Johannes Steiner, MD, is a cardiology and heart failure specialist at the University of Vermont Medical Center. He is also an assistant professor at the Larner College of Medicine at UVM.

Johannes Steiner, MD, is a cardiology and heart failure specialist at the University of Vermont Medical Center. He is also an assistant professor at the Larner College of Medicine at UVM.

This is the story of Greg, 46, a delivery driver and father from Rutland, Vermont, who had been feeling healthy his entire life.

On a Thursday morning, during his regular delivery run, he felt a pressure sensation across his chest. He contributed it to lifting heavy packages the day before. After trying to ignore the aches his entire shift, he went to his local emergency room, where he was shell-shocked by the diagnosis of an acute heart attack.

At this point, Greg felt worse than he has ever felt his entire life, complaining of cold sweats, nausea, shortness of breath, and dizziness. After receiving potent blood thinners to resolve potential blood clots within his heart’s circulation, he was transferred to the University of Vermont Medical Center for further care.

There, in the cardiac catheterization laboratory his recently occluded artery supplying large portions of his heart muscle was found to be partially open again thanks to the blood thinners. However, his overall heart pump function appeared dangerously reduced as a result of the prolonged lack of blood flow. His heart was failing him.

The Impella 2.5 pulls blood from the left ventricle through an inlet area near the tip and expels blood from the catheter into the ascending aorta.

The Impella 2.5 by Abiomed.

The blood flow to vital organs like brain, kidneys, and liver was low enough to warrant the insertion of a mechanical blood pump (Impella CP ©). Impella is a miniature pump so small it can be threaded through an artery and placed inside the heart, offering new hope to critically ill heart attack and heart failure patients who have run out of options.

While the mechanical blood pump is in place for hours or days, a seriously damaged heart gets crucial time to recover. Or, it can give doctors time to perform procedures such as opening blocked arteries, which might otherwise kill the patient, or it may allow physicians to place more durable mechanical heart pumps.

The Rise of the Machines

The term “heart failure” is a scary one, conjuring up images of a heart that is suddenly unable to work. In truth, it represents a more or less gradual decline in the heart’s ability to pump enough blood to meet the body’s needs. As the heart weakens, all parts of the body suffer the consequences.

Advances in modern day cardiology have allowed more and more patients to survive acute, life threatening heart attacks, heart infections, and rhythm abnormalities. On the flip side, the number of patients living with subsequently impaired cardiac function is increasing annually, and is currently one of the major reasons for hospital admissions in the Unites States.

The Heartmate II by Thoratec.

The Heartmate II by Thoratec.

Unfortunately, in very few cases, advanced heart failure requires more intense medical therapy even up to a heart transplant. When this is not possible, or while patients are awaiting a suitable donor heart, a mechanical left ventricular assist device can take over the pumping job of the left ventricle.

Greg appeared to be one of the unfortunate few. After restoring blood flow through the mechanical pump Greg – accompanied by his family – was transferred to Massachusetts General Hospital for further care. Greg’s heart function never recovered to the point where he would be able to survive without the help of his mechanical pump and his temporary pump was replaced with a more durable mechanical heart pump (Thoratec, HeartMate II ©) to allow for a life outside the hospital while awaiting a suitable donor heart. The HeartMate II consists of a small, lightweight blood pump implanted in a patient’s chest just below the heart. An electrical cable that powers the blood pump passes through the patient’s skin to an external controller worn around the patient’s waist.

Effects on Every Day life – Living with a Mechanical Heart

There’s no doubt that having a mechanical heart pump (LVAD) is a big adjustment, both for Greg and his caregivers. However, most people who have an LVAD are able to live at home, move freely, enjoy favorite activities and even return to work or school. A mechanical heart does not change how a recipient feels towards his family and vice versa. Many LVAD patients also find they have more energy than they did before, because more oxygen-rich blood is moving through their bodies. Greg is currently regaining his strength attending an intensive inpatient rehabilitation program anxiously awaiting his return to Vermont and a potential donor heart.

The University of Vermont Medical Center in cooperation with Boston transplant centers will continue its efforts to provide state of the art technology to assist heart failure patients like Greg during their sickest hours of their life time, enable them to live independently and reunite them with their love ones.

Johannes Steiner, MD, is a cardiology and heart failure specialist at the University of Vermont Medical Center and Massachusetts General Hospital. He is also an assistant professor at the Larner College of Medicine at UVM. 

 

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