Mr. Lin's Heart Failure and Biventricular Pacer

"Healthy" Mr. Lin has a problem with his heart. 

Mr. Lin is 55 years old. He always thinks that he is healthy. "I barely go to the hospital." He said. He thought everything is ok with him as long as he takes a few minutes rest, although recent two years saw him catching cold more often, coughing with sputum, or having chest tightness or gasping after walking up only three or four floors of stairs.

It is not until 3 months earlier that Mr. Lin noticed something was wrong. He found that he would have chest tightness even walking on the street, or sometimes it feels so tight in his chest that he has to sit up on the bed at night, otherwise he couldn't breathe. Mr. Lin immediately came to SAHZU for help. It turns out that "healthy" Mr. Lin is actually critically ill.

The echocardiogram shows that Mr. Lin's heart is completely dilated, like a balloon with reduced elasticity, with failing heart function. His ejection fraction of the left ventricle was only 28% (vs. 55% in normal people), meaning that only 28% of the total amount of blood in his left ventricle is pushed out with each heartbeat. It is an indicator of severe heart failure. What causes Mr. Lin's heart failure, though? Given that Mr. Lin is a chronic smoker and the segmental wall motion abnormalities of myocardium in his echocardiogram result, SAHZU cardiologists suggest Mr. Lin to have a coronary angiography. As expected, the angiography shows 100% stenosis of his proximal left anterior descending coronary artery, which indicates this artery is completely blocked probably due to a silent myocardial infarction happened in the past. After being ischemic for a long time, Mr. Lin's heart is dying in a young age.

What is heart failure?

Heart failure (HF) is a heart condition with close-to-cancer five-year survival rate that, however, tend to be neglected in our life. More than 10 million Chinese people are diagnosed with HF, patients aged 70 and above accounting for over 10%.

When the heart, "engine" of the circulation system, fails, the blood will be stagnated around the heart and its peripheral venous system instead of being pumped out, causing dizziness, fatigue, oliguria or other symptoms due to insufficient blood flow, or chest tightness after exercise, shortness of breath, cough, expectoration, dyspnea, lower limb edema, abdominal distension, nausea, loss of appetite or other symptoms linked with organ congestion.

HF is the final stage that various cardiovascular diseases progress to, such as hypertension, diabetes, coronary heart disease, cardiac valvular disease, cardiomyopathy, congenital heart disease or arrhythmia etc.

It often has an insidious onset that leads to a delayed diagnosis. Clinical manifestations such as chest tightness, shortness of breath and cough are not exclusive of HF, other diseases may cause similar symptoms. Although some patients suffer from the disease out of a sudden, HF in most patients still progresses slowly, from a mild to severe stage, because of these less detectable "disease signals".

Treatment for Heart Failure

Without a timely and active treatment, only one third patients can survive by the end of 5 years after diagnosis, which is almost the same as malignant tumors. The causes of death mostly are pump failure and arrhythmia, with sudden death to be another common cause too. However, compared to terrifying cancer, most of people lack knowledge about HF.

Early diagnosis and treatment play an important role in the prognosis of HF. To intervene the cause of HF as early as possible, to take standard medication therapy, and to use assisted device when necessary, remain three critical factors that contribute to improve the prognosis, life quality, death rate and life expectancy of HF patients.

Apart from medication therapy, Cardiac Resynchronization Therapy (CRT), a biventricular pacing device, is regarded as a valued treatment for HF patients. About one-third HF patients have asynchrony of ventricular contractions so that no single powerful pump can be generated from the ventricles. The CRT functions as a "commander" to send electrical signals to trigger ventricles to contract in a more coordinated way, thus "synchronizing the heart rate", so as to improve heart function. At the same time, this small device is also equipped with an automatic cardioversion defibrillator, which can prevent sudden cardiac death.

CRT-D Implantation at SAHZU

The diagnosis has been clarified for Mr. Lin, but difficulties still remain in terms of his treatment. The plaque in his completely blocked coronary artery needs to be eliminated as soon as possible, but his heart function is so poor that he suffers from chest tightness and shortness of breath right on the operating table, and cannot tolerate stent implantation. Therefore, Prof. XIANG Meixiang, Mr. Lin's cardiologist, adjusted the treatment strategy --- to improve Mr. Lin's heart function before managing the blockage, because Mr. Lin's ECG showed sinus rhythm with complete left bundle branch block, QRS duration as wide as 166 ms, which indicates an asynchrony of ventricular contractions.

After a period of optimized medication treatment, Prof. XIANG decided to implant a Cardiac Resynchronization Therapy with Defibrillation (CRT-D) in Mr. Lin, via a minimally invasive surgery, where a pacemaker wire is positioned in the heart through the blood vessel from a 3-5 cm incision above the left chest wall after local skin anesthesia, connecting to the CRT-D placed under the skin.

After 1-2 days' postoperative observation, Mr. Lin was discharged from SAHZU with much more relieved symptoms of chest tightness. But if Mr. Lin wants to stay healthy, the priority for him is to take medicine regularly as ordered, to get rid of bad habits, such as smoking, and then to deal with his cardiovascular problem in a later time.

About SAHZU Cardiology Department

SAHZU Cardiology Department is one of the first State Regional Medical Centers of Cardiovascular Disease and National Heart Failure Centers, sitting in the fourth position of the 2019 Chinese Best Hospital Ranking. The department is famous for its interventional diagnosis and treatment of cardiovascular diseases, and has been invited to demonstrate its technology and surgery skills around the globe.

The department's pacemaker team is among the best in China. In 2020, the total volume of pacemaker implantation (CRT-D included) ranks at the first place in the province and in the leading level in the country. On November 23, 2018, the team was the first in Zhejiang to implant the first leadless pacemaker Micra. The Department also stays in the forefront of advanced procedures such as laser electrode removal and CRT-D implantation.

Author: LI JING, CHEN LU | Reviewer:LI JING | Editor:LI JING | Source: SAHZU OFFICIAL WECHAT | Date:2021-09-20 | Views: