Just one heart to live

Tuesday, December 16, 2008

The problem with heart disease is that there is only one heart. People can live normal lives after losing a kidney or a lung, but when a backup heart is needed, the options are pretty limited. And Jerry Richardson, owners of the Carolina Panthers of the NFL, sits waiting. While reserve players can shuttle in and out of a football game, Mr. Richardson’s backup heart is still beating strong in somebody else’s chest. His salvation requires somebody else’s demise.

Richardson suffers from cardiomyopathy, a condition where the heart muscle is too weak to pump blood to meet the demands of the body and of the heart itself. There are different reasons for the muscle to fail. Most commonly, it occurs because of atherosclerosis or narrowing of the arteries to the heart causing ischemia or loss of blood supply. If parts of the heart muscle lose blood supply, muscle cells can die and be replaced by scar tissue. This can happen acutely in the case of a heart attack or chronically over time, where the muscle gradually weakens. Eventually, the heart cannot pump enough blood with each heartbeat to supply oxygen to the body.

The body requires oxygen for cells and organs to function normally and it also needs adequate blood flow to remove waste products of metabolism: carbon dioxide and lactic acid. The body tries to compensate by increasing oxygen intake through the lungs by breathing faster and deeper or the body tires quicker and demands rest. The symptoms are easy to predict. Fatigue, weakness and shortness of breath that gradually progress to limit the exercise capability. Initially, it may be tough to climb a hill, but then it might be harder to walk to the mailbox or even make it to the kitchen.

If the heart weakens further, it may not be able to pump all the blood that returns to it. Fluid can back up causing swelling in the legs and ankles. That same fluid may also back up into the lungs causing congestion and difficulty breathing. This is called congestive heart failure. And if the heart has to work too hard, the heart muscle can outstrip its own blood supply, causing angina, pain from the heart muscle itself.

The frustrating thing for Mr. Richardson is that he underwent bypass surgery a few years ago to try to restore blood supply to his heart muscle. That plumbing fix doesn’t necessarily repair previous damage done to the heart muscle, but it tries to prevent further damage from occuring. Unfortunately, much of the damage done to the heart is due to a lifetime of risk factors. High blood pressure, high cholesterol, diabetes and smoking the can cause blood vessels to narrow, not only in the heart but also in the brain causing strokes and other parts of the body as well. One doesn’t wake up in the morning after years of neglect and undo the damage done by being vigilant for a few weeks or months. What’s done is done. Preventing further damage is the goal of lifestyle changes.

Heart disease takes many forms but eventually it is the inability of the heart to pump adequately that causes people to suffer. Whether it is from ischemia or a viral infection or a myriad of other causes, there is little recourse for a patient with end stage cardiomyopathy except for heart transplant. Medications can allow many years of a fulfilling life, but eventually a backup heart may need to be found. And as any football fan knows, a good backup is hard to find.

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