Understanding Heart Disease: CardiomyopathySep 24, 2013
Craig Selzman: This is Craig Selzman. I am an Associate Professor of Surgery in the Division of Cardiothoracic Surgery here at the University of Utah, and I am the surgical director of our Heart Transplant Program and our Mechanical Circulatory Support and Artificial Heart Program.
Host: In the news, we've heard Randy Travis had something called cardiomyopathy. Am I pronouncing that right?
Craig Selzman: Correct.
Host: What exactly is that?
Craig Selzman: Cardiomyopathy is a generalized word. Cardio, heart. Myo, muscle. Opathy, not working so good. So basically it means that the heart muscle itself is not working so well.
Host: And there's a virus that causes this. Is that correct?
Craig Selzman: There are a lot of different things that can cause a cardiomyopathy. So the word that leads before cardiomyopathy describes why it had happened. It could be because of bad blood flow. We would call that ischemic cardiomyopathy. It could be because of something that we have no idea, which we would call it idiopathic cardiomyopathy. But if we think it's a virus, then we'll call it a viral cardiomyopathy.
Host: Yeah. And in the case of Randy Travis, it indeed is.
Craig Selzman: Well, that is the presumption.
Craig Selzman: To the best of my knowledge, it hasn't been confirmed. I think that's what everybody thinks is going on.
Host: All right. And this condition causes the heart to weaken, if I'm correct?
Craig Selzman: That's correct.
Host: And then what's the cure for that? What did they actually do in his case?
Craig Selzman: Well, the cure for the majority of patients, 80, 85, 90% is absolutely nothing. It's just supportive care. But there is this very small group of patients that go into cardiovascular collapse. That means that the heart muscle is unable to pump enough blood around the body to get to the brain, to the kidneys, and to other organs and such that they need extra help. A lot of the times, that extra help can be managed with medicines in the vein, but if that doesn't work, sometimes you actually have to use mechanical means to do that. And that's what happened for Randy Travis.
Host: Is this an invasive surgery? Do they have to open his chest to get it in?
Craig Selzman: No. This is not really surgery. What it is is basically a catheter that's snaked up through one of the blood vessels that's easily accessible through the skin in the groin. So we call it a percutaneous heart pump. It's not really surgery in the classic sense.
Host: But you're hosing that thing up through the groin all the way to the heart. How difficult of a procedure is that?
Craig Selzman: Just like a lot of things in life, 85% is very straightforward, and 10 to 15% can be challenging.
Host: Sure. But for the most part . . .
Craig Selzman: Conceptually, it's very straightforward. Technically, it's very straightforward, for the most part.
Host: And nowadays, it's fairly common?
Craig Selzman: Fairly common. We did one on Monday.
Host: All right. The device that they placed, is he going to have to have that in him for the rest of his life?
Craig Selzman: No. This is a temporary device. It's actually meant for really short periods of support. It could be hours or days.
Craig Selzman: The hope here, with someone with his kind of situation, is using this pump to try to support his organs, giving them blood flow while the doctors down there figure out is his heart muscle going to get better or not.
Craig Selzman: And what this pump does or what any mechanical pump does is it allows the heart to just rest because it takes over, giving blood flow to the rest of the body. If you don't have it, his heart is having to work so hard and it's just tired. By doing this, it allows the heart to relax and just kind of get a little bit of rest, get some new energy.
Host: Kind of like any other muscle, you're just giving it a chance to recover?
Craig Selzman: That's right. So by doing that, it gives the physicians a chance to see whether or not his heart will recover or not. If the heart recovers, let's take the first situation, you can just pull this thing out, and then it carries on. The majority of patients that have this problem can go onto live normal, active lives. A subgroup of those patients that won't get better will kind of limp along a little bit and become heart failure patients. And then there's this other category of patients that maybe will not be able to survive without a pump like this. In that situation, what we would do is we would switch this percutaneous pump to something that's a little bit more durable.
Host: Okay. So is he looking at some lifestyle changes if he recovers?
Craig Selzman: I don't know enough the guy to, I can imagine.
Host: Some alcohol use has been recorded.
Craig Selzman: He's lived a hard life in many ways, and that could be contributing to this. And certainly if you live a cleaner life, sometimes you can reverse a lot of this stuff, especially with the heart.
Host: Would a lifestyle change have prevented this from happening in the first place?
Craig Selzman: Potentially. But if it's truly viral cardiomyopathy, this can attack anybody. I mean, in the pediatric community, you see this much more frequently than in the adult community. This is a very promiscuous disease. The virus doesn't care who it attacks. Is your heart maybe more susceptible to it? Is somebody's heart more susceptible to it? Possibly.
Host: What would cause that?
Craig Selzman: Let's say he had lived a hard life and had an alcoholic cardiomyopathy, which is a type of thing that happens. For other folks, after pregnancy have a thing called peripartum cardiomyopathy that makes their heart a little bit weaker, so they're more susceptible to having other insults attack their heart.
Host: What kind of recovery time would you look for after a procedure like Randy Travis had?
Craig Selzman: I would hope that in the next three to five days that they'll have a sense of whether or not the left ventricle, there are two main pumping chambers of the heart, the left ventricle and the right ventricle. This pump is supporting his left ventricle. The hope would be, then, in a three to five period, that they would have some idea of which of those tiers he's in. Is he going to be somebody that's going to get completely better and pull the pump, not really better but let's pull the pump and see how he does without the pump, and then the third one being it isn't going to work and we're going to have to do something else. But usually within three to five days, you have an idea of what's going on.