Seeing is Believing

Many different types of echocardiography are available. Two dimensional echocardiography provides a good picture of the overall functioning of the heart and its various parts. The Doppler ultrasound echocardiogram and the color Doppler are images of heart motion and structures, combined with real-time color images of blood motion, which are useful for detecting abnormal blood flow and defective heart valves.

Zooming In

The transesophageal echocardiogram (TEE) was pioneered at NYU. With this procedure, an ultrasound device is attached to a tube that is inserted in the esophagus. Because the echoing device is much closer to the heart, the procedure produces an image that is 100 times clearer than those of other types of echocardiography. A full-time echocardiologist evaluates heart function before, during, and after operations. TEE is especially useful with patients undergoing surgery for faulty heart valves, because it shows the results of heart valve replacement or repair before a patient's chest is closed.

3-D Image

One of the most innovative tools is 3-dimensional (3-D) TEE. It is often used during valvuloplasty, a procedure performed in the Cardiac Catheterization Lab to widen heart valves that have become clogged or narrowed. In valvuloplasty, a balloon-tipped catheter is inserted into the femoral artery and moved through the blood vessels into the heart, where the balloon is properly positioned and then inflated, forcing the valve to open wider, and improving the flow of blood.

This procedure, performed by interventional cardiologists, "is an incredible option for patients who might not survive surgery," says Dr. Itzhak Kronzon, a specialist in cardiac diagnostics. In the treatment of faulty heart valves, Dr. Fred Feit, Director of NYU's Cardiac Cathetherization Lab, points out that "highly specialized surgical techniques can repair valves that otherwise would have to be replaced."

Elements of Excellence in Managing Heart Failure

• State-of-the-art noninvasive diagnostics including echocardiography, stress testing (exercise and pharmacologic), and nuclear cardiology.
• Comprehensive range of interventional diagnostic and therapeutic options, encompassing sophisticated programs of angiography, electrophysiology, and valvuloplasty.
• Full range of treatment approaches including optimal medical management and a variety of surgical options.
• Surgical innovation that includes minimally invasive techniques for coronary bypass and valve repair and replacement.
• Personal and lasting doctor-patient relationships, attentive nursing care, and coordinated hospital services.
• Comprehensive rehabilitation services.
• Scientific research to identify best clinical approaches.

Toward a Better Life: Treatment that Works

Clinical symptoms often seen with all types of heart failure include shortness of breath, fatigue, swelling of the legs, and persistent cough. A variety of drugs may be used to help relieve these symptoms, especially diuretics. "But the most fundamental approach to treating congestive heart failure," says Dr. Feit, "is an angiotensin-converting enzyme (ACE) inhibitor."

ACE Inhibitors

ACE inhibitors widen the blood vessels, thus reducing the load on the weakened heart and allowing it to pump more easily. The importance of this cannot be overestimated, for the heart - unlike other muscles - cannot rest; it must continue to work even when it is injured. The relief provided by ACE inhibitors is extraordinarily helpful in treating heart failure patients.

Although large-scale studies have demonstrated that ACE inhibitors decrease symptoms and prolong the lives of heart failure patients, they remain underused. A recent Harvard study found that 69 percent of patients with heart failure were not prescribed ACE inhibitors. And a University of California study found that 43 percent of the sampled practitioners prescribed inadequate doses. Some patients have contraindications - low blood pressure and renal failure are the two principal ones - but many patients would benefit if ACE inhibitors would be more widely prescribed.

Dangerous Heart Rhythms

Life threatening abnormalities in heart rhythm often develop in a sub-group of heart failure patients. Electro-physiological studies conducted in the catheterization lab may identify patients most at risk for these arrhythmias. Once identified, these patients are treated with antiarrhythmic drugs or the implantation of a pacemaker or cardiac defibrillator.

Rehabilitation: To Strengthen Muscle, Build Confidence

Physical rehabilitation is a critical and ongoing part of a patient's recovery process," says Dr. Mariano Rey, who runs NYU's Cardiac Prevention and Rehabilitation Center. "Patients with heart failure do better when they are seen at the hospital bedside by a physical therapist, who gets them started right away on ambulation and exercise. If appropriate, they can then be transferred to a dedicated inpatient cardiac rehab program that provides education about medications and assessment of changes needed in diet and activity to keep their hearts healthier. Once patients are discharged, they can join an outpatient program. NYU offers 36 exercise sessions and 12 lectures over three months. Help from nurses, cardiologists, psychologists, and exercise physiologists is always available."