By the time X-rays uncovered the cause of Nakia Hentz’ pain and weakness, her heart had swelled to three times its normal size.
No one quite knows what started the teen’s heart to swelling, though doctors suspect a virus. Whatever attacked the organ, her weakened heart responded in a devastatingly common way. It grew larger in an
, changes that further stressed her heart and set off a spiral of thickening and weakening that doctors call heart failure.
By the time surgeons opened the 17-year-old’s chest to install a blood pump, Hentz’ heart was “large and mushy,” said her mother, Lei Hentz.
“It’s like a balloon you blow up,” she said. “And when you deflate it, it never goes back to its old size.”
Up to 6 million Americans are struggling to live with big, weak, failing hearts.
is the leading cause of hospitalization among U.S. residents 65 and older and costs the country an estimated $33 billion or more each year. While the condition often affects older people who have had heart attacks, it also can hit younger adults attacked by viruses or children born with heart defects.
“Heart failure is really just the final, common pathway of all cardiac diseases,” said
, director of heart failure and transplant cardiology at Oregon Health & Science University.
And the condition is growing more common. By 2020, some actuaries think 20 million U.S. residents will have heart failure, Kim said. The American Heart Association calls heart failure an epidemic and an “enormous health threat.”
Several factors fuel the rise in heart failure, including an aging population and rising levels of obesity, diabetes and other factors that cause heart disease. The success of modern medicine also fuels the epidemic: Better cardiac care is saving the lives of people who might have died of a heart attack or infection a generation ago. But some of those people are left with hearts too weak to send oxygen through their bodies. And better treatments mean heart failure is killing fewer people, leaving more to live with the disease and cope with its painful and tiring effects.
In many ways, heart failure is a slow suffocation. When some injury scars or weakens the heart, its lower chambers struggle to pump enough oxygen-rich blood through the body. The overtaxed heart can’t keep up and enters its spiral of weakness. Fluid backs up into the lungs or other body parts, making people swell and retain water. The lack of oxygen leaves people less able to exercise or even walk and live normally, and many wheeze or cough up blood when they exert themselves. Chest pain, weakness, trouble concentrating and depression often accompany the syndrome.
Doctors rank a patient’s heart failure in one of four categories. Patients with early-stage disease may have few or minor symptoms. Doctors often try treating those people with drugs to help lower blood pressure, get rd of extra water and help the heart pump better, Kim said.
People in the latter stages of heart failure, Like Hentz, generally need a heart transplant or a surgery to install a ventricular assist device, or VAD — a pump that takes over much of the weakened heart’s work. The first VADs were fairly large objects that weighed several pounds, and sometimes sat outside the body. New versions — such as the
Hentz got — weigh about a pound and can sit in the palm of a large hand.
The pumps were initially designed to help people’s hearts pump until a donor heart could be found for a transplant. That’s still a chief use. But as the pumps have grown smaller and better, more people are using them as a “destination” treatment, some staying on the pump for years without seeking a transplant. Kim said transplants and the new VADs offer similar outcomes for people with advanced heart failure — about 90 percent live for a year after surgery. Without those treatments, half of people in the worst stage of heart failure die within a year.
“More and more, these pumps have become a mainstay therapy, almost a gold standard therapy,” Kim said. “And there is less and less distinction between a pump like this and what you might call a mechanical heart.”
The main distinction between those devices is a mechanical heart would replace the organ entirely, while a VAD sits next to it and helps it, the machine doing most of the work.
Roughly 4,500 people in the United States are connected to VADs now, and Kim expects that number to grow.
“I think you’re going to see a lot more of these over the next five to 10 years,” Kim said. “It might seem a little science-fictionish now, but I think these are going to be joining the mainstream.”
While some doctors work on treating heart failure, other health experts are trying to head off the predicted epidemic by treating early stage heart disease more aggressively. Public health experts are aiming more broadly at the way Americans live, hoping to help curb heart diseases before they take hold.
In Oregon, where heart failure kills about 800 people a year, public health officials are working to limit obesity, tobacco use and other factors that harm the heart, said Jonathan Modie, a spokesman for the state health division’s chronic disease program. The state’s Healthy Communities program works with counties and tribes to increase access to healthy food and promote exercise, for instance, and a Healthy Worksites Initiative aims to help employers take similar steps to fight disease.
“Really, it’s a lot of education,” Modie said. “We’re working to make healthy food choices easy and affordable, helping schools to offer physical education opportunities.”
And preventing heart disease is one goal of state efforts to limit tobacco use, from workplace smoking bans to a toll-free
for smokers who want to stop, Modie said.