Individuals in America die every 33 seconds due to heart disease. Due to the prevalence of cardiovascular disease, the most recent public health lecture offered free to the public by NorthShore University Health System, focused on congestive heart failure. The program highlighted NorthShore’s partnership with Mayo Clinic as the session opened up with Brooks S. Edwards, MD, followed by information presented by Robert A. Gordon, MD, and Amit K. Prusnani, MD, experts in their specialty areas of cardiology.
As part of his work in cardiac transplantation for advanced heart failure, Dr. Edwards, who hails from Mayo Clinic, also is involved with clinical trials and continuing medical education programs in the Chicago area. “As people age, the risk of heart failure may increase,” he said, adding that about 20 percent of older adults experience this. “We’ve experienced limited success with therapy and the majority of patients do well and need only standard care.” Those who experience a heart attack and require heart transplants require lifelong immunosuppressants” The problem is complicated by the fact there is a lack of donors to meet the needs of those in need. More patients are put on heart pumps as an alternative to transplantation.
The first heart transplants were performed by South African senior cardiothoracic surgeon Christiaan Barnard, MD, in 1967. Things have progressed a lot since Seattle dentist Barney Clark became the first recipient to receive a permanent, albeit tethered, artificial heart and survived 112 days. Even though medicine has greatly advanced since those early years, Dr. Edwards said, “There is no free lunch. We must determine the right options for each patient.” Dr. Edwards said one of the options looming for use in the not-so-distant future is nuclear reprogramming of stem cells.
Between 75,000 and 100,000 Americans are at risk for heart failure, according to Dr. Gordon. However, this is not always age-related. Studies have shown that those who exercised did better while undergoing therapy for heart failure. “It is hard to get people to exercise regularly, although those who exercised did better,” said Dr. Gordon, as exercise increases blood flow to the skeletal muscles. He added that the risk of heart failure diminishes with a more consistent schedule of exercise.
Physiologic age can be very different from a chronological age. Ideally, when exercising, one should measure their heart rate. To do this, they subtract their age from 220 to determine their idea heart rate and try to reach 60 percent of that rate. However, various medications (like chemotherapy and radiation) and conditions can impact or injure the heart. Dr. Gordon stressed that people should use their bodies wisely “now or pay later. Don’t strain,” he said, “but do SOMETHING.”
A cardiologist trained at New York University and who served his residency at the University of Chicago, Dr. Prusnani discussed the diagnostic tests currently available to determine the risk of heart failure. These include electrocardiograms (EKGs), x-rays of the heart of a lungs, echocardiography, stress testing, coronary computerized tomography (CT), angiography and magnetic resonance imaging (MRI).
The EKG measures the electrical activity of the heartbeat while an x-ray can reveal the size of the heart and reveal any fluid that may be present. This is called pulmonary edema when fluid collects in the numerous air sacs in the lungs, making it difficult to breathe.The echocardiogram exposes different views and angles of the heart to reveal a great deal of vital information and is very safe. Another test, positron emission tomography (PET) helps show tissue and organ function. Each of these diagnostic tools, along with exercise tolerance testing — including the Bruce Protocol, can help physicians determine the condition of the heart, the notations of any blockages and the course of action that should be taken for the particular patient.
“Noninvasive tests are preferred,” said Dr. Prusnani, “but they cannot be used to fix many of the problems.” Stents, surgically implanted, are often the solution.