Q: My friend is 50 years old and has had a series of medical issues over the past year. On his last trip to the hospital he was ultimately found to have a weak lower portion of his heart. I don’t understand how such a small organ can malfunction in one area and be healthy in another. Can you fill in the blanks?
A: The heart is a hollow muscular organ that pumps blood throughout the body. The average human heart beats 72 times each minute, pumping up to 5.7 liters of blood during that same period. It has four chambers, two upper atria and two lower ventricles. The right atrium receives blood from the veins and pumps it on to the right ventricle. The right ventricles then pumps that blood to the lungs where it receives oxygen and releases carbon dioxide. The left atrium receives the oxygenated blood and pumps it, in turn, to the left ventricle that pumps it to the rest of the body. Long-standing failure can occur on the left, right, or both sides of the heart but typically the left side, and specifically the left ventricle (the main pumping station) being the chamber affected. Left sided failure may cause shortness of breath and fluid to back up into the lungs. Right sided failure may cause edema because of fluid backing up into the feet, legs and abdomen.
Coronary artery disease (CAD) is the most common form of heart disease and one of the most common reasons for heart failure to occur. This is often a condition that develops over time from a buildup of fatty deposits within the coronary arteries. Areas of the heart deprived of oxygen-rich blood cause symptoms to occur. Faulty heart valves can prevent blood from flowing in the proper direction, forcing the heart to work harder than it was intended in an attempt to keep blood flowing as it was meant to. With time, this can weaken the heart. Hypertension also causes the heart to work hard and is a common cause of heart failure. The heart muscle may thicken and weaken. Cardiac arrhythmias (abnormal beating) may create additional work for the heart. Over time, failure can result. Then there are countless conditions such as emphysema, infection, blood clots in the lungs and more that can aggravate the heart.
Diagnosis can be made through an echocardiogram that can help a physician determine how well the heart pumps, lab testing to check for kidney function and heart failure, an electrocardiogram (ECG) that can detect arrhythmias, CT scan or MRI, or angiogram that can help identify arterial narrowing.
Treatment depends on the cause for the failure. Lifestyle changes that may include dietary modifications, discontinuing smoking/drinking/weight reduction if appropriate and remaining active will go a long way toward improving his health. Valves can be repaired, medication can be prescribed, and devices that include an implantable pacer or defibrillator can get your friend back on the right track.
Your friend should be under the care of a good cardiologist who can detect the cause for the failure and make the appropriate recommendations for getting him back on the road to recovery. You indicate other medical conditions that could impede his progress but hopefully those are also being addressed.
