Heart Failure Archive

In the past decade, a remarkable series of experiments from laboratories all over the world has begun to show what causes aging—and how to slow it. In the latest example of such aging research, two of my Harvard Medical School colleagues, cardiologist Richard T. Lee (co-editor in chief of the Harvard Heart Letter) and stem cell biologist Amy Wagers and their teams have found a substance that rejuvenates aging hearts in mice. The researchers joined the circulation of an old mouse with a thick, stiffened heart to that of a young mouse. After four weeks, the heart muscle of the old mouse became dramatically thinner and more flexible. The team then identified a substance called growth differentiation factor 11 (GDF11) as the probable “anti-aging” substance. It’s too soon to tell if this discovery will ever help humans with heart failure. But it reveals that there are substances naturally present in all living things that cause aging and that retard it. By understanding them, we may someday be able to slow aging.

Drinking two cups of coffee a day may protect against heart failure, likely by lowering the risk of high blood pressure and diabetes.

Older women who are being treated with trastuzumab (Herceptin), alone or with a class of chemotherapy drugs called anthracyclines, may be at increased risk for heart failure and heart muscle damage.

Are you at increased risk for this often-symptomless disease?

The aorta is the body's largest artery—and its lifeline. The aorta carries freshly oxygenated blood from the heart down through the chest and abdomen, before dividing into the arteries that serve the legs. All organs and arteries in the body owe their survival to blood delivered through a healthy aorta.

For some, the stress of grief causes serious heart problems.

Love is such an intense emotion that losing someone you love can cause profound grief. All of us grieve differently, and in some people, the emotional and psychological impact of grief can manifest itself physically by triggering a heart attack or causing a serious—albeit temporary—disease of the heart muscle.

Their value immediately after surgery is being questioned.

Drugs known as angiotensin-converting enzyme (ACE) inhibitors can make all the difference in the world to length and quality of life for some people with heart disease and high blood pressure, one of the risk factors for heart disease. ACE inhibitors work by blocking hormones that regulate blood vessel constriction. This can reduce damage to the heart and kidneys in many ways—for example, by slowing deterioration of the heart muscle that occurs over time following a heart attack or deterioration of the kidneys in people with diabetes and kidney disease. The first ACE inhibitor, captopril (Capoten), was approved by the FDA in 1981 to lower blood pressure. Nine more are available today (see box).

In the early 1990s, the ability of ACE inhibitors to prolong survival in people with heart failure was discovered, along with their ability to lower the risk of having a heart attack. Soon thereafter, Harvard researchers led by Dr. Marc Pfeffer found that people taking ACE inhibitors were less likely to die from their heart attacks. These unique benefits secured the place of ACE inhibitors mong the most significant drugs for the treatment of heart disease.

Advance planning will ensure your wishes are followed.

Mr. J. had an implantable cardioverter defibrillator (ICD) for advanced heart failure. Having survived one episode of cardiac arrest, in which he nearly died, he was at high risk for another episode caused by a rapid, unorganized heart rhythm called ventricular fibrillation. Should this happen, the ICD would shock his heart back into normal rhythm. But at his daughter's wedding, the ICD fired nine times. Each time, it saved his life, but the painful episodes terrified him, and he asked that the ICD be turned off.

Dr. Eva Chittenden, associate director of palliative care at Harvard-affiliated Massachusetts General Hospital, met with Mr. J. to explore his decision further. He stated that he had already been hospitalized five times within 12 months, and he felt this took too much time away from his family.

Many therapies can be effective, but care must be individualized.

Modern treatments for heart disease have saved many people. Some of them, however, now live with heart failure—a heart that does not function well. Blood from the body is constantly returning to the heart and then being pumped out to the body. A "failing" heart either resists the inflow of blood, struggles to pump it out, or both.

Men struggle with heart failure and depression.

Learning you have heart failure (HF) can be an emotional blow, since the disease can lead to significant health complications and poor quality of life. And while depression is more common in women with HF, a study presented at the American Heart Association's 2012 Quality of Care and Outcomes Research Scientific Sessions found that the severity of the depression is much greater in men with HF. "Heart failure can make one quite physically weak, and this may hit men especially hard, based on their traditional views of masculinity," says interventional cardiologist Dr. Deepak Bhatt, a professor at Harvard Medical School. There is also growing evidence that depression can worsen heart disease. Depression may cause a person to stop taking medicine, exercising, or eating properly, which may hurt heart health. So depression after a diagnosis of HF can lead to a downward spiral. That's why it's so important for depression to be recognized.

Warning signs include loss of interest in activities, changes in weight and sleeping patterns, feelings of hopelessness, and withdrawal from friends or relatives. Dr. Bhatt says don't ignore any of these signs in yourself or a loved one. "Be honest and admit that depression might exist. Then ask for help, usually starting with the primary care doctor, and in really severe cases, seeking the help of a psychiatrist."

Erectile dysfunction drugs may do what no others have done.

Sildenafil (Viagra) treats erectile dysfunction (ED) by blocking (or inhibiting) an enzyme called PDE5. This relaxes arteries that send blood to the penis, causing it to enlarge. Viagra and similar ED drugs also relax the arteries of the heart. Now there is evidence that PDE5 inhibition may be an effective treatment for heart failure (HF). Harvard researchers have shown that Viagra can improve exercise capacity in people with this chronic disease. In May, the researchers received a $26.3 million grant from the National Institutes of Health to study whether the PDE5 inhibitor Cialis can extend length of life in people with heart failure and reduce heart failure-related hospitalizations.