Heart Failure and Treatment Options for Younger Patients

Heart failure, respiratory failure, septic shock, cardiac hypertrophy, severe anemia?

Hello, doctor.
My mother (57) was almost unable to walk by herself last night.
We took her to the hospital and found out she has cardiomegaly (approximately twice the size of a normal heart), heart failure (the doctor mentioned a heart failure index that was as high as 27,000), respiratory failure, and septic shock.
She underwent emergency intubation for resuscitation and is currently in the intensive care unit, conscious.
The nurse mentioned that she is on vasopressors and the ventilator is set to the maximum.
They might remove the ventilator next week to start her on respiratory rehabilitation.
The emergency physician also said that if her condition worsens, there may be no chance of recovery.
Typically, such cases are transferred to a tertiary care hospital, but calling an ambulance would take too long, so treatment was done at the local hospital.

She has severe anemia and is scheduled for an endoscopy next week to investigate the cause of the anemia.
Her urine is slightly orange-red, and the doctor said that if her condition improves, she will need to follow medical advice for treatment.
I would like to ask the doctor if there is a possibility for a heart transplant or an artificial heart in this situation.
The five-year mortality rate for heart failure is 50%.
Is this related to age? Heart failure is more commonly seen in older adults, so would the prognosis be better for my mother, who is younger? If well managed, will the mortality rate decrease significantly?
I saw that last year, the National Health Insurance approved a subsidy for artificial hearts, but I couldn't find much information.
Could you please advise if I should take my mother to a medical center to discuss the possibility of getting a long-term artificial heart with the health insurance subsidy or a heart transplant once she is stable enough to be discharged? Also, could you briefly explain the conditions for that subsidy? Since it is difficult to get an appointment at the medical center, would it be possible for this hospital to assist in referring her directly to the medical center? Thank you.

Niming, 50~59 year old female. Ask Date: 2019/03/09

Dr. He Dongjin reply Cardiology

Hello, respiratory failure, septic shock, and severe anemia can exacerbate heart failure.
It is important to first identify the correctable causes of heart failure before considering the use of a long-term artificial heart or heart transplantation.
It is recommended to refer to a cardiology department at a medical center with a transfer order from the hospital to thoroughly investigate the underlying causes before deciding on subsequent treatment options.
Currently, there is no need to consider the use of a long-term artificial heart or heart transplantation.
Changhua Hospital cares about your well-being.

Reply Date: 2019/03/09

More Info

Heart failure is a complex condition that can affect individuals of any age, including younger patients. It occurs when the heart is unable to pump blood effectively, leading to a range of symptoms such as fatigue, shortness of breath, and fluid retention. In your mother's case, her diagnosis of heart enlargement (cardiomegaly), heart failure, respiratory failure, and septic shock indicates a severe and acute medical situation that requires immediate and intensive care.

Understanding Heart Failure
Heart failure can be classified into several types, primarily based on the heart's ability to pump blood. The two main categories are:
1. Heart Failure with Reduced Ejection Fraction (HFrEF): This occurs when the heart muscle does not contract effectively, leading to a reduced ejection fraction (the percentage of blood that is pumped out of the heart with each beat).

2. Heart Failure with Preserved Ejection Fraction (HFpEF): In this case, the heart contracts normally but has stiffened, leading to inadequate filling of the heart chambers.

In your mother's situation, the high heart failure index (27000) and the presence of respiratory failure suggest that her heart is struggling significantly, which can lead to serious complications if not managed properly.

Treatment Options
The treatment for heart failure often involves a combination of medications, lifestyle changes, and in some cases, surgical interventions. Common medications include:
- Diuretics: To help reduce fluid overload.

- ACE inhibitors or ARBs: To help relax blood vessels and lower blood pressure.

- Beta-blockers: To slow the heart rate and reduce blood pressure.

- Inotropes: Medications that help strengthen the heart's contractions.

In more severe cases, especially when medical management is insufficient, surgical options may be considered:
1. Heart Transplant: This is a viable option for patients with end-stage heart failure who meet specific criteria. The success of a heart transplant can significantly improve quality of life and survival rates.

2. Mechanical Circulatory Support: Devices such as ventricular assist devices (VADs) can be used to support heart function temporarily or as a bridge to transplant. These devices can help pump blood for patients whose hearts are too weak to do so on their own.

Prognosis and Age Considerations
Age does play a role in the prognosis of heart failure. Generally, younger patients tend to have better outcomes compared to older patients, primarily because they often have fewer comorbidities and a better overall physiological reserve. However, the specific prognosis for your mother will depend on various factors, including the underlying cause of her heart failure, her overall health status, and how well she responds to treatment.

Next Steps
Given your mother's current condition, it is crucial to have open discussions with her healthcare team about her prognosis and treatment options. Once she stabilizes, you can certainly discuss the possibility of heart transplantation or the use of mechanical support devices with her cardiologist.
Regarding the artificial heart device, it is essential to inquire about the specific criteria for eligibility and the application process for any available subsidies. Typically, these discussions are best held in a specialized heart failure clinic or with a cardiologist who has experience in advanced heart failure management.

Conclusion
In summary, while your mother's situation is serious, there are treatment options available that can improve her condition. Engaging with her medical team and exploring all available avenues for treatment, including potential surgical options, will be crucial in managing her heart failure effectively. Remember, timely intervention and adherence to treatment plans can significantly impact outcomes in heart failure patients, regardless of age.

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