Get those heart devices optimized

Published 10:31 pm Saturday, March 17, 2007

Internal heart monitoring devices need to be checked and optimized after implantation to achieve a higher success rate and provide a longer healthier life for the recipient.

Intracardiac defibrillators are installed in patients through Cardiac Resynchronization Therapy who have suffered heart failure in the past. Traditionally a pace maker would be implanted make sure a heart did not pump too slowly while a defibrillator would be implanted to make sure a heart did not beat too fast. CRT devices perform the functions of a defibrillator and a pace maker, said War Vichayanond, diagnostic cardiovascular and ultrasound practitioner with Fellow of the American Society of Echocardiography credits. An average heart pumps at about 60 to 70 beats per minute.

“When it slows down to 40 you’re in danger mode,” Vichayanond said.

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Vichayanond said he and Dr. Stephen Baker, a cardiologist in Gulfport, noticed that after patients were implanted with CRT devices due to heart failure those patients still suffered from heart failures. A heart failure occurs when the heart fails to pump sufficient blood to the body. Damage to the heart usually occurs due to a heart attack, coronary artery disease, diabetes, untreated high blood pressure, deterioration of the heart muscle or heart valve malfunction. How much damage the heart suffers determines the stage of heart failure, which varies from mild, moderate and severe. Vichayanond said heart failure can be misinterpreted as fatigue, shortness of breath and inability to exercise.

Symptoms of heart failure could also include swelling of the feet and legs, lack of energy, difficulty sleeping due to breathing problems, cough accompanied by frothy mucus, swollen or tender abdomen, loss of appetite, increased night urination and confusion or impaired memory, Vichayanond said. While Cardiac Resynchronization Therapy is used to combat heart failure, it needs to be combined with optimization therapy, Vichayanond said.

Patients have found many benefits to having their implant optimized through CRT optimization to ensure that everything is operating properly. Vichayanond said there is evidence to suggest that a number of patients have a positive response to the CRT implant when the implant is adjusted to meet the patient’s unique heart pumping needs.

The need for optimization is found under the observation of a licensed cardio sonographer, a certified ICD programmer and a cardiologist. In order to determine if there is continued heart failure after implantation, a physician may order tests such as an EKG, chest X-ray, echocardiogram, blood work, exercise or other stress tests, cardiac CTA and/or cardiac catheterization, Vichayanond said.

An echocardiogram is used to watch the heart in real time, much like an ultrasound performed on pregnant women. Through this process practitioners such as Vichayanond can detect abnormalities in the pumping of the heart and effectively reprogram and optimize the CRT with the help of a licensed programmer and cardiologist through guided optimization.

“We need good technology and people who know what they are doing,” Vichayanond said.

With the use of a Ecocardiogram machine, Vichayanond said he can determine a heart’s failure rate and if the CRT needs optimization. Vichayanond said statistically 30 percent of CRT recipients do not respond favorably to the implant, but with optimization that statistic drops to about 10 percent.

“It’s not like (something was implanted) in your body and you (can) forget about it,” Vichayanond said. “We just care about what we can do to better our health care services to the community.”

Vichayanond said he provides services via his Mobile Heart Station for patients in Picayune, Gulfport and Sebastopol. There are four FASE practitioners in the state of Mississippi, Vichayanond said.