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Treating A Sick Heart

From: "Heart Disease," by Robert Soufer, M.D., in The Yale University School of Medicine Heart Book, edited by Barry L. Zaret, M.D., Marvin Moser, M.D., and Lawrence S. Cohen, M.D. Copyright 1992 by Yale University School of Medicine. Reprinted by permission of William Morrow and Company. To order, call 800-843-9389.Overview The heart's primary function is to pump blood to all parts of the body, bringing nutrients and oxygen to the tissues and removing waste products. When the body is at rest, it needs a certain amount of blood to achieve this function. During exercise or times when greater demands are placed on the body, more blood is required. To meet these variable demands, the heartbeat increases or decreases, and blood vessels dilate to deliver more blood or constrict during times when less blood is required.

When a person is diagnosed with heart failure, it does not mean the heart has stopped working, but rather that it is not working as efficiently as it should. In other words, the term "failure" indicates the heart is not pumping effectively enough to meet the body's needs for oxygen-rich blood, either during exercise or at rest. The term congestive heart failure (CHF) is often synonymous with heart failure but also refers to the state in which decreased heart function is accompanied by a buildup of body fluid in the lungs and elsewhere. Heart failure may be reversible, and people may live for many years after the diagnosis is made.

Heart failure may occur suddenly, or it may develop gradually. When heart function deteriorates over years, one or more conditions may exist. The strength of muscle contractions may be reduced, and the ability of the heart chambers to fill with blood may be limited by mechanical problems, resulting in less blood to pump out to tissues in the body. Conversely, the pumping chambers may enlarge and fill with too much blood when the heart muscle is not strong enough to pump out all the blood it receives. In addition, as the architecture of the heart changes as it enlarges, regurgitation of the mitral valve may develop, making the heart failure even worse.

Who develops heart failure? There are an estimated 2 million people in the United States with heart failure. The incidence of chronic congestive heart failure—the number of new cases developing in the given population each year—has increased in recent years. This is possibly a result of the overall decline in deaths from coronary (ischemic) heart disease, an improvement attributed to medical advances and the fact that people are living longer.

The most common cause of congestive failure is coronary artery disease—narrowing of the arteries supplying blood to the heart muscle. Although coronary disease often starts at an early age, congestive failure occurs most often in the elderly. Among people more than 70 years old, about 8 out of 1,000 are diagnosed with congestive heart failure each year. The majority of these patients are women, probably because men are more likely to die from coronary artery disease before it progresses to heart failure.

Heart failure is also associated with untreated hypertension, alcohol abuse, and drug abuse (primarily cocaine and amphetamines) at any age. Hyperthyroidism and various abnormalities of the heart valves (particularly aortic and mitral) are among the other disorders that can cause heart failure. In addition, viral infection or inflammation of the heart (myocarditis) or primary heart muscle disease (cardiomyopathy), and in rare instances, extreme vitamin deficiencies, can result in heart failure.

Treatment Whenever possible, the best treatment of congestive heart failure is one of prevention. This includes diagnosing and treating high blood pressure and attempting to prevent atherosclerosis. Other important preventive steps include not smoking, using alcohol in moderation if at all, and abstaining from cocaine and other illicit drugs. A prudent diet, regular exercise, and weight control are also important.

When a patient is diagnosed as having heart failure, the first treatment is often restriction of dietary sodium. Drugs may be prescribed as well. Diuretics, available since the 1950s, are often used to help the kidneys get rid of excess water and sodium, thereby reducing blood volume and the heart's workload.

Digitalis, a drug that has been used since the 18th century, is still a component of modern therapy. It is prescribed to strengthen the heart's pumping action. Patients taking both diuretics and digitalis may need to supplement their levels of potassium.

