What is Heart
Failure?
Heart
failure is a condition in which the heart is unable to pump enough blood to
meet the needs of the body. To
compensate for this, the heart must work harder. This can strain and damage the heart muscle, causing it to
stretch. The enlarged heart is weakened
and can’t function as efficiently. This
causes the heart to work even harder to compensate, leading to further
enlargement and continuing the cycle of deterioration.
Patients with heart failure may develop hearts that are much larger and rounder than normal (see Figure 1).
In some cases, fluid backs up in
the lungs, abdomen, or ankles. This backup of fluid is often called
“congestion”, which is why heart failure is sometimes referred to as congestive
heart failure or CHF.
What causes Heart Failure?
Heart failure often develops over a period of years. The cause is not always known. In some cases it is the result of other illnesses, such as long-term high blood pressure, valvular disease, or coronary artery disease that has damaged the heart tissue. You may wish to talk with a health care provider to better understand the possible reasons for development of heart failure in a specific individual.
What are common symptoms of
Heart Failure?
How common is Heart Failure?
It is estimated that more than 25 million people worldwide have some form of heart failure, with approximately 2 million new cases are diagnosed each year. The chance of developing heart failure tends to increase with age.
How is Heart Failure
diagnosed?
Heart failure may be diagnosed following a thorough evaluation by a health care professional. He or she will ask questions about the patient’s health, habits, current medications, and family history. Some tests may also be performed, such as:
· Blood tests to evaluate how different organs are functioning including the heart, kidneys, and liver
· Echocardiogram (Echo) to show the size and shape of he heart and heart valve function
· Electrocardiogram (EKG or ECG) to show the electrical pattern of the heart beat
· Cardiac Catheterization (Angiogram) or nuclear scans (Stress tests) to evaluate the health of the heart muscle and how well blood flows through blood vessels in the heart
· Exercise Tests to evaluate physical activity
Once a diagnosis of heart failure has been made, the health care provider may classify the severity of heart failure into one of four categories. These categories are based on ability to perform activities of daily living. This classification is called the New York Heart Association Functional Class (NYHA) I, II, III, or IV system.
- NYHA Class I: There is clinical evidence of heart failure or some other cardiac disease, but the patient’s physician activity is not limited by symptoms.
- NYHA Class II: The patient notices some limitations to physical activities. They are comfortable when resting but have mild symptoms with ordinary activity.
- NYHA Class III: The patient has marked limitations to physical activities. They are comfortable at rest but have symptoms with light activity
- NYHA Class IV: The patient is unable to engage in physical activity without experiencing severe symptoms. They have symptoms at rest and increased symptoms with any level of activity.
How is Heart Failure treated?
Heart failure is managed in a variety of ways. Often, patients are prescribed medications along with a diet and exercise program. Changes in symptoms and weight should be closely monitored, with any noted changes promptly communicated to a health care provider. Close follow up with a health care provider may help patient to manage symptoms and limit heart failure progression.
Medications: Often, a combination of medication is prescribed by a health care provider, to improve heart function and minimize symptoms. It may take several months to adjust heart medications to the optimal dosage. It is very important that medications are taken as directed and that names, dosages and dosage frequency is tracked and monitored. Patients may choose to write this information down and carry it with them. Any noted side effects should be reported to a health care provider. Heart failure medications may include:
· Beta Blocker: Blocks substances in the blood that can damage and weaken heart muscle. Also slows the heart rate, which lessens the work the heart has to do. Over time this helps the heart beat stronger and work better
· ACE Inhibitor/ARB: Keeps blood vessels open making it easier for the heart to pump and helps limit the build up of extra fluid in your body (This drug may also be used to lower your blood pressure if it is too high.)
· Diuretic (Water Pill): Helps your kidneys remove extra fluid and salt from your body
· Aldosterone Inhibitor: Helps with removal of excess fluid but retains Potassium
Diet: Heart failure may lead to storage of excess sodium (salt) in your body. This can lead to shortness of breath due to a back-up of fluid in the lungs. Swelling due to excess fluid may also be noted in the legs and feet. Adhering to a low–sodium diet can help to minimize excess salt and fluid in the body. Weight loss may also be advised in order to decrease stress to the heart, since excess weight may cause the heart to work harder in order to pump the blood through your body.
Exercise: An exercise program can keep muscles in shape and facilitate better heart function. Suggested activities may include walking, slow biking and relaxed swimming. Exercise programs should always be discussed with a health care provider who is familiar with an individual patient’s needs and abilities, and exercise limits should be followed.
Why might a physician consider treatment with the CorCap CSD?
If a patient
continues to experience progressive symptoms, despite treatment with diet,
exercise, and optimal heart failure medication, alternative treatment options
may be considered. Patients with an
abnormally large heart with a decreased ability to pump (ejection fraction) may
be candidates for CorCap CSD therapy.
