Pradeep Mammen, M.D. Answers Questions On: Heart Failure
Is congestive heart failure a terminal illness?
A common misconception about congestive heart failure is that it’s a terminal illness. While it’s true that doctors couldn’t do much to help people with heart failure just a couple decades ago, that’s completely changed with our current therapies.
Another common misconception is that heart failure always means that the heart muscle is weak. Actually, only 50 to 60 percent of patients diagnosed with heart failure have it because their heart muscle is weak.
The other 40 to 50 percent have diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF), in which the heart function may be normal but something has caused the heart muscle to get stiff. For example, elevation blood pressure or hypertension can contribute to diastolic heart failure.
Regardless of what causes it, heart failure is a serious condition – not a death sentence – that has the potential to be stabilized, improved, or even reversed. People with suspected or confirmed heart failure should be evaluated and treated by a specialist.
What is neuromuscular cardiomyopathy?
The heart is a muscle, and neuromuscular cardiomyopathy is heart failure that results from neuromuscular disorders such as muscular dystrophy, myotonic dystrophy, and mitochondrial myopathies. These conditions are almost always the result of genetic mutations that also cause the arms and legs to get weak, and the heart is affected more often than not.
Because many patients with neuromuscular disorders used to die before they reached adulthood, most didn’t receive specialized care for their hearts.
But thanks to advances in health care and the work done by our colleagues in pediatrics and other related disciplines, a lot of these patients are living well into adulthood. The problem is that these productive, valuable people are now dying mainly of heart-related issues.
I founded UT Southwestern’s Neuromuscular Cardiomyopathy Clinic in 2010 to give these patients the opportunity for the most current heart failure therapies to be applied to them.
Another of the clinic’s goals is to learn more about how to best treat neuromuscular cardiomyopathy. Because very few patients with the condition took part in the original clinical trials for many of today’s heart failure therapies, we’re investigating whether these patients see the same therapeutic results as patients suffering from other types of heart failure.
We hope to eventually form a network with similar clinics around the U.S. so that we can initiate clinical trials dedicated to neuromuscular cardiomyopathy.
How do you determine which patients with advanced heart failure are candidates for LVADs and which are candidates for heart transplants?
Heart transplantation is the gold standard for treating patients with advanced heart failure, so first and foremost, we evaluate every patient for transplant.
Patients with issues that disqualify them for a heart transplant – an active cancer or very advanced age, for example – are often then considered for left ventricular assist devices (LVADs) or other types of mechanical circulatory support.
There are currently two approved uses in the U.S. for LVADs: as a “destination therapy” – for patients with weak hearts who aren’t candidates for transplant – and as a “bridge to transplant,” for patients who qualify for heart transplantation but whose hearts require stabilization while they wait for suitable donor hearts.