Newer drugs for the treatment of heart failure include vasodilators, which cause the peripheral arteries to dilate, or open up. This reduces the work of the heart by making it easier for blood to flow. Among the newest vasodilators used for heart failure are the angiotensinconverting enzyme (ACE) inhibitors, which may be used, along with diuretics, in patients with mild-to-moderate or severe congestive failure. ACE inhibitors, which include captopril (Capoten) and enalapril (Vasotec), block the production of a substance called angiotensin II, a potent constrictor of blood vessels. If blood vessels are dilated, the amount of work needed for the heart to pump blood forward is decreased.

Other drugs used in the treatment of heart failure include calcium-channel blockers, which dilate blood vessels; beta blockers, which slow the heart (used only in unusual circumstances); and medications that affect various heartbeat irregularities. Most cases, however, respond to diuretics and digitalis, especially when ACE inhibitors are added.

Sometimes, surgery proves effective. When heart failure is due to valvular disease, surgical implantation of an artificial heart valve or valve repair may alleviate the problem. Surgery may also be helpful in correcting congenital heart defects that can lead to heart failure. Coronary artery bypass graft surgery and catheterization using a balloon to flatten fatty deposits (called angioplasty) are among the therarpeutic techniques used to prevent and treat heart failure caused by occluded, or blocked, arteries.

Heart transplants are a last resort in treating severe heart failure caused by diseased heart muscle. Although the success rate of heart transplants has significantly improved, the cost of the operation and shortage of donor organs makes it impractical except as a last resort.

Learning From Failure

Source: Andrey Popov / Adobe Stock

In most cultures, failure is frowned upon. We often blame others for what goes wrong, rather than reflect on the reasons for falling short and what we can take from the experience moving forward.

Our fear of failure can be challenging in many parts of our lives. In a big organisation, it can be disastrous.

Fear of being seen to fail stifles innovation, leads to issues being brushed under the carpet when they could have been addressed in their infancy, and deters people from sharing their ideas. It can all be summed up in the well-known maxim, "Nobody ever gets fired for buying IBM"; make the safe and secure choice and your job will be protected.

Amy Edmondson, professor of leadership at Harvard Business School and author of seven books, including Right Kind of Wrong, The Science of Failing Well, has been studying failure for more than thirty years and occasionally gets frustrated at how badly many large organisations respond to failure.

Edmondson explained, "Organisations need to keep learning in a world that keeps stubbornly changing, and yet that turns out to be a rather unnatural act. It's hard for organisations, especially big ones with their processes and routines, to easily adapt and shift to be more successful in the world as it changes. And failure plays a central role in learning.

"Yet, most organisations have a culture that is more conducive to bragging about our successes than talking openly about our failures.

"I'm interested in failure because I'm interested in learning. I'm interested in learning because I'm interested in effectiveness in a changing world."

Intelligent Failure

Edmondson challenges the perceived wisdom that all failure is, by its very nature, bad for us. She talks about "intelligent failure", an outcome that results from experimentation. "An intelligent failure is an undesired outcome; it's not the outcome we had hoped for, maybe even expected, but it takes place in new territory where we lacked available knowledge about how to get that result that we wanted.

"An intelligent failure happens in pursuit of a goal. We're not just messing around with resources; it's thoughtful. We've done our homework.

"These are the kinds of failures that we really must train ourselves to welcome because they are the source of discovery."

In The Right Kind of Wrong, Edmondson talks about how failures in early attempts at open-heart surgery laid the pathway for the successes we have witnessed in this field ever since. She explains how we take for granted that "surgeons today can crack open the breastbone and operate on the heart of a living person and repair it and give you more years of life.

"And yet there was a point in history where no one had ever done that before. It was initially considered more or less impossible because you couldn't operate on a beating heart."

To get from that point to the daily miracles we witness in the current era, doctors had to fail and patients died. But the key, according to Edmondson, is that they never operated on a patient who had a better option. "If the choice was between operating and possibly making them better or not operating and they would still be OK, they wouldn't operate."

Intelligent failure is all about the failure being "no bigger than it has to be to get the new knowledge that it brings." By only operating on patients who had no other alternatives and would have died without an attempt to save them, the risk of failure was mitigated.

