Pulmonary Hypertension in Children
Heart Failure Deaths Are Increasing. New Treatments Could Help.
Ann Ramirez first noticed something was wrong when, at age 48, she started waking up in the middle of the night out of breath. It felt like she was underwater, and had to wait for a wave to pass to come up for air.
"It was very scary, because you didn't know how long that wave would last," Ms. Ramirez, now 55, said.
For months, she dismissed the issues as a flare-up of her asthma, anxiety over her father's recent cancer diagnosis or a sign of impending menopause. But when she finally got checked out, a doctor diagnosed Ms. Ramirez with heart failure. Her condition eventually became so severe that she needed a heart transplant.
Heart failure is a condition that occurs when the heart can't pump out enough blood and oxygen to meet the body's needs. Deaths from it have been climbing steadily nationwide since 2012, wiping out earlier declines. Rising rates of metabolic disorders like obesity, diabetes and high blood pressure are likely contributing.
There are medications to treat one of the two main types of heart failure, but they aren't used as much as they should be, doctors said. "The treatments that have been proven in trials to work are not getting prescribed to people in a timely way," said Dr. Janet Wright, the director of the division for heart disease and stroke prevention at the Centers for Disease Control and Prevention.
But growing awareness of the condition and its risk factors could change that. And new drugs to treat the other form of heart failure could also change the trajectory for patients with the disease.
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7 Critical Facts About Heart Failure Everyone Should Know
Heart failure sounds alarming—and rightfully so. Yet approximately 6.5 million Americans currently live with this condition, many with the specific variant called systolic heart failure, and a surprising number remain undiagnosed. Here's an essential overview of this serious cardiac condition that affects more people than the entire population of Missouri.
How your heart's pumping function changesWhen functioning properly, your heart acts like a powerful compression pump, contracting with sufficient force to circulate blood throughout your body. In systolic heart failure, this pumping capacity becomes compromised.
Medical professionals measure this pumping efficiency through a metric called ejection fraction—the percentage of blood your heart expels with each contraction. A healthy heart typically pumps out 55-70% of its blood volume. With systolic heart failure, this number drops below 40%, indicating that the heart's contractions have weakened significantly.
This reduced pumping efficiency creates a cascade of physiological consequences as your body attempts to compensate for decreased circulation. The heart enlarges to try creating more force, blood vessels constrict to maintain pressure, and the kidneys retain more sodium and water, increasing blood volume.
The prevalence may surprise youThe statistical reality of heart failure presents a concerning public health picture. With 6.5 million Americans affected—more than the monthly visitor count at Disney World—heart failure ranks among our most common serious medical conditions.
Nearly half of these cases involve systolic heart failure specifically. Age significantly increases risk, with incidence rates rising dramatically after age 50. By age 75, heart failure affects nearly 10% of the population.
Even more concerning, about 670,000 new cases are diagnosed annually, yet many more individuals likely remain undiagnosed because they attribute their symptoms to normal aging or other conditions. Early identification could significantly improve outcomes for these individuals.
Recognizing your body's distress signalsYour body communicates heart failure through specific warning signs that develop as your circulatory system struggles to compensate for reduced cardiac output:
Persistent rapid heartbeat, even during rest periods, indicates your heart attempting to circulate sufficient blood despite weakened contractions.
Unusual fatigue during ordinary activities occurs because your muscles receive less oxygen-rich blood. Activities once considered routine—walking short distances, climbing stairs, or carrying groceries—suddenly require extraordinary effort.
Paroxysmal nocturnal dyspnea—waking suddenly gasping for air—happens when fluid redistributes within your body while lying down, congesting the lungs.
Peripheral edema, particularly noticeable in the ankles and feet, develops as reduced circulation allows fluid to accumulate in body tissues. This often presents as unexpected swelling that makes shoes uncomfortable or leaves indentations when pressed.
Cognitive symptoms like concentration difficulties or confusion can develop when reduced cardiac output affects brain perfusion, creating noticeable mental fogginess or memory issues.
Unexpected weight gain, particularly over short periods, typically indicates fluid retention rather than increased body mass—a common heart failure symptom where the body holds extra water.
