Heart Failure & Heart Transplantation
Management of Heart Failure
Lifestyle Changes
- Dietary Modifications: Low-sodium diet, balanced nutrition.
- Exercise: Regular physical activity as tolerated.
- Smoking Cessation: Quit smoking to improve overall heart health.
- Alcohol Limitation: Limit or avoid alcohol consumption.
Medications
- ACE Inhibitors: E.g., Enalapril, Lisinopril.
- Beta-Blockers: E.g., Metoprolol, Carvedilol.
- Diuretics: E.g., Furosemide, Spironolactone.
- Aldosterone Antagonists: E.g., Spironolactone, Eplerenone.
- ARBs (Angiotensin II Receptor Blockers): E.g., Losartan, Valsartan.
- ARNIs (Angiotensin Receptor-Neprilysin Inhibitors): E.g., Sacubitril/Valsartan.
- Digoxin: Helps strengthen the contraction of the heart muscle.
Devices and Procedures
- Implantable Cardioverter-Defibrillators (ICDs): Prevent sudden cardiac death.
- Cardiac Resynchronization Therapy (CRT): Helps the heart beat more efficiently.
- Coronary Artery Bypass Grafting (CABG): For patients with coronary artery disease.
Mechanical Circulatory Support
Extracorporeal Membrane Oxygenation (ECMO)
- Indications: Severe cardiac or respiratory failure.
- Types:
- VA-ECMO (Veno-Arterial): Supports both heart and lungs.
- VV-ECMO (Veno-Venous): Supports only the lungs.
- Mechanism: Oxygenates blood outside the body and then pumps it back into the bloodstream.
Ventricular Assist Devices (VADs)
- Indications: Advanced heart failure, as a bridge to transplant or destination therapy.
- Types:
- Left Ventricular Assist Device (LVAD): Supports the left ventricle.
- Right Ventricular Assist Device (RVAD): Supports the right ventricle.
- Biventricular Assist Device (BiVAD): Supports both ventricles.
- Mechanism: Assists the heart in pumping blood to the rest of the body.
Orthotopic Heart Transplant for End-Stage Heart Failure
Indications
- Severe, refractory heart failure not amenable to other treatments.
- Cardiomyopathies, severe coronary artery disease, congenital heart disease, and other conditions leading to end-stage heart failure.
Evaluation and Listing
- Comprehensive evaluation including medical history, physical exam, psychosocial assessment, and diagnostic tests.
- Placement on the transplant waiting list based on severity of illness and organ availability.
Surgical Procedure
- Preoperative Preparation: Optimization of patient’s condition, possible use of bridging therapies like VADs or ECMO.
- Transplant Surgery: Removal of the diseased heart and replacement with a donor heart.
- Postoperative Care: Intensive monitoring, immunosuppressive therapy to prevent rejection, management of complications.
Complications and Management
- Rejection: Acute or chronic; managed with immunosuppressive medications.
- Infections: Due to immunosuppression; prophylactic antibiotics and antivirals.
- Graft Vasculopathy: Chronic rejection leading to coronary artery disease; regular monitoring and possible interventions.
Long-term Follow-Up
- Regular follow-up visits for monitoring heart function, medication adjustment, and managing any long-term complications.
- Lifestyle modifications and adherence to medications are crucial for long-term success.