Turning Congestive Heart Failure Into Success With Medications And Implantable Devices

Asghar Fakhri, MD

Associate Chair of Cardiology, University of Maryland Baltimore Washington Medical Center

Hearing the words “congestive heart failure” can be frightening. But with the right combination of medications and, when appropriate, implantable devices, heart failure is often a highly treatable condition with patients able to live longer with a higher quality of life.

Heart failure means the heart muscle is either weak or stiff and cannot pump blood efficiently. This can cause fluid buildup in the lungs (leading to shortness of breath), abdomen (causing bloating and poor appetite), and legs (resulting in swelling and difficulty walking).

Without treatment, it can worsen and affect other organs. The good news is that early, guideline-directed therapy can dramatically improve quality of life and survival.

Medications that treat congestive heart failure are highly effective, resulting in patients seeing a 90% to 95% improvement in symptoms. These drugs strengthen the heart, reduce fluid buildup, regulate blood pressure and can protect against harmful hormonal changes. For many patients, medications along with a heart healthy diet and exercise can stabilize the condition and prevent hospitalizations.

Some patients may benefit from also having an implantable device, such as a pacemaker or a defibrillator.

There are two key tests used to understand if a patient may need an implantable device in addition to medications to treat their heart failure. The first is an echocardiogram, or an ultrasound of the heart, that measures the heart’s pumping strength, called ejection fraction. Patients with a significantly reduced ejection fraction (especially below 35%) may benefit from a device in addition to medication.

The second test is an electrocardiogram (EKG), which is used to evaluate electrical patterns in the heart. Patients with a specific pattern called a left bundle branch block, where the electrical impulse to the left ventricle of the heart is delayed or blocked, also benefit from an implantable device.

It’s important to understand that devices do not replace medications; they enhance protection in carefully selected patients. If diet, exercise and medication are used to treat 90% to 95% of heart failure symptoms, the last 5% to 10% is achieved with the implantable devices.

Who needs a pacemaker versus a defibrillator?

Devices are typically reserved for more advanced heart failure cases.

A defibrillator is recommended for patients with weak heart muscles who are at risk for life-threatening fast heart rhythms. It continuously monitors the heart and can deliver a life-saving shock if needed. It does not make the heart stronger, but it prevents sudden cardiac death.

A pacemaker treats slow heart rhythms. However, in heart failure patients with reduced ejection fraction who require constant pacing — or who have left bundle branch block — a specialized pacemaker called cardiac resynchronization therapy (CRT) may be needed. CRT improves coordination of the heart’s contractions and can actually strengthen the heart over time. Some patients receive a combined CRT-defibrillator device. All of these devices are implantable through surgery and are considered permanent solutions.

These devices are implanted through a minor surgical procedure, and 99.9% of the time, patients do very well.

While heart failure is serious, it is not hopeless. With the right diet and exercise, modern medications and implantable technologies, we can turn what can be a frightening diagnosis into a manageable success story.

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