My Adventures with Heart Failure

Apparently, the marketing people from Coreg read this blog. They asked me if I'd be willing to add a link to Coreg's web site. I checked out the site, and decided that it would be worthwhile to add a link to the part of their web site that specifically discusses heart failure. There are some interesting bits of information in there, including differences in the incidence of heart failure among races, which I knew some of, but did not know that Mexican-American women have a lower incidence of heart failure than either Anglo or African-American women. So, you might also find interesting information by reading Coreg's site, despite its equally obvious commercial intent. It's by gathering information from as many sources as possible that we learn the most, right?

Another article of interest (I've been on antidepressants since long before I got diagnosed with CHF):

Depression Worsens Outcomes for Heart Failure Patients

March 6 (HealthDay News) -- Depression is a major factor in poor medical outcomes for heart failure patients, says a new U.S. study.
The study, conducted by researchers at Duke University Medical Center and the University of North Carolina, included 204 heart failure patients who were followed for an average of three years. Tests showed that 46 percent of the patients had significant symptoms of depression. During the study period, 26 percent of the patients died, and 48 percent were hospitalized at least once for their heart
condition.
The researchers concluded that patients with depression were more
than 50 percent likely to die or be hospitalized for their heart condition than
patients who weren't depressed. This means that, in heart failure patients, depression ranks in importance with risk factors such as high cholesterol, hypertension and even the ability of the heart to pump blood throughout the body, the study authors said.
"While many studies have linked depression to worse outcomes for patients with heart disease, there has been uncertainty about the extent to which depression is related to the adverse medical outcomes independent of known medical risk factors," study co-author James Blumenthal, a clinical psychologist at Duke, said in a prepared statement.
It's not clear why heart failure patients with depression have worse outcomes. The researchers are launching a new clinical trial to further investigate depression in heart failure patients.
The study was published in the Feb. 26 issue of the Archives of Internal Medicine.

SOURCE: Duke University Medical Center, news release, February 2007

This is especially interesting in light of something my cardiologist told me back when I first got started on Coreg (carvedilol), which is that many people get depression as a side effect of taking beta-blockers until they get fully acclimated to them, and that for that reason while the dose of Coreg is being titrated, which takes weeks, the cardiologist asks questions at every visit intended to detect depression and consider prescribing anti-depressants. So, depression is a side-effect of one of the medications used to treat heart failure, and depression can lead to worse outcomes in heart failure... we're sort of in a catch-22, aren't we!!

This is, of course, NOT a message that you should stop taking your Coreg; for one thing, for most people the benefits of the beta-blocker undoubtedly outweigh the risks, and for another thing, discontinuing any medication suddenly is a bad idea, and especially a bad idea for certain drugs including beta-blockers. Suddenly stopping taking your Coreg could land you in the hospital right quickly. However, if you are taking Coreg and feel fatigued, listless, have trouble concentrating, or have trouble sleeping through the night, these could be signs of depression, and you should ask your doctor about appropriate additional treatment for depression.

This week's article:

Lipitor Approved for Additional Uses
March 8
(HealthDay News) -- Pfizer's anti-cholesterol drug Lipitor (atorvastatin)
received expanded approval from the U.S. Food and Drug Administration on
Wednesday to reduce users' risks of non-fatal heart attack, fatal and non-fatal
strokes and hospitalization for heart failure, and for use in certain types of
heart surgery, the company said.
The new approvals expand use of Lipitor to people who have had a prior heart attack, heart surgery or chest pain.
The expanded approval of the 80 mg. dose was based on a five-year trial involving people with both heart disease and elevated levels of LDL, the so-called "bad" cholesterol, Pfizer said. The company added that the trial was the longest and largest study of the 80 mg. dose's safety and effectiveness.
More than 15 million Americans have a history of coronary heart disease, Pfizer said, adding that about 300,000 Americans are expected to have a recurrent heart attack this year.
Lipitor was first approved by the FDA in 1996 to treat high cholesterol.

Happy New Year!