Culture Blocks

The challenge is that too few modern organisations operate within a culture that encourages intelligent failure. Short-term pressures can often make failure something to hide under a rock rather than shine a spotlight on to learn from and progress.

Edmondson argues that organisations need to think beyond short-term reporting and, if necessary, take a hit. After all, if everyone just focused on quarterly profits, nobody would ever take a risk or try something new at all. "I don't think you have to be a visionary, but you have to be reasonably thoughtful. And you do need to get people on board with that.

It's important to recognise longer-term thinking as a cost of being in business five years from now and making that a cost you are willing to pay."

Perfectionism also, somewhat naturally, creates a barrier to learning from failure. Edmondson argues that "perfection equals disconnection", explaining that leaders who strive for perfection may impose the same unrealistic standards on their team members, creating a culture of fear. "There's no such thing as perfect", Dr. Edmondson explains, "and so they end up blaming and shaming if they make a mistake."

Rather than striving for perfection and creating a climate of fear, Edmondson wants to see leaders who are focused on developing trusted relationships across their team and encouraging honest and vulnerable conversations that lead to growth and innovation.

"High-quality relationships, are ones where we're willing to tell each other the truth and we can roll up our sleeves and get hard things done because we have that honesty, because we're not posturing and we're not putting on a show for each other. We're authentically digging into the challenges on our mutual plates.

"That's how I think of high-quality relationships, not people who I know really well, but ones where I believe I can be truthful."

Top Footballer Aged Just 24 Dies From Heart Failure After Collapsing In Training As Club Pays Heartfelt Tribute

COLOMBIAN footballer Guillermo Beltran has tragically died aged 24 after collapsing in training.

The Real Santa Cruz striker complained of dizziness and nausea before falling to the floor on Friday.

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Real Santa Cruz star Guillermo Beltran has tragically died aged 24Credit: REAL SANTA CRUZ

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Real Santa Cruz paid tribute to their late player with a heartfelt Instagram videoCredit: Instagram / @club_realsantacruz INSTAGAM@CLUB_REALSANTACRUZ

Club staff desperately tried to resuscitate the forward and promptly called an ambulance after their efforts to rouse him failed.

But he tragically passed away as he was being transported to the hospital.

Bolivian side Real Santa Cruz announced his passing in a statement on their social media pages.

It read: "Today, at 7:30 p.M., we say goodbye to our beloved player, Guillermo Denis Beltran, at the Real Santa Cruz Club headquarters.

"We extend a cordial invitation to all realistic fans to join us for our final goodbye and say goodbye to our player, who left an indelible mark on our hearts and on the history of our club.

"We thank you in advance for your presence and expressions of affection at this difficult time for all of us."

In another statement, the club said of Beltran: "He was much more than a talented player: he was a friend. 

"A teammate and an inspiration to many.

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Real Santa Cruz confirmed Beltran's passing in a heartfelt statementCredit: REAL SANTA CRUZ

"His passion for the game and his tireless spirit will continue to be remembered and valued forever."

Real Santa Cruz director Adolfo Soria Galvarro said of the tragedy: "He was training as usual and then he collapsed.

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"They tried to resuscitate him but he died as he was being moved to a clinic."

Real Santa Cruz posted a touching video tribute to their late player on social media, with the accompanying caption reading: "Fly high, dear friend."

Scores of fans commented, with one saying: "How sad, may the Lord give strength to his family."

Another said: "Fly high."

And another said: "Lots of strength for your family and friends, it's a shame."

One remarked: "God give you eternal light."

Another chimed in: "What a great talent that left us, God, I have you in his glory, champion."

Bolivian Football Federation president Fernando Costa also paid tribute to the late Beltran and has vowed to launch a full investigation into his passing.

The Bolivian national team paid their respects to Beltran on Friday night with a minute's silence before their FIFA Series match with Algeria.

Beltran - who joined Real Santa Cruz last year from Paraguayan side Rubio Nu - began his career with Atletico Nacional.

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Bolivia and Algeria paid tribute to the late Beltran with a minute's silence before their matchCredit: GETTY

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