A New Life After Open Heart Surgery: Daniel’s Story

DanDaniel Lo, 77, was diagnosed in 2010 with multiple myeloma, a relatively rare cancer affecting plasma cells in the bone marrow. The condition was discovered when Daniel was scheduled for open heart surgery to repair blockages found during a routine angiogram. The diagnosis was a surprise since Daniel had none of the symptoms of multiple myeloma, which include fatigue and problems with bruising and bleeding.

The heart surgery was canceled and Daniel began chemotherapy, while his family gathered round to lend their support. Daniel and his wife, Colleen, had raised three sons and were looking forward to a move to Edmonds following his retirement after 40 years as a pharmacist in the Tacoma area.

“There was a lot going on for us,” says Daniel. Rather than open heart surgery, his cardiologist decided to put in stents while Daniel continued his chemotherapy. He and Colleen made the move to Edmonds and for a couple of years, Daniel was relatively stable. But in May 2012, he was diagnosed with congestive heart failure, an inability of the heart to pump adequately. Symptoms include shortness of breath, fluid retention and rapid heartbeat.

Daniel’s daughter-in-law, who is a nurse, recommended he transfer his cardiac care to Virginia Mason. “It was a good move,” says Daniel. He desperately needed open heart surgery, but it was considered too risky because of his ongoing chemotherapy for the multiple myeloma. The Virginia Mason doctor gave Daniel hope that the surgery could be done. In late spring of 2014, Daniel was well enough to go off chemotherapy for two months, a requirement for the surgery to be scheduled.

“The multiple myeloma made surgery a big risk, but because they took that risk, I got my life back.” 

In June, the open heart surgery was done to replace Daniel’s mitral and aortic valves. During the hours-long operation, Colleen was surrounded by family and appreciated the Virginia Mason practice of frequent updates on how the surgery was progressing.

By the time Daniel was out of recovery and into intensive care, he was “really doing well.” He could tell right away, he says, that the surgery was successful because of the way he felt. After seven days in the hospital, Daniel went to a transitional rehab facility and then home. For now, Daniel doesn’t need to resume chemotherapy since tests show that he is “stable.” There is no cure for multiple myeloma.

Today, Daniel goes to the gym regularly to do exercises that keep his heart strong. “And I go for walks just like a normal person,” he says with a laugh. He adds that one of the things he appreciates most about his care at Virginia Mason is that the doctors decided to do the surgery at all. “The multiple myeloma made it a big risk,” says Daniel, “but because they took that risk, I got my life back.”

Heart Failure: Proper Management Improves Quality of Life

**By Sara Weiss, MD**

HeartAccording to the American Heart Association, heart failure affects 6.5 million Americans and is projected to increase 46 percent by 2030, impacting more than 8 million people. Unfortunately, this common condition was given one of the most misleading names in medicine.

Heart failure does not mean the heart has failed and is no longer working. It simply means the heart’s pumping power is weaker than normal.

With heart failure, blood moves through the heart and body at a lesser rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart may respond by stretching to hold more blood or by becoming stiff and thickened. This helps keep blood moving, but the heart muscle walls may eventually weaken and pump less efficiently. As a result, the kidneys may respond by retaining fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested – thus the term “congestive heart failure.”

Causes

Heart failure may result from many health conditions that directly affect your cardiovascular system. This is why it is important to get annual checkups to lower your risk for heart health problems.

Heart failure can be prevented by early treatment of high blood pressure, coronary artery disease and valve conditions. Other less common causes of heart failure include alcohol abuse, certain kinds of chemotherapy and genetic disorders.

Symptoms

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).

In the early stages of heart failure, you may not have any obvious symptoms. However, if your condition progresses, your body will experience gradual changes.

Symptoms you may notice first include fatigue, swelling in lower legs, ankles and feet; and weight gain. Symptoms that indicate your condition has worsened include irregular heartbeat; a cough that develops from congested lungs; wheezing and shortness of breath, which may indicate pulmonary edema (fluid accumulation in the lungs). And symptoms that indicate a severe heart condition include rapid breathing; skin that appears blue due to lack of oxygen; fainting and chest pain that radiates through the upper body.

Remember, since chest pain that radiates through the upper body can also be a sign of a heart attack, or if you experience any of the symptoms of a severe heart condition, seek immediate medical attention.