Understanding the underlying causesSeveral conditions can damage the heart's muscular function, leading to systolic heart failure:
Coronary artery disease remains the leading cause, with arterial plaque buildup restricting blood flow to heart muscle tissue. This gradual narrowing creates a progressive weakening of cardiac muscle as it receives insufficient oxygen and nutrients.
Hypertension forces the heart to pump against increased resistance, gradually weakening cardiac muscle through constant overexertion. This stress causes the heart to enlarge and lose efficiency over time.
Previous myocardial infarctions (heart attacks) leave scarred heart tissue that cannot contract properly, reducing overall pumping capacity. Even small heart attacks can contribute to cumulative damage over time.
Valvular heart disease disrupts normal blood flow patterns, creating additional strain on the cardiac chambers. Leaky or stiffened valves force the heart to work harder, eventually leading to muscle fatigue.
Viral myocarditis, an inflammatory condition where viruses directly attack heart tissue, can cause acute or chronic damage to cardiac muscle cells, reducing contractile strength.
Diagnostic approaches and testingCardiologists employ sophisticated diagnostic tools to identify heart failure and determine its severity:
Electrocardiograms record the heart's electrical activity, revealing abnormal rhythms, conduction problems, or evidence of previous heart attacks that might contribute to heart failure.
Chest radiographs can show heart enlargement and pulmonary congestion—visible signs of the body's attempt to compensate for reduced cardiac output.
Echocardiography uses ultrasound technology to visualize heart structures in motion, providing real-time assessment of chamber size, wall thickness, valve function, and most importantly, ejection fraction. This test typically provides the definitive diagnosis of systolic heart failure.
Natriuretic peptide blood tests measure hormone levels released when the heart experiences pressure overload. Elevated levels strongly suggest heart failure and help monitor treatment effectiveness.
Comprehensive treatment approachesManaging systolic heart failure requires a multifaceted approach combining medication, possible device intervention, and lifestyle modifications:
Medication regimens typically include:
ACE inhibitors or angiotensin receptor blockers relax blood vessels, reducing the resistance against which the heart must pump and lowering blood pressure. These medications have demonstrated significant mortality benefits in clinical trials.
Beta-blockers, once contraindicated in heart failure, now represent cornerstone therapy by reducing heart rate, blood pressure, and the detrimental effects of stress hormones on cardiac tissue. This allows the heart to remodel more favorably over time.
Diuretics help eliminate excess fluid through increased urination, reducing congestion in the lungs and peripheral tissues. While they provide symptom relief, they don't address the underlying cardiac dysfunction.
Advanced interventions may include:
Implantable cardioverter-defibrillators monitor heart rhythm and deliver corrective electrical shocks if dangerous arrhythmias develop—a common complication in heart failure patients.
Cardiac resynchronization therapy uses specialized pacemakers to coordinate contractions between heart chambers, improving pumping efficiency when electrical conduction becomes disordered.
Left ventricular assist devices serve as mechanical pumps that supplement heart function in advanced cases, either as temporary support or as destination therapy for those ineligible for transplantation.
Lifestyle modifications prove essential:
Sodium restriction helps prevent fluid retention that complicates heart failure management. Most cardiologists recommend limiting sodium intake to 2,000mg daily or less.
Physical activity, carefully structured and monitored, strengthens remaining healthy heart muscle and improves overall cardiovascular function. Cardiac rehabilitation programs provide safe, supervised exercise options.
Stress management techniques like meditation, deep breathing, or guided imagery can reduce sympathetic nervous system activation that places additional strain on the heart.
Elimination of tobacco and excessive alcohol, both direct cardiac toxins, removes substances that further damage heart tissue and complicate management.
Taking proactive steps for heart healthWhile systolic heart failure represents a serious chronic condition, early intervention significantly improves prognosis and quality of life. Understanding this condition empowers you to recognize warning signs and seek prompt medical attention.
For those already diagnosed, adherence to medication regimens, regular medical follow-up, and lifestyle modifications can dramatically alter disease progression. Many patients successfully manage heart failure for decades with proper care.
