Healthcare Solutions

I didn't know it at the time, but I was days away from a massive heart attack," said 58-year-old Wim van Akelijen. "I would be walking in the street and have to stop at every corner to get my breath back. It was impossible to walk up stairs - and simple things like combing my hair and brushing my teeth took a tremendous effort. "For a long time I thought I had the flu, but it wouldn't go away. When I went to my own doctor he told me I had congestive heart failure, but he felt that a diet was the solution. So I was eating rice and beans for weeks. But soon it became clear that I wasn't getting any better. I told him he had to get me to a cardiologist. In 1994, he referred me to NYU Medical Center."

Almost immediately, van Akelijen underwent a battery of tests. An echocardiogram revealed that his heart had an ejection fraction of only 20 percent and an angiogram revealed that he had severe coronary artery disease - the leading cause of congestive heart failure - which can cause myocardial infarction.

"What are my alternatives?" van Akelijen asked his NYU cardiologist, Dr. Frank O'Brien. "You have none," said O'Brien. "A surgeon is on his way right now." The following morning, cardiac surgeon Dr. Eugene Grossi performed quadruple coronary bypass surgery and put van Akelijen on the road to recovery.

Follow-Up for Life

The steps that followed in the subsequent 2-1/2 years - extensive drug therapy, closely monitored physical rehabilitation, continual watchfulness by Dr. O'Brien and his colleagues, and, recently, the timely installation of a pacemaker - describe a standard of care that eludes many patients seeking relief from the devastating consequences of a failing heart. At the center of successful treatment is a committed relationship between doctor and patient. "Dr. O'Brien and I are on a first-name basis because he's going to be my partner for the rest of my life," said van Akelijen. When van Akelijen was diagnosed with heart failure in 1994, he was not alone - some 400,000 new cases are diagnosed annually. Heart failure kills 38,000 people every year and is a contributing factor in the deaths of 225,000 others. But van Akelijen was fortunate; his heart problems were treatable.

"The key to treating heart failure," says Dr. Arthur C. Fox, Chief of NYU's Division of Cardiology, "is to look for reversible causes - the underlying problems in the heart that can actually be fixed."

"It's so important to make the right diagnosis. It's in the hands of the individual doctor who knows his or her patient and has all the necessary support." This includes echocardiography, nuclear cardiography, stress tests (both exercise and pharmacologic), angiography, and studies of electrophysiology.

An echocardiographic evaluation identifies defective heart valves, assesses the severity of heart valve disease, pinpoints areas of heart muscle damage, maps abnormal blood flow patterns, and estimates the strength of the heart's contractility. High-quality echocardiography provides the cardiologist with a unique opportunity to determine the etiology of the patient's heart failure. Knowing the precise cause of heart failure allows the physician to make crucial decisions regarding the most effective treatment. For example, echocardiographic images of the ventricle can indicate if heart wall motion is compromised, and further pharmacologic or nuclear testing can determine whether this area is infarcted or merely ischemic; if ischemic, revascularization has a high probability of allowing the heart to recover.