Treating a complex condition like congestive heart failure requires education, specialty training, resources, and understanding in creating an individualized care plan tailored to the unique needs of each patient. Bringing together a diverse and wide range of specialty skills, Deborah’s Heart Failure Team offers state-of-the-art care.
Deborah’s nationally-renowned program has also been recognized by the American Heart Association as a Get with the Guidelines Heart Failure, Gold Plus Award, hospital. This distinction indicates that Deborah promotes consistent adherence to the latest scientific treatment guidelines, achieving significant patient outcome improvements and reductions in readmissions.
What is Congestive Heart Failure?
Nearly 6 million Americans live with Congestive heart failure (CHF), which describes the inability of the heart to adequately pump blood to meet the demands of the body. The most common symptom of heart failure is shortness of breath. With mild heart failure, shortness of breath occurs almost exclusively with exertion. As heart failure worsens, the shortness of breath occurs at lower levels of activity or even at rest. In severe cases of CHF, the heart muscle function deteriorates so badly that fluid backs up into the lungs, creating a life-threatening condition called pulmonary edema.
Heart failure can occur on the left side of the heart, the right side of the heart, or both sides of the heart. Congestive heart failure does not usually happen suddenly. It gradually worsens over the years.
Symptoms and Causes of Heart Failure
Some of the symptoms of CHF include:
- Shortness of breath
- Swelling in the extremities
- Coughing and wheezing
- Difficulty keeping up with your normal routine and lifestyle
The most common causes of heart failure is damage to the heart from a heart attack. Other causes are also common—severe untreated high blood pressure, blocked or leaking heart valves, disease of the heart muscle itself (cardiomyopathy) or damage to the heart from a viral infection (endocarditis/myocarditis).
Diagnosis of Heart Failure
A physician can often tell from a physical exam that a person has CHF based on swelling in the legs and feet, and hearing fluid in the lungs with a stethoscope. Additional testing will confirm a preliminary diagnosis and might include:
- Blood tests
- Electrocardiogram (EKG)
- Chest x-ray
- Cardiac catheterization
- Stress Test
- CT Scan
These tests will help your physician calculate your ejection fraction, which measures how much blood is pumped out (or ejected) by your ventricles with each heart contraction, as well as classify your heart failure from Stage A-D. Based on a complete picture of your specific condition, a treatment plan can be put into place.
Excellent medications are available for earlier stages of heart failure. These medications widen blood vessels to help lower blood pressure, increase blood flows, control abnormal heart rhythms, and help draw excess fluid off your body. Sometimes you will need to take several medications to help control your CHF.
If your heart failure is caused by blocked vessels or damaged valves, surgery may be recommended to clear the blockages or repair, or replace, the valve.
Individuals with CHF are also at significant risk for abnormal heart rhythms, some of which can be fatal. More than half the deaths of patients with CHF are sudden—the result of a serious heart rhythm disturbance called ventricular fibrillation. While medication can lower the risk of ventricular fibrillation, the only effective treatment when it occurs is an electrical shock to the heart (defibrillation). An implantable cardioverter defibrillator (ICD), a device similar to a pacemaker, is often recommended for patients with CHF.
A patient whose CHF has progressed to more critical stages may be recommended for a VAD, or Ventricular Assist Device. This surgically implanted mechanical device, which can take over the pumping function of the heart, can be used both to support sick patients until a donor transplant heart becomes available. Increasingly, VADs are now being used for patients who are not eligible for a heart transplant, and become a permanent replacement to help their heart function.
Extracorporeal membrane oxygenation, or ECMO, is a highly-specialized life support system that sits outside of the patient’s body. It provides cardiac and respiratory support to patients whose heart and lungs are not working properly and are unable to sustain life. ECMO is often a last option for patients who have serious lung or heart failure, and need intense intervention while treatment options are deployed.
ECMO works similarly to a cardio-pulmonary bypass machine, which is used during open heart surgeries, but its design allows for it to be used for a longer period of time. Typically patients are on ECMO for a few hours to a few days, but depending on how their condition progresses, they could remain on ECMO for a few weeks.
Deborah Heart and Lung specialists have expert training in the use of ECMO. The Hospital remains one of the few centers nationwide with access to this extremely complex life support.
Who Needs ECMO?
ECMO is usually the last resort when other treatments aren’t working. Using ECMO doesn’t cure a patient, but it provides support to the patient’s heart and lungs while they are healing, or other treatment options are being pursued.
