Suggest treatment for congestive heart failure
Patient: Name: Diane Deaton Email:Comment: My dad is 88 years old and just admitted to hospice with congestive heart failure. I was reading about heart pumps and would like to see if he would be eligible for this and if he could get an appointment. I know his age is not good but I would rather take the chance of doing this than doing nothing except waiting for him to die. Please email me in regards to this. Me and my dad have grown closer in the past two years and I am not ready to let that go if there is any hope at all. Thank you so much.Phone: 859-912-1154 Doctor: Hello and welcome to HCM, madame. I carefully read your query. If you are referring to a left ventricular assist device (LVAD), they are usually used as a bridge to heart transplant. I am not sure how this works in your country, but I am quite confident that an 88-year old is not a candidate for transplant and, I am afraid, does not pass in the heart transplant committee. However, there are other precautions that can be undertaken in cases of congestive heart failure with low ejection fraction. It would be helpful for me, if you had provided the ejection fraction of the left ventricle, assessed with an echocardiogram. Nevertheless, the therapy should be strict and adhered to. Besides other drugs, a good outcome accompanies the addition of an angiotensinogen converting enzyme inhibitor (ACE-I) or an angiotensinogen II receptor blocker (ARB), a potassium-sparing diuretic (spironolactone) and a loop diuretic (furosemide), to both oppose the compensatory mechanism which, when acting longer than needed, are dangerous to the organism, and, also to reduce the heart workload. Besides this, salt should be totally withheld from his diet, because it is estimated that 1 g of salt retains 10 g of water. Also, you can discuss with his cardiologist about the possibility of implanting an ICD (implanted cardioverter-defibrillator, to automatically convert the potentially life-threatening ventricular arrhythmias, should they happen, which have a high predilection in the damaged heart muscle) and of a CRT (cardiac resynchronization therapy, basically a biventricular pacemaker, which helps both ventricles to contract closer in time). I hope this helps and answers your questions. Take care. Regards, Dr. Meriton