Well, 4 years (and a couple of weeks now) since I got diagnosed. The good news, I'm still alive. The bad news, my EF hasn't budged from 20% despite all medications, and three tries at implanting a third lead from the pacemaker to do bi-V pacing have all failed. Oh well.

I gained a few pounds this past year, and I need to lose it again. I think that's a battle all of us fight. I'm going to attempt to lose some of it by eating more vegetarian meals; I don't eat that much meat to begin with, but I'll eat less, and try to get more fish in there when I do feel like some fast protein. I've ordered lots of stuff from Eden Foods - almost all of their canned stuff comes in low-sodium versions, including some baked beans they didn't have last time I looked! - and the 12-pack of low-sodium cheddar from Heluva Good, to give me a good start on more home cooking, less eating out. Now to go peruse Healthy Heart Market and Mr. Spice, to round out my groceries - an order from each of them, and I think I'll be set for cooking meals several times a week for at least a month!

Easy recipe time!
Roasted Winter Vegetables
1 bag "Golden Nugget" or other fingerling (tiny) potatoes
1 bag pearl onions
1 sweet potato
1 butternut squash
1 bag parsnips (giant white carrots)
optional: 1 small box brussels sprouts, if you're not a supertaster who hates them
olive oil
fresh rosemary
fresh thyme

Scrub the potatoes, but you don't have to peel them. Peel the outer layer off the onions. Peel the sweet potato and cut it into 1" cubes. Peel the butternut squash and cut it into 1" cubes. Scrub and peel the parsnips, cutting off the tops, and cut them into 2" long segments at the thin end, 1" long segments at the thick end. Remove any wilted leaves from the brussels sprouts.

Place all the veggies in a large baking dish or casserole dish. Bloop a few tablespoons of olive oil over them, and toss till everything has a very slight touch of olive oil on it. Now strip the leaves from 4-5 branches of rosemary, and from 4-5 branches of thyme, and sprinkle them over the veggies. Toss the veggies again, so that the herbs are distributed throughout. Roast, uncovered, in a 350° to 375° F oven for about one hour, or until a fork stuck in a potato or cube of sweet potato goes in easily. Serve hot. This makes a lot - 8 people or so's worth - so if there are leftovers, they taste just fine rewarmed the next day.

The even easier version of this recipe:
Instead of all those kinds of veggies, just get one bag of the Golden Nugget potatoes and one bag of some other kind of tiny potatoes - "new potatoes" or "fingerlings" or anything else where each potato is only golf-ball size. Do the same bit with the olive oil and the herbs. But you don't have to do all that peeling and cutting. Same baking instructions.

This week's article:

Magnets may interfere with pacemakers and ICDs
Dec 08 (HealthCentersOnline) - Certain types of magnets that are becoming increasingly popular in clothing and jewelry may interfere with the function of pacemakers and other implanted cardiac devices, according to new research.
Implanted in the chest, pacemakers and implantable cardiac defibrillators (ICD) are two types of battery-powered devices that monitor and, if necessary, correct an abnormal heart rhythm by sending electrical charges to the heart.

Researchers in Europe recently evaluated several types of magnets to see if they were capable of interfering with pacemakers and ICDs that had been implanted in patients.

The study found that while traditional magnets commonly found in the home and office are not dangerous, other types of magnets can be. Specifically, the research found that powerful magnets made from neodymium-iron-boron (NdFeB) are capable of interfering with cardiac devices implanted in the chest.

NdFeB magnets are becoming increasingly popular in office products, toys, jewelry and some clothing. Because of this, the researchers urge the manufacturers of the magnets to place warning labels on their products.

The study included 70 patients, 41 with pacemakers and 29 with ICDs. Each of the patients was tested with two spherical magnets that were 8 and 10 millimeters in diameter, as well as a necklace made of 45 spherical magnets. In every instance, the magnets interfered with the implanted heart devices of the patients. After the magnets were removed, the devices all resumed their normal function.

"Physicians should caution patients about the risks associated with these magnets. We also recommend that the packaging include information on the potential risks that may be associated with these types of magnets," explained Thomas Wolber, a cardiologist at the University Hospital of Zurich in Switzerland and lead author of the study, in a recent press release.