Prevention remains the optimal approach. Controlling blood pressure, maintaining healthy cholesterol levels, exercising regularly, avoiding tobacco, limiting alcohol, and managing diabetes all reduce heart failure risk substantially.
Your heart has functioned continuously since before birth. Protecting this remarkable organ requires awareness, vigilance, and proactive health measures. By understanding heart failure's warning signs and risk factors, you gain valuable knowledge that could quite literally save your life or the life of someone you love.
Michigan Medicine Tests New Heart Assistance Device In Clinical Trial
Cardiac surgeons and heart failure specialists at Michigan Medicine are testing a new left ventricular assist device developed by BrioHealth Solutions called BrioVAD. The trial, known as the INNOVATE Trial, opens up the possibility for future Food and Drug Administration approval of the device.
Heart pumps are used to assist the heart in pumping blood to the rest of the body for patients with severe heart failure. In an interview with The Michigan Daily, Dr. Francis Pagani, the national lead investigator for the INNOVATE Trial and cardiac surgeon at the Michigan Medicine Frankel Cardiovascular Center, said BrioVAD can pump blood more efficiently due to its smaller pump, as opposed to the currently available Heartmate 3.
"One of the major features of the BrioVAD is that it is a smaller pump than (what is) currently available to patients," Pagani said. "The only pump that exists today is a pump called the Heartmate 3 and that pump is 10 years old. That technology is fairly old and the BrioVAD is newer technology. We feel that its size and the way it performs might have better outcomes."
Both Heartmate 3 and BrioVAD use magnetic levitation, which stabilizes the device and keeps it from moving around inside the body. Pagani explained the way the BrioVad process of magnetic levitation can be safer than older models.
"Inside the pump there's an impeller and it's almost like a screw," Pagani said. "When it spins, it pushes the blood through the pump. And that screw, rather than being held in place by a connection to the pump wall, is actually suspended in the blood by a magnetic field so it doesn't touch this impeller."
Teresa Colaianne, Michigan Medicine cardiac surgery VAD program faculty member, said even with the technological differences, patient concerns remain the same.
"Just getting a VAD period is a big change in their lifestyle because now they have this artificial equipment that they have to carry around and take care of," Colaianne said. "They have to learn the alarms and how to manage and treat any of those."
Teresa Colaianne also said the small size can help decrease potential infections such as bloodline infections and sepsis.
"The BrioVAD has a little bit smaller diameter of the drive line that's coming out of the abdomen," Colaianne said. "So we're hoping that that will help decrease infections due to the smaller diameter."
Pagani said the trial is important because previous LVAD recalls have limited patient's VAD options.
"The availability of only one pump now limits the choices that physicians and patients have," Pagani said. "The point of the clinical trial is to demonstrate to the FDA that the BrioVAD is as safe or safer than the Heartmate 3 and then potentially use that in the United States commercially."
Although BrioVAD is still in the early stages of testing for U.S. FDA approval, Pagani said the device does have credible success elsewhere, with about 400 implants performed in China.
"There's approximately now over 400 patients in China that have received the device," Pagani said. "So we have a lot of clinical information from patients in China that the device performs well."
In an email to The Daily, Rackham student Mario Migaldi, president of the U-M Mu Epsilon Delta chapter, a co-ed pre-health fraternity, emphasized the importance of including patients from a variety of backgrounds in a trial like this one. Participants in the trial were chosen randomly, increasing the likelihood for diversity in the research.
"Like any other current research that participates in clinical trials, the focus on picking a diverse and equitable patient population to study the effects of a device is crucial," Migaldi wrote. "Advanced stage cardiovascular disease affects a myriad of patients, so the breadth of different populations scientists choose will give different results for their clinical trial."
Overall, Pagani said he is optimistic about BrioVAD receiving FDA approval someday.
"It's a very rigorous trial," Pagani said. "We're hopeful that the device is going to be safe and effective. And then it offers an alternative treatment for advanced heart failure for our patients."
Daily News Contributor Kayla Lugo can be reached at klugo@umich.Edu.
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