Sunday, November 30, 2008

Patient kept alive with new defibrillator vest while waiting for a heart transplant

Life preserver for the heart, but sometimes hard to find

Debbie Rinde-Hoffman, M.D., medical director of the cardiac transplant program at Tampa General Hospital in Florida, talks about a new heart vest (a wearable defibrillator) that is saving the lives of patients with heart failure.

How much trouble was your heart patient in when he came to you?

Dr. Rinde-Hoffman: He was in a lot of trouble when he first came to us. He had actually been evaluated for heart transplant up north and was told that he wasn't a candidate and could barely walk from his room to his bathroom at his house before getting significantly short of breath. He had been hospitalized at least two or three times in the last few months because of worsening congestive heart failure.

What was his diagnosis?

Dr. Rinde-Hoffman: What he had was what we call an ischemic cardiomyopathy, which means that his heart muscle was weak because of blockages in his heart arteries and damage to his heart from previous heart attacks. He also had congestive heart failure, which is when the heart is unable to keep up with the demands that you need to place on it, so patients often get short of breath or fatigued or swelling in their legs, and they can develop rhythm problems because of the congestive heart failure as well.

Why did he need the vest?

Dr. Rinde-Hoffman: Actually, when he came to us, we discovered that he was growing some bacteria in his blood, and we were unable to clear the bacteria from his bloodstream. We found out that his previously placed defibrillator had become infected, so then the defibrillator had to be removed. During the time when the defibrillator was removed and he was on intravenous antibiotics, he couldn't have another one placed until that infection was gone.

What was the problem with having the defibrillator removed?

Dr. Rinde-Hoffman: Without the defibrillator, the risk is that he could die from something called sudden cardiac death, which is a common way that patients with end-stage heart disease die.

What happened when you put the vest on him?

Dr. Rinde-Hoffman: We had put the vest on Mr. Benton in preparation for discharge home the following day, and we put the vest on the patients knowing that there's always a risk that the vest is going to shock him. That's what they have it for, and that evening the vest did what it was programmed to do. He went into a potentially lethal rhythm disturbance, and the vest shocked him and saved his life.

What did that do for his future?

Dr. Rinde-Hoffman: It allowed us to continue treating him with the intravenous antibiotics, waiting for the infection to completely clear, and then the next step was for him to get on the list for a heart transplant. In the interim, unfortunately, his heart deteriorated, and he needed a ventricular assist device. He then eventually got a heart transplant, so he's been through the ringer.

His successful treatment means that he's going to be able to watch his grandchildren grow up. He's going to be able to take trips and spend time with his family that he wasn't going to be able to otherwise.

What kind of impact does the heart vest make on patients' lives?

Dr. Rinde-Hoffman: We give patients a second chance at life. The patients that have end-stage heart disease who, we think, within a year or two would no longer be around without these options, this is something that really gives them a new lease on life.

Without this treatment, what would have happened to your patient?

Dr. Rinde-Hoffman: He would have probably died.

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