Monday, June 23, 2008
George Carlin died of heart failure and broke the hearts of his fans who had come to expect nothing but the blunt truth from him on stage. Here is the blunt truth about heart failure.
Think of the heart as having two sides with two chambers on each side. The atrium accepts blood and the ventricle pumps it. The right heart receives blood from the body and pumps it to the lungs to get oxygen. The left heart gets this blood and pumps it to the rest of the body.
Right heart failure means that the right ventricle doesn’t have the strength to pump the blood that arrived from the body. Gravity causes the blood to pool in the lower parts of the body and fluid leaks from the blood vessels into tissues causing swelling of the legs (and if you’re sitting too much, into your buttock).
Left heart failure is similar except that fluid backs up into the lung tissue, making it hard for oxygen to get from inhaled air onto hemoglobin molecules in the blood. This leads to increasing shortness of breath.
Congestive heart failure is the situation where right and left heart failure occur in the same patient. Regardless of the terms used, heart failure is a progressive failure of the heart to be able to meet the blood pumping needs of the body. It is not a disease to be ignored but even with aggressive care, the mortality rate is high. Once the diagnosis is made, 50% patients will die within 5 years. And it has its other costs as well. A third of patients with heart failure get admitted to the hospital each year.
Cardiomyopathy is the most common reason for the heart to fail. Whether the failure occurs because of coronary artery disease, narrowing of the heart’s blood vessels that cause lack of blood supply muscle or because the muscle fails because of the complications of diabetes or alcohol abuse, or a variety of other potential causes the end result remains the same.
Symptoms are pretty straight forward. Shortness of breath occurs with exertion and as the disease progresses, less activity brings on symptoms. Because laying flat increases blood return to the heart, patients may complain of orthopnea or shortness of breath when they lay down. Paroxysmal nocturnal dyspnea is a term used to describe wakening in the middle of the night with shortness of breath that is more long lasting than simple orthopnea. Patients often describe having to stand by a window to try to catch their breath. Patients end up sleeping on two or three pillows or in a recliner.
The doctor’s exam may find swelling in the legs and lungs sounds that crackle or wheeze. Remember that all wheezing is not asthma. A chest x-ray may show an enlarged heart and excess fluid within the lungs.
Treatment begins with diuretics or water pills to decrease the amount of fluid within the body and therefore the amount returning to the heart that needs to be dealt with by the ventricle. Other medications try to make the heart beat more efficiently to handle the work load.
Increasing shortness of breath can be tempered by the medication but with time, the symptoms worsen and the quality of life suffers. Eventually, the disease wins, breathing loses and so does the patient.
George Carlin was famous for his seven words that couldn’t be said, though he said them enough that a generation knew them by heart. While Carlin’s heart failed, his stories will live on.