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Coping with Heart Failure

Posted on Oct 30, 2013 by Ruth Loftus  | Tags: heart, attack, failure, cardiac, artery, clot, survival, surgical, technique, tissue, damage

Forty years ago in the UK, almost 70% of older people experiencing a heart attack died as a direct result of the attack itself. Now, the statistics reveal that this percentage of all those suffering a heart attack actually survive it and that this survival rate has increased significantly over the last decade or so. While in 2002 survival rates were in the low 60% range across most of England, they are now in the low 70% range and even reach 80% in some parts of the country.

However, no one who survives a heart attack is left unscarred by the experience – quite literally. A heart attack damages heart tissue and leaves the organ functioning inefficiently. The resulting condition - heart failure - can itself have a deteriorating effect on quality of life. 750,000 people now live with heart failure in the UK and as a result, cardiac professionals are now facing new challenges regarding the development and refinement of treatments to improve quality of life for sufferers.  New approaches to this include novel surgical techniques and other alternatives, all of which are the subject of active research and trials.

A heart attack occurs when the blood supply – and hence the oxygen supply - to the heart itself is interrupted (typically as a result of a blockage in a coronary artery) . When this happens, part of the heart muscle is damaged and ceases to function. The vital response to this is rapid action to restore the blood supply which limits the damage caused by the initial blockage and prevents it spreading and affecting other areas of the heart.

A crucial requirement is for the patient or someone near them to appreciate that they are in fact experiencing a heart attack and to seek emergency help. Once this is recognised, clot busting drugs and other techniques such as angioplasty (which uses direct physical intervention to open up a blocked artery and restore at least some function) can begin. It is the combination of the development of these interventions, as well as speedy recourse thanks to emergency services that has brought about the dramatic improvement in heart attack survival rates.

However, anyone who has experienced a heart attack will have some part of the heart permanently damaged as heart attacks result in scar tissue which is unable to function as it once did. As time passes, scar tissue may stretch resulting in the chambers of the heart growing in size and therefore requiring more blood to be pumped out with every heartbeat. The consequence of all of this is that ultimately, the heart becomes weaker and less able to do its job, and everyday tasks such as climbing the stairs can eventually require great exertion.

A new surgical technique has been developed in the UK which is now being tested to determine how this situation might be better managed. In it a form of "cardiac sewing" has been designed which seeks to get rid of the scar tissue and as a result, ‘shrink’ the heart so it is able to pump with a greater efficiency.

Using a wire anchored at both ends, surgeons pierce two sections of heart and the scar tissue is in effect removed, resulting in reduction of the enlarged chamber of the heart and therefore, the volume of blood required is reduced by up to a quarter.

In the past, a procedure which required the opening up of the chest and actually stopping the heart was used to achieve these sort of benefits but it was understandably regarded as a high risk technique and has since fallen out of medical favour. The medical profession hopes that this much less invasive approach, undertaken while the heart continues to beat, will be a better option.

This new approach is now being trialled in hospitals across Europe. If this trial process does prove successful then it will allow heart failure sufferers to achieve a continuing level of exercise which in itself will benefit their condition and enable them to undertake average daily activities of life.

There are a range of other research programmes which have also addressed the goal of bringing back functionality to heart tissue that has been damaged by a heart attack. One of the most radical procedures requires the application of gene therapy, whereby the presence of a protein of which heart failure sufferers are known to be deficient in would be increased so as to lead to spontaneous repair of damaged tissue. However, while gene therapy has been seen as the next great prospective breakthrough in many areas of medicine, it still continues to present serious practical challenges.

While new methods such as the above mentioned could result in a positive outcome for many heart attack sufferers, medical advice will continue to stress the ways in which heart attacks - and consequent heart failure - can be avoided rather than treated. The simple message will continue to stress for people not to smoke, to eat sensibly, take sufficient exercise and generally lead a healthier life to prevent such outcomes in the first place.


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