Congestive Heart Failure (cont.)
Congestive Heart Failure Interventions
Other treatment or procedures may be offered, depending on the underlying cause of the heart failure.
Angioplasty: This is an alternative to coronary bypass surgery for some people whose heart failure is caused by coronary artery disease and may be compounded by heart damage or a previous heart attack. Angioplasty is performed to treat narrowing or blockage of a coronary artery that supplies the left ventricle with blood. The narrowing or blockage is caused by cholesterol deposits.
Angioplasty begins with the cardiac catheterization procedure during which a long, thin tube called a catheter is inserted through the skin, into a blood vessel, and threaded into the affected artery. This procedure is performed while the person is under local anesthesia.
At the point of the atherosclerotic narrowing or blockage, a tiny balloon and/or an expandable metal stent, attached to the end of the catheter, is inflated and/or deployed.
The expanded stent pushes aside the cholesterol deposits (plaque) that are blocking the artery so that blood can flow through in a more normal manner.
Pacemaker: This device controls the rate of the heartbeat. A pacemaker may keep the heart from going too slow, increasing heart rate when the heart is not increasing enough with activity. It also helps sustain regular rates when the heart is not beating in a coordinated way. Or, the pacemaker performs some combination of these.
A pacemaker is an electrode on the tip of a wire, usually implanted inside the heart by an electrophysiologist or specialized cardiologist in the cardiac cath lab. This wire goes to the right ventricle, frequently with a second wire to the right atrium (dual chamber pacemaker).
A pacemaker can stimulate a heart that is beating too slowly to beat faster; sometimes, this requires medications in addition to the pacemaker.
Implantable Cardioverter Defibrillator (ICD): This device returns the heart to a normal rhythm by pacing or delivering an electrical shock, with a life-threatening arrhythmia.
ICDs are indicated for ischemic or nonischemic cardiomyopathy patients with slight or marked physical limitations and low left ventricular ejection fractions (<30% to 35%), since these patients are at higher risk for serious ventricular arrhythmias. In these circumstances, an ICD may be implanted as part of a pacemaker device. This defibrillator can detect and electrically shock a life-threatening arrhythmia back to normal.
Cardiac Resynchronization Therapy (CRT): This involves a biventricular pacemaker that is used to synchronize the pumping action of the left and right ventricles. Synchronization improves the effectiveness of the heart as a pump, since with heart failure the pumping action is sometimes uncoordinated.
One pacer lead is placed in a coronary vein on the back side of the heart, overlying the left ventricle. The other pacer is placed in the usual right ventricular position. This improves the coordination of contraction between the left and right ventricle, especially if the patient has left bundle branch block (LBBB). In LBBB, the electrical signal to the left ventricle is delayed.
Biventricular pacing has been shown to improve exercise capacity, prevent progression of heart failure symptoms, and prolong life in certain patients.
Cardiac resynchronization therapy is frequently combined with an ICD to shock a person out of life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation. The worse the function of the left ventricle, the higher the risk for sudden death secondary to these arrhythmias.
Temporary Cardiac Support: An intra-aortic balloon pump is used as a temporary support of left ventricle function, such as in a large heart attack, waiting for the heart to recover. There are other similar devices that can be used to temporarily support the heart if there is something that can be done for the underlying heart failure.
Medically Reviewed by a Doctor on 11/11/2014
Terrence X O'Brien, MD, FACC
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