The results of the study were published in the December 2006 issue of the journal Heart Rhythm.

This week's article:

Possible cause found for deadly rapid heartbeats
Nov 30 (HealthCentersOnline) - A recent study may help researchers to better understand the mechanism involved in a certain type of heart failure.
Heart failure is a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid backup or swelling in the lungs, legs and ankles.

Ventricular tachyarrhythmia is a type of tachycardia, or abnormally rapid heart rate, that originates in the lower chambers (ventricles) of the heart. Ventricular tachyarrhythmia can lead to ventricular fibrillation and/or heart failure.

Researchers from Germany may have found an explanation for why ventricular tachyarrhythmia occurs in some instances. Using mice and heart muscle cells from rabbits, the researchers were able to find a possible molecular reason for the abnormal heartbeats.

The study showed that a substance known as an "effector" for a protein called calmodulin may be improperly regulating the influx of sodium ions into the muscle of the heart. Previous research has shown that genetic problems with the regulation of the sodium ion influx puts a person at increased risk for ventricular tachyarrhythmia.

The researchers suspect that the disruption observed during the study may be a contributing factor to the onset of dangerous ventricular tachyarrhythmias that are associated with heart failure.

The results of the report were published online on November 22 in advance of its print publication in the December issue of the Journal of Clinical Investigation.

This week's article:

Blood pressure may help predict heart failure risk
Nov 20 (HealthCentersOnline) - A simple vital sign taken during admission to the hospital may be able to predict whether a patient's heart failure will worsen, according to a recent study.
Heart failure is a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid backup or swelling in the lungs, legs and ankles.

Blood pressure is a measure of the force, or tension, of the blood against the walls of the arteries. The higher this measurement, the higher the workload and strain on the heart. Blood pressure is expressed as systolic pressure over diastolic pressure.

Researchers from several universities have found that heart failure patients with a higher systolic blood pressure appear to have a lower risk of dying when compared to heart failure patients with lower systolic blood pressure. The study also found that a lower systolic blood pressure in a heart failure patient may indicate advanced disease as well as a poorer prognosis.

For the study, the researchers analyzed patient data from a large heart failure patient registry known as the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). This registry includes data gathered from some 48,612 heart failure patients seen at 259 U.S. hospitals.

After studying the data, the researchers found that there was a 7.2 percent mortality rate for heart failure patients with systolic pressure of less than 120 mmHg, while heart failure patients with pressures between 120 and 139 mmHg (considered the normal range) had a 3.6 percent mortality rate. Patients who had systolic pressures between 140 and 161 mmHg had a 2.5 percent mortality rate and patients with high systolic pressures over 161 mmHg had a 1.7 percent mortality rate.

Because a patient's blood pressure reading is a vital sign that is always taken during admission to the hospital, the researchers are confident that this new research may lead to a simple way to identify those patients most at risk for worsening.

"Systolic blood pressure taken at hospital admission was a strong independent predictor of mortality and morbidity in this large, representative heart failure patient population. We hope the findings may help clinicians more effectively stratify risk and offer more targeted treatments based on a patient's systolic blood pressure level," explained Dr. Gregg C. Fonarow, The Eliot Corday Chair in Cardiovascular Medicine and Science, principal investigator and director, Ahmanson-UCLA Cardiomyopathy Center, in a recent press release. The results of the study were published in the November 8 issue of the Journal of the American Medical Association.

My local newspaper (the Baltimore Sun) had an article a few days ago entitled "Working on MRIs that are safe for pacemakers." Subhead: "Patients with heart implants may be able to undergo diagnostic scanning procedure."

The article was cautiously optimistic; a study of the first pacemaker designed to withstand MRIs is scheduled to start at the end of this year. However, the article doesn't say whether this study applies to ICDs, or just plain pacemakers, and it doesn't make it completely clear whether the difference between ICDs and plain pacemakers matters for these purposes.

MRIs are used, among other things, to detect cancers.