Wednesday, September 17, 2014

Monday, October 27, 2008 Pete Benavides, Community Member, asks

Q: can a person live if only the back part of thier heart is working?

My mother who had triple bypass earlier this year has suffered fron another attack which has destroyed the front part of her heart.  They were able to put a couple of stints in the back and seems to working fine. 

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Answers (1)
Martin Cane, M.D., Health Pro
11/ 2/08 10:45pm

Pete Benavides,

 

Thanks for your question.  Sorry to hear your Mother is having continued heart problems.

 

A lot depends on how much actual heart damage has occurred to the heart wall.  This is best gauged by performing an echocardiogram which looks at the wall motion.  It can also calculate the ejection fraction of the left ventricle, which is the major pump of the heart.  Ejection fraction is the amount of blood that is pumped out with each beat divided by the total volume of blood just before it contracts.  This is expressed as a percentage.  A normal percentage is 52 to 60%.  When the percentage falls below 45 percent, the risk of developing congestive heart failure is greater which can greatly affect a person's symptoms and lifestyle. 

 

It is also important to know that after an acute heart attack, the muscle wall is very fragile and pumps very poorly.  As the healing process proceeds, some areas that were borderline can begin functioning again.  Also, with the development of scar tissue, the heart wall stiffens up a bit which can somewhat improve cardiac output (ejection fraction).  This is why doctors perform serial echocardiograms to monitor this important factor. 

 

The good news is that there are several medications which can improve cardiac output, and it may take time for the doctors to tailor the right regimen for each patient.  Should all the new medication not produce an adequate response there are newer techniques that have shown to improve and lengthen patients' lives.  One is to insert a LVAD (left ventricular assistive device).  This device works with the patients own heartbeat and delivers an electrical stimulation that is timed in such a way that the heart muscle pumping action is improved.  This can greatly improve patients symptoms and in many cases, improve longevity.  Another, lesser used surgical treatment, is to perform open heart surgery (again) and cut out any dead tissue, which is not contributing to the hearts function, and may actually be detrimental to the ejection fraction.  In this situation, when the heart pumps, the dead tissue balloons out which negates much of the pumping action.

 

Every patient's situation is unique and should be discussed with the doctors involved.  What may sound promising on paper may not fit well in a patient's situation. 

 

I hope this has been helpful.  Best wishes.

 

Martin Cane, M.D.

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By Pete Benavides, Community Member— Last Modified: 06/13/12, First Published: 10/27/08