Theresa Nessralla: Reversing Heart Failure
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Theresa Nessralla thought she merely had the flu.
"I had a heavy chest and a dry cough," said the 59-year-old South Shore woman who worked in customer service at the time, in the winter of 2006.
"I just got weaker and weaker," she said. "Breathing became tough." After several weeks, she ended up at the emergency room at a local hospital. "First, they told me I had pneumonia," she said.
The next day, however, she received a visit from a cardiologist. "He said my heart was weak," she said. "They were going to run some tests and watch me."
Ultimately, Nessralla was diagnosed with
congestive heart failure, a condition where the heart can't pump enough blood to meet the body's requirements. Over time, conditions such as
coronary artery disease or
high blood pressure gradually can leave the heart too weak or stiff to fill and pump efficiently. Other causes can be a virus, alcohol, toxins, chemotherapy and
kidney disease. Sometimes, there is no obvious underlying cause.
Symptoms can include shortness of breath, fatigue, swelling in the legs, rapid heartbeat, persistent cough and others. Complications can include kidney failure,
heart valve problems, liver damage,
stroke, and sudden death from
abnormal cardiac rhythms.
"I had experienced no health problems before this, but I did have heart disease in my family," Nessralla said.
Nessralla eventually made her way to Beth Israel Deaconess Medical Center, because her mother had been treated there successfully for a heart problem back in the 1980s. "They were wonderful," she said. "She was on her death bed one day and a year later she was traveling in Rome. They treated the whole person, not just the disease. Based on that, I wanted to go to Beth Israel."
Once there, she was treated by
Dr. James Chang, acting director of the hospital's
Advanced Heart Failure Center.
He said her ejection fraction -- a measurement of the heart's pumping strength - was just 10 percent. The lower end of normal is 55 percent. Because there was no obvious reason for her heart failure -- she did not have coronary artery disease or hypertension, for example -- the idea was to treat her intensively with medications to increase her pumping capacity. Of course, if a specific cause for her heart failure had been identifiable, the underlying cause itself would have been treated, as well.
Dr. Chang said he was confident her situation could be improved with medications and he told her so.
"He calmed me down," she said. "He and his team were great."
She was treated with several medications, including digoxin, a cardiac glycoside which increases the strength of heart contractions; amiodarone, an antiarrhythmic agent to suppress abnormal heart rhythms associated with heart failure; lisinopril, an ACE inhibitor; metoprolol, a beta blocker; and a blood thinner and a diuretic.
Over the course of several years, her ejection fraction returned to 50 percent - nearly normal.
Now, she is on just two drugs, the ACE inhibitor and the beta blocker.
"I'm back to a normal life," she said.
Dr. Chang said she should have a normal life expectancy. "She's doing really well," he said.
Had her ejection fraction not been improved beyond 10 percent, her life expectancy would have been only three to five years, he said.
He said her improvement took four years, but it was clear right away that she was responding. "We were patient with her," he said. "No one can be certain that medical therapy can result in such a positive outcome, but, although her full response took somewhat longer than some might tolerate before resorting to therapy with implantable cardiac devices, she ultimately exhibited a dramatic recovery which made such device therapy unnecessary."
In some cases, patients with advanced heart failure require therapy with
implanted devices such as defibrillators and specialized pacemakers, both of which therapies are provided to appropriately selected patients by experts at BIDMC. But Dr. Chang said that is usually in cases where medical therapy has failed to improve the pumping strength of the weakened heart muscle and the patient remains burdened with symptoms such as shortness of breath and excessive fatigue, neither of which applied to Nessralla.
Heart transplantation is also a last resort for all patients. "The question of heart transplantation is on the table when the heart condition is truly end-stage, and no significant improvement has occurred despite optimal management with medications and devices," said Dr. Change. "But I was confident we could get her ejection fraction above 40 percent."
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