Heart failure: in what situations might a patient need a heart transplant?

A heart failure (HF) is a very common disorder in Brazil, affecting approximately 2 million patients, with an incidence of approximately 240,000 new cases per year. In terms of public health impact, HF led to more hospital admissions than all types of cancer in Brazil, being responsible for a higher mortality rate than all types of cancer.

Data from the Ministry of Health indicate that in 2021 alone, more than 167 thousand visits to patients with heart failure were recorded in primary health care centers. Often, however, it stops being just a chronic issue and becomes disabling, requiring a heart transplant. The cardiologist Rafael Vignoli explains a little more about the symptoms of heart failure, treatments, medications and how to identify the need for a transplant. Check out!


What is it cardiac insufficiency?

According to Dr. Vignoli, “the cardiac insufficiency is syndrome in which the heart is unable to supply enough blood to meet the body’s demands, either due to an inability to pump the blood or a change in cardiac relaxation”. Therefore, it is not just a heart health problem, but can have severe impacts on other organs, generating comorbidities in the lungs, kidneys and liver, for example. Therefore, it is extremely important to be alert to the main symptoms of this condition.


Heart failure symptoms: how to identify?

Heart disease is often silent – ​​and failure is no exception. Symptoms depend on the severity of the case and their onset can be slow and progressive, or, depending on the case, have an acute onset. Among the main and most recognized symptoms of the disease are tiredness when exerting effort, swelling in the legs, difficulty breathing when lying down and difficulty performing physical activity. “Advanced heart disease manifests itself with a very reduced cardiorespiratory capacity, where the patient has intolerance to minimal exertion and even at rest”, explains the cardiologist.

It is also possible to notice in more advanced cases, an increase in volume in the abdominal region due to the accumulation of fluids, changes in weight and coughing with hints of blood. As it is a progressive disease with variable symptoms, it is important to follow-up with the cardiologist at the first signs of the disease.


Causes of heart failure

The most common causes of heart failure are: coronary artery disease (acute myocardial infarction being the most serious condition), high blood pressure and diabetes. Other causes are diseases that affect the heart muscle (cardiomyopathies), heart valve diseases, arrhythmias, congenital heart defects, thyroid disease, some chemotherapy treatments and radiotherapy for cancer, HIV/AIDS and alcohol or cocaine abuse. Treating these problems can prevent or improve heart failure.


What are the risks of heart failure?

Heart failure is a disease that reduces life expectancy and has a high morbidity and mortality rate. According to epidemiological data, 50% of people diagnosed with cardiac dysfunction are expected to die within 5 years. When the disease reaches an advanced stage, the death rate is expected to be 50% within a year..


When is a heart transplant necessary?

In many cases, heart failure is so advanced that the heart is compromised and the patient’s guarantee of survival depends on a transplant. Heart transplantation is a therapeutic option considered in patients with advanced HF and refractory to treatment using the best possible therapy and in accordance with national and international guidelines, and with an estimated adverse prognosis. The main indications for heart transplantation are:


  • – Advanced HF in dependence on inotropic drugs and/or mechanical circulatory support;
  • – Advanced HF with symptoms on minimal exertion or at rest in the presence of optimized treatment and with other poor prognostic factors;
  • – Advanced HF and maximum oxygen consumption (VO2) ≤ 12mL/kg/minute in patients using beta-blocker medications;
  • – Advanced HF and peak VO2 ≤ 14 mL/kg/minute in patients intolerant to beta-blockers;
  • – Symptomatic ventricular arrhythmias refractory to management with drugs, electrical devices and ablation procedures.


However, there are selection criteria for those who are most likely to get a new organ: “Potential contraindications are ages >70 years, comorbidities with low life expectancy, active systemic infection, severe obesity, severe cerebrovascular disease, advanced liver and lung disease, severe peripheral vascular disease with no possibility of advanced treatment, severe and irreversible kidney disease, hypertension fixed lung disease, among other serious conditions, in addition to low social support, psychiatric illnesses and chemical dependency”, explains the doctor.


What are the risks of heart transplant surgery?

Every surgery, invariably, has risks – no matter how small they may be. In the case of a heart transplant, complications may also arise, as the cardiologist explains. “Some risks include: complications during the peri-operative period (hemorrhage, disseminated intravascular coagulation, sepsis, etc.), acute complications (humoral and cellular rejection), complications arising from immunosuppressive treatment (opportunistic infections), kidney disease, late complications (vascular disease) of the graft, neoplasms)”, explains Rafael.

Among the early causes that can negatively impact the success of the transplant are primary dysfunction of the transplanted heart, which is the main cause of early mortality after heart transplantation, corresponding to 36% of deaths in the first 30 days, right ventricular dysfunction and infections.

“These complications are managed with specialized medical monitoring, use of specific medications and rigorous assessment of cardiac function, immunity and the patient’s general condition with laboratory tests and clinical evaluation”, emphasizes the cardiologist. The post-operative period also requires very specific care. “Patients must undergo periodic follow-up with the transplant service, with immunological monitoring, rejection assessment with imaging or biopsy performed in the first few months. They are advised on general care. Cardiovascular rehabilitation is necessary.”


In addition to transplantation, are there other treatments for heart failure?

The answer is yes! Heart Failure in its various types has adequate and effective treatment, capable of reducing the risk of mortality and cardiovascular and renal complications. However, monitoring only with a doctor qualified to treat this disease, in addition to the availability of a multidisciplinary health team for good monitoring, is essential for the good result and success of the treatment.

The post Care for Life.

Source: cuidadospelavida.com.br

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