pacemaker, 69% of the patients had a significant improvement in quality of life," William Abraham, MD, tells WebMD. Abraham headed up the MIRACLE, meaning Multicenter InSync Randomized Clinical Evaluation, trial. He says that means the difference between being bedridden, struggling to breathe, or being "able to accomplish most activities of daily living."

Normally, the two atria and two ventricles work together, contracting and relaxing to pump blood out of the heart. But in people with heart failure, the heart no longer pumps efficiently. As a result, the heart enlarges and struggles to do its work. Symptoms include difficulty breathing, fluid retention, and extreme fatigue. About 5 million Americans have congestive heart failure, and the number continues to grow because risk increases with age.

About one in four people with severe heart failure also has a faulty electrical system that causes a type of irregular heartbeat in which the right and left sides of the heart are out of sync, like a grandfather clock that ticks when it should tock. None of the current heart failure drugs effectively help these people, he says.

The pacemaker has three wires or leads: One is threaded into the left ventricle of the heart, one in the right ventricle, and the third is placed in the atrium. In this study, 266 patients were implanted with the devices, but in 132 patients, the devices were not turned on, says Abraham, who is chief of cardiovascular medicine at the University of Kentucky Hospital in Lexington. The study was completed in six months. "At that time, we asked the control group if they wanted their pacemakers turned on and universally, they did," Abraham says.

Sidney Smith, MD, chief science officer for the American Heart Association, tells WebMD that the pacemaker therapy is "very impressive because there really isn't anything else for these people." He says that while pacemaker technology is commonly used to correct irregular heartbeats, "using it for heart failure patients is a new application." Because the heart beats more efficiently with the resynchronization unit, over time the "heart will remodel. It becomes once again decreased in size," Abraham says. He says that the first patient implanted for this study received the "device in 1998, and he is doing very well two years later."

After six months, half of the patients with active devices could "walk about 50 meters or more -- that's about 150 feet," Abraham says. In the group with inactive devices, only about a third of the patients could walk 50 meters or more. He says that there also was a trend toward lower blood pressure in patients who had activated devices. Abraham says the device, which is Made by Medtronic, will "probably cost about $10,000 to $12,000." .( 2001 WebMD Corporation. All rights reserved.)

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Last Modified on August 25, 2001

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