Prevention

Although not all conditions that lead to heart failure can be reversed, treatments can improve signs and symptoms of the condition, and help you live longer. For instance, lifestyle changes – such as exercising, reducing salt intake, managing stress and losing weight – can improve your quality of life.

Like the saying, “An ounce of prevention is worth a pound of cure,” one approach – and, really, the best way – to prevent heart failure is to control the conditions that cause it, such as coronary artery disease, high blood pressure, diabetes or obesity.

When to see a doctor

If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean the existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

And if you experience any of the following, seek emergency treatment:

  • Chest pain
  • Fainting or severe weakness
  • Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. As I always tell patients, don’t try to diagnose yourself. Instead, call for immediate assistance.

Treatment options

Heart failure is very treatable and usually involves the use of various medications. A cardiologist will work closely with you to find the ideal combination of medications that will help your heart work better and help with the demands of the body. Managing heart failure involves a delicate balance between taking the work load off your heart and supplying enough oxygen and nutrients to the other organs.

There are invasive treatments for advanced congestive heart failure including heart transplantation and the implantation of a pacemaker or pump that helps the heart push blood along.

Avoiding progression

In addition to compliance with medication, there are things that may help keep congestive heart failure at bay. They include:

  • Regular visits with your primary care physician and cardiologist. Congestive heart failure must be closely monitored and any changes treated promptly. You should weigh yourself weekly and report weight gain of 3 lbs. or more to your physician since it could be the result of fluid retention.
  • Dietary changes. Weight loss, even if you are slightly overweight, is imperative to prevent further damage to your heart muscle. The larger your body, the harder your already damaged heart has to work to supply much-needed oxygen and nutrients. Even moderate weight loss can greatly impact congestive heart failure management.
  • Exercise. Exercise can be a challenge due to symptoms of congestive heart failure. However, any increase in activity is helpful. Walking is a great low-impact option for patients with congestive heart failure. If weather is an issue, or if you don’t have a safe, level place to walk, try a local shopping mall. Many malls open early and even place distance markers for people who exercise there. It is a great way to meet people, have fun and stay healthy. Before starting an exercise regime, consult your doctor.
  • Avoid fluid overload. Restricting fluid intake is important. A decrease in fluid intake can reduce the amount of work the heart has to deal with.
  • Salt intake. Where there is salt, there is water. If you have a lot of sodium in your body, you will retain fluid. For this reason, avoid foods with high amounts of salt.
  • Smoking. If you smoke, stop immediately. It must be avoided at all costs since cigarette smoke carries a lot of carbon monoxide, which worsens the ability of oxygen to be carried throughout the body.
  • And lastly, stay healthy. It requires a lot of energy for your body to fight off common illnesses, like flu. So, stay current on flu and pneumonia vaccinations. Respiratory diseases may cause heart failure symptoms to worsen. So, the best approach is simply to avoid the risk.

Whether you have heart failure or not, I encourage everyone to take care of their heart to enjoy a lifetime of better health.


Dr Sara WeissSara Weiss, MD, is a board-certified cardiologist who specializes in heart failure management, echocardiography, and women and cardiovascular disease. She practices at Virginia Mason Hospital and Seattle Medical Center.

What is Broken Heart Syndrome?

Broken HeartOf all the times I’ve suffered the emotional pain of romantic failure, it has been a comfort knowing I couldn’t die from a broken heart. But, as it turns out, the pain of losing a loved one can cause physical symptoms, much like a heart attack, that can be life threatening. It’s called broken heart syndrome, and I asked Connie Keibler, ARNP, of the Heart Institute at Virginia Mason, to answer a few questions about the condition.

What is broken heart syndrome? Is it the same as a heart attack?
Keibler: Broken heart syndrome feels like a heart attack and causes temporary, reversible heart failure. Although the symptoms are similar to a heart attack, patients do not have obstructive coronary artery disease, and they do not have permanent heart damage. In fact, this condition reverses in just a couple weeks or months. However, broken heart syndrome can be fatal, causing severe heart failure, low blood pressure, cardiogenic shock, and life threatening heart rhythm abnormalities or arrhythmias.