ECMO is designed to help patients whose lungs can’t give the body enough oxygen, or whose bodies can’t remove carbon dioxide, or whose hearts can’t pump enough blood, and can include numerous conditions:
- Respiratory failure
- Cardiogenic shock
- Failure to come off the cardio-pulmonary bypass machine post-surgery
- Cardiac arrest
- Extremely severe flu
- While waiting for a lung transplant
- While waiting for a heart transplant
- As a bridge to a ventricular assist device
ECMO is not usually indicated if a patient has a fatal diagnosis or has a serious other condition like end stage cancer. The earlier a patient is identified as a potential ECMO candidate, the better the long-term prognosis.
How Does ECMO Work?
A patient is connected to an ECMO machine with tubing in their veins and arteries. The ECMO machine then pumps blood from the patient’s body to an artificial lung that adds oxygen and removes carbon dioxide (replacing the patient’s own lungs) and then pumps the blood back into the body (replacing the patient’s own heart). An ECMO patient may — or may not — also be on a ventilator, and — may or may not — be fully sedated. During the time a patient is on ECMO, they will be closely monitored by a team in the Intensive Care Unit. While the patient’s vitals and oxygen levels are regulated, the Deborah healthcare team will be working on the underlying medical condition that needs treatment.
The goal when a patient is on ECMO is have them removed from the machine as quickly as possible.
What are the Risks of ECMO?
ECMO is a highly complex machine that is performing vital functions for the body. There are a number of complications and risks associated with the use of the ECMO machine including:
- Kidney Failure
- Leg Damage
Your Deborah team of specialists will review with you all the risks and complications associated with ECMO. It is important to remember, that if ECMO is recommended, it is because it is a necessary step to treat a very serious condition, and your physicians think the benefits outweigh the risks.
Deborah Heart and Lung Center is the region’s preeminent heart, lung and vascular hospital, offering leading-edge surgical techniques and non-surgical alternatives for treating a multitude of cardiac and pulmonary conditions. It also is the only Ventricular Assist Device implant facility in the region, providing advanced heart failure patients with a treatment option as a bridge to a heart transplant, or as destination therapy for long-term mechanical heart support.
The skills, training, expertise, knowledge and experience of its specialists — combined with the latest technology — provides an optimum environment for something as complex as ECMO. Additionally, the Deborah team will work seamlessly with your other physicians to deliver coordinated care. Second opinions are frequently sought from the Deborah team, and our specialists are always open for consult on treatment options.
Why Deborah Heart and Lung Center?
A significant gap exists in the treatment of patients with heart failure. Appropriate medication is prescribed in less than 75% of patients hospitalized with heart failure at the time of discharge. Even fewer receive the appropriate combination of medications at the doses shown to prevent repeat hospitalization and reduce the risk of death. Fewer patients still receive pacemakers to improve their heart’s pumping capacity or potentially life-saving treatment with a device that can shock the heart out of a life-threatening heart rhythm such as an ICD. Additionally, very few cardiac centers offer patients the option for a VAD implant as a long-term heart failure solution.
Deborah Heart and Lung Center provides comprehensive care to patients with all forms of heart failure. Our comprehensive team approach can treat patients with even the most advanced forms of congestive heart failure. Since so few patients with heart failure can be offered heart transplantation, the specialists at Deborah strive to maximize heart performance and minimize risk, using medications and specialized implanted devices. This is a unique approach to the management of heart failure and is not offered in such a coordinated fashion in most other hospitals and medical centers.
Patients with heart failure should know that with the right medications, their symptoms can improve. Over time, their physical function can significantly increase as well. With the appropriate medications and device therapy, patients can increase their activities of daily living and rest assured that they are protected from serious cardiac arrhythmias.
Deborah Heart and Lung Center also remains an excellent option when seeking a second opinion. The CHF team works closely with community cardiologists and primary care physicians in order to deliver coordinated care. Second opinions are frequently sought to both confirm a current diagnosis and treatment plan, as well as learning about other treatment options.
Medical Director, Kulpreet Barn, MD
Dr. Barn holds numerous Board Certifications, including one of the very few regional Advanced Heart Failure/Transplant Cardiology certifications, offering expertise in:
- Advanced Heart Failure
- Transplant Cardiology
- General Cardiology
- Internal Medicine
- Cardiovascular Computed Tomography (CT)
- Nuclear Cardiology
- Registered Physician in Vascular Imaging
Advance Practice Nurses
JoAnne Chichetti, DNP, RN, APN-C, CHFN
Abroo N. Muzaffar, MSN, RN, APN-C, CHFN, CCRN-CMC
These highly-trained, expert Advance Practice Nurses bring a wealth of clinical experience in managing heart failure. The integrated team approach ensures that patients receive the very best care by utilizing the latest techniques and technologies, ultimately resulting in a better quality of day-to-day life for patients in heart failure.