Reawakening continued
patients live longer with a damaged heart , without adequate treatment , they go into heart failure ,” she says .
Heart failure occurs when the heart cannot pump enough blood to meet the body ’ s needs . It can be caused by a wide variety of conditions . Heart failure becomes advanced when it affects daily activity . At this point a person may notice shortness of breath , a loss of appetite , or nausea . Cardiologists hope to see heart
“ As patients live longer with a damaged heart , without adequate treatment , they go into heart failure .”
— Dr . Nandini Nair
failure patients at the onset of such symptoms , because it ’ s easier to treat at that point , says Dr . Nair .
It came without warning Not everyone with heart failure is of advanced age . For one of Dr . Nair ’ s patients , advanced heart failure came on suddenly . Rick Meyer , a resident of Gatesville , Texas , could not sleep after spending a day at the lake with his family in July 2009 . “ I just kept waking up , gasping for air ,” says Mr . Meyer , 45 , who had always been very active and healthy .
After a second sleepless night , he went to the emergency room at a local hospital and was taken by ambulance to Scott & White . There he became one of Dr . Nair ’ s patients .
Mr . Meyer was diagnosed with cardiomyopathy , which is a weakening of the heart muscle , and congestive heart failure that was likely caused by a virus . Dr . Nair prescribed medications and light exercise , and Mr . Meyer ’ s condition improved into the fall . “ I ’ ve never had a specialist , once you were past the critical stage , stick with you ,” Mr . Meyer says . “ And she does .”
Mr . Meyer continues to improve . “ I feel pretty normal ,” he says . “ I ’ ve come quite a way .” Dr . Nair hopes she can continue to treat his heart failure medically , but she has told Mr . Meyer that he may at some point become a candidate for a heart transplant , which is now an option at Scott & White .
A needed infrastructure The Advanced Heart Failure Clinic opened its doors in 2010 with new clinical talent and services to help patients . In 2009 , Scott & White recruited cardiologists Dr . Nair and Allen Anderson , MD . In addition , the team consists of Robert Scott , MD , and Philip Houck , MD . Dr . Nair received her training in advanced heart failure and transplant cardiology at Stanford University School of Medicine . Cardiovascular thoracic surgeons experienced in adult transplantation were recruited as well : Kenton Zehr , MD , and Surgical Director of Thoracic Transplantation Enrique Gongora , MD , who served as chief cardiovascular thoracic resident at the
Mayo Clinic , in Rochester , Minnesota .
“ The cardiology and surgery teams are almost inseparable . They are very intricately connected pre- and postoperation ,” says Dr . Nair .
The clinic brings another option to heart failure patients in Central Texas : ventricular-assisted devices , or VADs . A VAD is a mechanical pump implanted in a patient ’ s heart . Connected to an external battery and control unit , the VAD assumes the heart ’ s pumping duties if medications fail . VADs can be used temporarily to bridge a patient to transplant surgery , or they can be used permanently as “ destination therapy ” for the patients who are not transplant candidates .
“ People with VADs have a very good quality of life ,” Dr . Nair says . “ Some lucky people have their heart function completely return because the pump takes over the function , so the heart gets a break and can heal .”
A new frontier for selected patients After receiving approval from the United Network for Organ Sharing , or UNOS , the group that governs transplant centers in the United States , Scott & White began listing candidates for donor hearts . To date , Scott & White has performed six heart transplants . Patients need a heart transplant when the conventional medical therapy described earlier fails to adequately improve their quality of life or life expectancy . It ’ s for patients with various forms of cardiomyopathy , inoperable valvular disease , coronary
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