Why is it called broken heart syndrome?
Keibler: The condition usually follows intense emotional or physical stress, and symptoms typically begin minutes to hours after someone is exposed to severe, unexpected stress. It is believed the heart muscle is overwhelmed by a massive amount of stress hormones, adrenaline and epinephrine, that result from exposure and response to the stressor. Broken heart syndrome is known by other names: stress cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome and Takotsubo cardiomyopathy.

Why does it happen?
Keibler: Science is attempting to understand the exact pathophysiological process. Preceding clinical stressors have been identified as a sudden illness, asthma attack, death of a loved one, fear or anger. Patients who present with broken heart syndrome have symptoms and clinical findings that mimic a heart attack or myocardial infarction. They complain of chest pain, shortness of breath, have symptoms of congestive heart failure, and often have very low blood pressure. Clinically there will be EKG changes suggesting an acute coronary syndrome. When the patient is taken for a coronary angiography, the coronary arteries are found to be free of disease, but there is severe heart muscle weakness (cardiomyopathy).

Is it similar to a panic attack?
Keibler: No, it really is not. A panic attack causes similar physiologic symptoms experienced with a response to a perceived stress. Panic attacks do not cause the physical damage to the heart muscle, as we see in broken heart syndrome or stress cardiomyopathy.

Who is at risk? Can anyone get broken heart syndrome?
Keibler: Broken heart syndrome is diagnosed in 1.7 to 2.2 percent of patients presenting with acute coronary syndrome. It is very difficult to predict risk. We know that most patients do not have a previous history of heart disease, and we know that it primarily affects women. The average age is 60, and the vast majority of patients are post-menopausal women. This syndrome has been observed in young women and men, but is far less common.

Why do more women than men experience broken heart syndrome?
Keibler: We really do not know. Further research will be necessary to help explain this phenomenon.

How do you prevent it?
Keibler: It is difficult to predict who is at risk. Therefore it is difficult to prevent this rare condition. Once discovered or experienced, there is a chance of recurrence. It is recommended that patients stay on long-term treatment with beta blockers or similar medications to help prevent the damaging effects of stress hormones. It seems imperative that we all should strive to manage stress in our lives. Many stressors are not avoidable, but we can grow in our ability to respond to stress in healthier ways.

What should you do if you think you’re experiencing broken heart syndrome?
Keibler: You should seek medical attention immediately. Call 911 and get to an emergency room. It is reassuring that this condition is reversible, but it can be life threatening. Patients will require hemodynamic support and medical management, along with monitoring and treatment of arrhythmias during the acute phase. After recovery, the long term prognosis is excellent.

Chocolate: The Next Drug?

Chocolate HeartRecently, a clinical study was published evaluating the effect of flavanol rich chocolate (FRC) in patients with stable heart failure. Heart failure, also known as congestive heart failure (CHF), is a medical condition where the heart is not able to pump blood effectively. One of the treatment goals is to help blood vessels relax, or dilate, so the heart doesn’t have to pump as hard. Nitric oxide is a natural chemical in our bodies that can cause blood vessels to dilate; patients with CHF normally have decreased nitric oxide levels in their blood. Chocolate has been shown to improve the nitric oxide dependent blood vessels.

In this study, 22 patients were assigned to consume 40.8 grams of chocolate (FRC) or 24.8 grams of chocolate-flavored placebo twice daily. Researchers found that two hours after ingestion of their first dose, the artery diameter increased from approximately 5 percent to 6 percent. After two weeks into the study, arteries increased to 5.8 percent and after 4 weeks, it further increased to 6.7 percent for those patients in the chocolate treatment group. The size of the artery did not change in the patients who only received the chocolate-flavored placebo. While this study is small and the rest of the patients’ diet was not controlled, this is the first study to show a potential long-term benefit with flavanol-rich chocolate.

Although this study showed potentially positive results for patients with congestive heart failure, it’s important to note that additional and larger trials will be required before chocolate becomes a routine treatment for heart failure. It’s always important to discuss with your physicians all treatment options before making any changes.

As the holidays approach, remember, the next time you reach for a chocolate-covered goody, there may be some hidden benefits to consuming it on top of satisfying a sweet-tooth craving.

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Sandy Hong is currently a pharmacy resident at Virginia Mason Medical Center. She obtained her PharmD degree from Washington State University, and she is receiving extra training with Virginia Mason Medical Center’s pharmacy team.