This treatment has
been shown to help the heart return to a more normal size and shape, and
improve patient quality of life.
Implant requires surgery, and should be discussed with a health care
provider familiar with the patient’s unique medical history and a cardiac
surgeon familiar with the implant technique.
What is the CorCap Cardiac Support Device (CSD) and how is it
implanted?
The CorCap Cardiac Support Device (CSD) is a latex-free polyester mesh wrap designed to support that heart to halt or reverse heart failure progression. This material used in its construction has a history of use in implantable medical devices. The device has been designed for biocompatibility and does not necessitate anti-rejection medication.
During surgery, the CorCap CSD is placed around the lower chambers of the heart, then secured and adjusted to provide a custom fit. The CorCap CSD designed to allow for normal heart function, while alleviating the stress to the muscle which otherwise may lead to damage to the muscle tissue. This is intended to prevent the heart from becoming larger. The CorCap CDS may be implanted as an independent procedure, or along with other cardiac procedures.
How long does the surgery take?
The total length of surgery will vary depending on the requirements of the surgery, and whether additional procedures will be performed. Once the chest is opened it usually takes about 30 minutes to implant the CorCap CSD.
What are the risks of CorCap CSD surgery?
What happens after the operation?
Patients are typically taken to a recovery area or intensive care area (ICU) to as the anesthetic wears off and consciousness is regained. Family members may be permitted to visit in the recovery room or the ICU within an hour or two following surgery. Tubes and wires are typically attached to the patient’s body in order to facilitate a safe and efficient recovery from surgery. Patients are monitored closely for any complications during the hospital stay. Typically time in the ICU ranges from 1-2 days and hospital stay often ranges from 5-7 days, but this is patient dependant.
Will there be pain following the operation?
There is likely to be some discomfort at the site of the incision(s). Patients experiencing severe pain ma be provided medication to relieve the pain.
What can be done to facilitate recovery?
- Deep breathing exercises and coughing
are important to help speed recovery. Frequent deep breathing and coughing
reduces the chance of pneumonia and fever and shouldn’t harm incisions.
Following a sternotomy procedure, it may be easier to cough or deep
breathe by supporting the chest with a pillow.
- Changing position in bed every few hours
can also aid recovery. Lying prone for an extended period of time may be
detrimental to the lungs.
- Patients are encourages to get out of
bed and sit in a chair or walk around the room as soon and as often as
possible. Assistance may be
required at first, but as a patient progresses, frequent short walks in
the hall may be helpful to regain strength and mobility.
- Incisions should be kept clean, dry and
open to the air. This lets the wound dry and begin to heal. Depending upon the surgery performed,
a health care provider will determine when patients are able to shower and
wash incisions with soap and water.
- Once the digestive system is functioning
normally, patients will typically be encouraged to eat a varied diet as
prescribed. Appetite may be
reduced following surgery, but it is important to take in adequate
nutrition as it aids healing. Small frequent meals may be best during the
first days after surgery.
What can patients expect after they are sent home?
- It is common for patient’s to feel weak and tired even after being released to go home. It may take 6-8 weeks for a chest incision to heal completely following a sternotomy procedure. Patients are typically advised to avoid lifting objects heavier than 5-10 pounds during this time. The incision color usually changes from purple to red to pink, but will not return to a normal color for several months.
- Mild to moderate daily exercise is the best way to regain strength. Follow the recommendations of a health care provider. Although patients may start slowly, some physical activity several times a day is often beneficial.
- Depression is common in patients when they first return home. Recovery from surgery may not seem fast enough, and time may seem to stand still. The best way to work through depression is to be physically active and to discuss feelings openly.
Does implant of a CorCap CSD eliminate the need for medications?
The CorCap CSD is not intended to take the place of medications, dietary or exercise recommendations. CorCap CSD therapy is intended to prevent and possibly reverse the worsening of heart failure, but is not a cure for heart failure. Patient will need to continue to manage their heart failure as they did prior to having the CorCap CSD implanted.
Is there anything special
required following implant of the CorCap CSD?
Following cardiac surgery, patients should contact their health care provider immediately if any of the following symptoms are noted:
- Signs or symptoms of infection such as redness, drainage at incision sites, fever >100° F or >37.7°C, or chills
· A weight gain of 3 pounds in a day or 5 pounds in a week
· Shortness of breath or fatigue that
o is worse than usual lasting 2 or more days in a row, or
o is gradually worsening over a period of a week, or
o causes a decrease in your normal activity level, or
o breathlessness that wakes you up at night.
· Any new symptoms such as heart palpitations, swollen ankles and feet, abdominal swelling, or any other sign or symptom that seems unusual
· Unexplained bleeding or bruising
Where might I obtain additional information about heart failure and
CorCap CSD therapy?
It is important that all your questions regarding heart failure and treatment options are answered. You may wish to write down questions as a reference when talking with health care providers. The space below is provided for you to note any questions you may have regarding the information provided.
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