What is end stage heart disease?
End Stage heart disease is heart disease of any origin that progressed to an
end stage or an advanced form of that disease. Although the patient can be maintained
on treatment, the patient is still sick, probably disabled, and generally unable
to function at even limited levels of activity.
What determines when heart disease has reached the end stage?
Usually, the chronicity of the disease. For example, someone who has end stage
ischemic heart disease has been suffering with that problem for many years.
They will frequently have a history of multiple heart attacks and possibly surgical
Is heart disease hereditary, and if it is what can be done to lower risks?
The answer to that is really two questions. First of all, there are forms of
heart disease that are hereditary. Secondly, there are forms of heart disease
that are not hereditary. The speed with which the acquired heart disease develops
can be related to the presence of risks factors. For example, patients who have
ischemic heart disease where the blood supply to the heart has decreased - the
rate at which this disease develops or progresses is influenced by many well-known
risks factors. The patient can control some of these risks factors and some
cannot. The risk factors that cannot be controlled are advancing in age, gender,
and family history. The risk factors that can be controlled include such things
as obesity, smoking, high-blood pressure, exercise or lack thereof, and so on.
Is there much hope for a patient with end stage heart disease? Should a
patient at this stage of the disease consider cutting edge treatments if all
else is not working out in their benefit?
That depends upon the primary disease. But in general, patients with heart
disease should seek care provided by a specialist. The heart specialist can
then recommend the appropriate therapy for the patient.
At what age do most people develop it? Does it affect more men or women?
That depends upon the disease. Again, there are a variety of different types
of heart disease. Again, depending upon the primary disease state, it can occur
in any age group. Usually heart failure and ischemic heart disease is associated
with advancing in age.
What kind of role does diet play in preventing it?
Appropriate diet plays an important role in the prevention of ischemic heart
disease. To lower the risk of ischemic heart disease, everyone should avoid
foods that are high in fat content and cholesterol. Everyone should also attempt
to avoid obesity by choosing an appropriate diet associated with an exercise
program. And no one who wants to be healthy should smoke.
What does surgery entail? What is the approx recovery time?
There are many types of open-heart surgery, each of which has a different recovery
time. As an example, the most common open-heart operation performed is coronary
by-pass surgery for patients who have blockages in the arteries supplying blood
to the heart. Depending upon the complexity of the operation, and the patient's
pre-operative health status, the patient usually remains hospitalized 4-6 days
after the operation. With appropriate rehabilitation, the patients are usually
back to full activity within 6 to 12 weeks.
Who is the ideal candidate for surgery?
Again, that depends upon which operation is being performed. We look at a variety
of pieces of information related to the function of the patient's heart, and
other health related conditions in determining the patient's operative risk.
How many bypasses are possible through minimally invasive bypass surgery?
That number is increasing as experience with this operation has increased.
Originally, access was limited to the front of the heart. Now even the vessels
on the back of the heart can be by-passed without the use of the heart-lung
What is the average life expectancy after bypass surgery?
That depends on the patient's age, the completeness of the by-pass operation,
the patient's underlying heart function, and the patient's associated medical
problems. In general, the by-pass operation will correct the patient's ischemia
for 10 to 15 years. At that time, the angina may reoccur. If angina does reoccur,
the patients candidacy for medical and surgical therapy is re-evaluated.
What makes a surgery "minimally invasive"?
Traditionally, open-heart surgery is performed with the patient connected to
a machine known as the heart-lung machine. The heart -lung machine replaces
the function of the patient's heart and lungs while the operation is performed.
The patient's heart is stopped while we operate on it. Recently, there has been
interest in performing heart by-pass surgery without the use of the heart-lung
machine. In this instance, the patient's heart and lung continues to function
while the operation is performed. The patients anatomy and the type of
operation they require determine whether the heart-lung machine is employed.
For some time, it was thought that such an approach would allow the operation
to be performed through a smaller incision - hence the term, minimally invasive.
In fact, most "op-pump" surgery is still being performed through the standard
incision through the length of the breastbone.
Who is a candidate for a heart transplant?
Heart transplantation is usually offered to someone who has end-stage heart
failure. Their heart problem is not correctable by any other operation, and
the patient's must fulfill a number of selections and exclusion criteria. Examples
of such criteria include: no irreversible kidney or liver failure; the patient
is receiving appropriate heart failure therapy; and despite medical therapy
has a limited life expectancy. The patients and their families are also appraised
of what cardiac transplant entails including medication changes, the operative
plan itself, and the need for close long-term follow-up. If the patient's physician
believes the patient is a suitable candidate for heart transplantation and the
patient has been appropriately educated, then the patient is offered this therapy.
If the reader is particularly interested in heart transplantation, they might
also check back to this site later today when Dr. Cadaret is online.
Are the veins taken from the leg during bypass surgery? If so, why?
The purpose of by-pass surgery is to improve blood flow to the heart muscle.
The blockages in the artery supplying blood to the heart are not removed. Rather,
blood is routed around the blocked areas in the arteries supplying blood to
the heart. This entails the use of conduit. Conduits that are available are
the veins from the leg, the saphenous vein, the artery from the inside of the
chest wall called the internal mammary artery, and occasional an artery from
the forearm, known as the radial artery.
What is the mortality rate following bypass surgery?
In general, the operative mortality is about 2 to 4 percent depending on the
patient's heart function and other associated medical problems. If a patient
had depressed heart function or other medical problems such as kidney failure
requiring dialysis, the operative risk may be higher. In general, this is a
relatively safe operation.
Do people experience swelling following a bypass?
Patients do develop swelling in the legs following coronary by-pass surgery,
for two reasons: First, patients who are placed on the heart-lung machine will
tend to retain water for a few days following the operation. Secondly, removal
of the saphenous vein from the leg can lead to temporary swelling in that leg.
That swelling usually resolves in a matter of a few months.
What foods/vitamins can help keep your heart healthy?
The best recommendation for diet is to avoid foods high in fat and cholesterol.
At what age are most people at risk for heart attack?
That depends on the patient's family history, and their risk factors. In general,
older patients, in particular those who smoke, who are obese, who have elevated
cholesterol, are at higher risk for heart attacks.
Is it safe for people to exercise after having bypass surgery?
Absolutely. However, the exercise program should be recommended and overseen
by formal cardiac rehabilitation program. The purpose of by-pass surgery is
to return the patient to as normal a lifestyle as possible.
What other surgeries do you perform for those with end stage heart disease?
We tailor the surgical therapy to the patient's cardiac condition. If the patient
has end-stage heart disease related to problems with the heart valve, valve
replacement or repair may be the appropriate operation for that patient. If
the patient's heart failure is related to a lack of blood supply to the heart
muscle, in selected cases, we may perform by-pass surgery. Any patient with
heart failure not amendable to a standard cardiac operation may be offered cardiac
transplantation. A promising form of therapy for patients with severe heart
failure is a mechanical blood pump. Mechanical blood pumps are currently planted
in patients who are awaiting a heart transplant, but who deteriorate prior to
the availability of a donor heart. In this instance, a blood pump is inserted
until a donor heart is available, at which time, the blood pump is removed,
and the heart transplant is performed. As the number of patients who require
a heart transplant exceeds the number of donor hearts that are available, it
is anticipated that mechanical blood pumps will serve as a primary therapeutic
modality for patients with end stage heart failure in the future.
Are people with end stage heart disease a candidate for cardiac rehab?
Yes. Again, it should be performed through a formal cardiac program.