Treating Heart Failure and Heart Block

One of the major complications of a heart attack are heart failure and heart block. In heart failure, the heart beat cannot generate enough power to maintain adequate blood flow to all the regions of the body. Fluid builds up in the tissues and the lungs, and the patient becomes weak, breathless and swollen.

Heart failure is usually a sign of relatively severe myocardial damage. If it occurs in the first few days, the action of the heart can be helped by extra pumps attached to the circulation, programmed to beat in coordination with the heart beat. This can only be a temporary measure, until the heart recovers as fully as possible from the damage. Drugs to improve the heart beat and to remove the strain from the heart will help to some extent in the initial period.

Many patients do recover from this form of heart failure, and go on to leave hospital and enjoy good health. For a minority, however, the cause of the failure is the extent of the damage to the heart - and this is too great to allow recovery. For these people, heart transplant is the only option. It is not an easy option: transplant waiting lists are long, and priority must be given to the young. Life after transplant is much preferable to the alternative, but it also has its problems.

Waiting for a transplant involves much personal care from doctors, nurses, physiotherapists, and above all, family. It means the need for support for the failing heart using drugs. The patient needs a balanced personality, a full understanding of what lies ahead, and acceptance that it will not be easy.

A successful transplant is like being reborn. Many patients are able to do things they have not done for years: they enjoy life to the full. However, the price to be paid is a lifetime of watching for infection and rejection. As treatments of both these complications improve, more and more heart transplant patients are living long, successful and fulfilling lives.

Heart block may be another complication of heart attack, although it can arise out of the blue in an otherwise normal heart. In heart block, the electrical message to the heart muscle to contract does not pass as it should from the upper chambers, the atria, to the lower chambers, the ventricles. The ventricles therefore decide to beat at their own rate, which is usually too slow for comfort or for the needs of the circulation.

The answer to heart block is usually a pacemaker, which stimulates the ventricles to contract at the desired rate. Pacemakers are inserted under the skin of the chest, in a minor operation; leads from the battery stimulate the heart to beat at the rate set in the pacemaker.

Most MI patients who need pacemakers only do so for the first week or so. The heart usually slips back into a normal rhythm itself, and the pacemaker can be removed. For the small minority who need more permanent pacemakers, they are now so small and so convenient that their wearers can virtually forget them until their annual consultant appointment. Today's pacemakers are even programmed to increase and decrease their rates of 'firing' to cope with their wearer's needs.

From this description of the modern management of heart attacks, it is reasonable to be optimistic about the future of anyone who reaches the relative security of an intensive care unit. Most patients who reach it alive come out of it alive and looking forward to a worthwhile quality of life.

It must still be stressed, however, that around one-third of all heart attack victims die in the first few hours of their first attack - before they reach the emergency ambulance or hospital. Of those that reach hospital six hours or more after the onset of their attack, around one in five will die some time in the next year from a further attack or from heart failure. This figure improves to one in six if the hospital treatment starts within six hours, and to one in eight if it begins within one hour.

These figures, from a study of 11,712 Italian heart attack patients, reported in 1987, suggest that there are two lessons to be learned. The first is that time must never be lost in moving people with suspected heart attacks into hospital - the sooner thrombolytic (clot-dissolving) treatment is started the more chance there is of long-term survival.

The second is that leaving hospital well after your heart attack is only the first step towards a new life. Your prime aim should then be to ensure that you do not have another attack, and that you can look forward to a long and happy life ahead. 

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