Patient Profile: Cardiac Care/Congestive Heart Failure
Making congestive heart failure easier to diagnose and live with
Sean Murphy is not your typical heart patient. At 35, the North Reading-based construction company owner is younger and more physically active than the majority of the estimated 5 million Americans who live with congestive heart failure.
Six years ago, Murphy was bothered by blurry vision while doing a building job for his uncle. He was diagnosed with high blood pressure at Lawrence Memorial Hospital of Medford (LMH). When Murphy's assorted medications left him feeling drained of energy, he skipped medications and doctors' appointments, hoping for the best. After a couple of years, he had begun to feel "lousy" and breathless. Under the care of kidney and hypertension specialist Anthony Dash, MD, and cardiologist Laurence Conway, MD, LMH's chairman of the Cardiac Performance Improvement Committee, Murphy was diagnosed with congestive heart failure.
Uncontrolled hypertension causes complications
"He had all the dire consequences of severe, uncontrolled hypertension," says Dr. Conway.Congestive heart failure, explains Dr. Conway, is "the most common reason for people to be admitted to hospitals across the country, except for pregnancy." It occurs when the heart fails to pump blood efficiently enough to supply adequate oxygen to body tissues.
Symptoms usually include shortness of breath, profound fatigue and swelling of legs and ankles. The underlying causes are typically the same as those for coronary artery disease: high blood pressure, high cholesterol levels and smoking. Although congestive heart failure is more common among older people, it can affect people at any age.
Latest in diagnostic imaging, lab testing confirms doctor's suspicions
"I usually suspect congestive heart failure based on a medical and family history and a physical exam," says Dr. Conway. However, high-tech imaging confirms the diagnosis.In Murphy's case, diagnostics began with angiography at Melrose-Wakefield Hospital to check for blockages in the coronary arteries. Then, in LMH's cardiac non-invasive imaging laboratory, he had an echocardiogram, an ultrasound test that uses sound waves to examine the heart's structure and motion.
At LMH's state-of-the-art nuclear cardiology laboratory, Murphy was also given a test that provides vital information about blood flow through the heart, the motion of the heart wall and exactly how much blood the heart can pump with each beat.
Murphy also had a newly available blood test to assess his level of Brain Natriuretic Peptide (BNP). BNP, explains Dr. Conway, is a protein released into the bloodstream in response to pressure inside the heart and a good indicator of the severity of heart failure.
Defibrillator implant, new medication improve quality of life
Arrhythmia is a common complication of congestive heart failure, and Murphy's case proved no exception. A small defibrillator (similar to a pacemaker) was implanted in his chest to correct any significant rhythm disorder.Now, Murphy's new medication regimen includes the latest, low-side-effect medication for heart failure, nesiritide, which is so successful that Dr. Conway runs a clinic specifically to make it available to people in the community on an outpatient basis. For Murphy, his tough diagnosis was a wake-up call. Encouraged by his wife, he quit smoking and began to improve his diet. Dietitians at LMH stressed that too much sodium can cause the body to retain excess fluid, causing serious complications for patients with congestive heart failure. Once he began studying nutrition labels, Murphy realized for the first time that salt does not only come in a shaker but in virtually every form of processed food.
"Sean is doing fabulously well," says Dr. Conway. Murphy, for his part, feels that he landed on his feet when he walked into LMH. "The doctors were always great to me," he says. "Any time I called, they would say, 'You come right in, we'll take care of you right now.'"
