Sep 24, 2013


Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Craig Selzman: This is Craig Selzman. I'm an associate professor of surgery in the division of cardiothoracic surgery here at the University of Utah and I'm the surgical director of our heart transplant program and our mechanical circulatory support and artificial heart program.

Host: So, 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, the muscle itself, is not working so well.

Host: And there's a virus that causes this. Is that correct?

Craig Selzman: Well, there are a lot of different things that can cause a cardiomyopathy. So, the word that leads before cardiomyopathy describes why it happens. It could be because of bad blood flow. We would call that an ischemic cardiomyopathy. It could 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 the case of Randy Travis, it indeed is.

Craig Selzman: Well, that is the presumption.

Host: Oh, okay.

Craig Selzman: It's not, to the best of my knowledge it hasn't been confirmed that, I think that's what everyone 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 and to the kidneys and other organs and such that they need extra help. A lot of times that extra help can be managed with medicines in the vein, but if that doesn't work, sometimes you have to actually use mechanical means to do that, and that's what happened to Randy Travis.

Host: Is this an evasive surgery? Do they have to open up his chest to get it in?

Craig Selzman: No. So, 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 and the groin, and so we call it a percutaneous heart pump. So, 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: Well... Just like a lot of things in life, 85% is very straight forward and 10 to 15% can be challenging.

Host: Sure. But for the most part...

Craig Selzman: The problem is it is a very conceptually, it's very straight-forward, technically it's very straight-forward for the most part.

Host: And nowadays, it's fairly common.

Craig Selzman: Fairly common. We did one on Monday.

Host: All right.

Craig Selzman: So.

Host: 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.

Host: Okay.

Craig Selzman: You know, the hope here with someone like, 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.

Host: Gotcha.

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's having to work so hard and it's just tired. And so, 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. That's right.

Host: Okay.

Craig Selzman: And so, by doing that it gives the physicians a chance to see whether or not his heart will recover or not. If his heart doesn't recover...if the heart recovers, let's take the first, if the heart recovers, you can just pull this thing out and then he carries on. And, majority of patients that have this problem can go on to live normal, active lives. A population, a sub-group 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. And in that situation, what we would do is switch this percutaneous pump to something a little bit more durable.

Host: Okay. So, is he looking at some lifestyle changes if he recovers?

Craig Selzman: I'm sure. I don't know enough about the guy to, I can imagine, knowing a little bit that...

Host: Some alcohol use has been reported.

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, you know, the thing if it's truly a viral myocarditis, this can attack anybody. I mean, we've seen this in, you know, in the pediatric community you see this very much more frequently than the adult community. This is a very promiscuous disease. The virus doesn't care who it attacks. Is your heart maybe more susceptible, is somebody's heart more susceptible to it? Possibly.

Host: And what would cause that?

Craig Selzman: Perhaps if he, let's say he had lived a hard life and had an alcoholic cardiomyopathy, which is a type of thing that happens. Other folks after pregnancy have a thing called peripartum cardiomyopathy, that maybe their heart's a little weaker so that they're more susceptible to having other insults attack their heart.

Host: And, 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, which, there's 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 day period that they would have some idea of which of those tiers, is he going to be somebody that's going to get completely better, pull the pump? Not really better but let's pull the pump, see how he does, okay without the pump? And then the third one being it isn't going to work. 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.

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