Heart Failure

Heart Failure

Heart Failure

Heart Failure

 

NBN Infusions provides a comprehensive nursing and pharmacy program that services patients of all ages from pediatrics to geriatrics. NBN’s on-site, licensed pharmacy provides all required medications and equipment that patients will need for the duration of their home infusion therapy. Home Infusion Therapy involves the administration of medications using intravenous, subcutaneous and epidural routes. This care is administered to patients in the convenient and comfortable surroundings of their own home and allows them to take a more active role in their own health care. Home Infusion Therapy is not only more cost-effective than inpatient treatment, it eases the stress and anxiety of treatment resulting in better patient outcomes.

 

The past 20 years have seen medical and surgical advances in the treatment of congestive heart failure that can extend and improve life. This section describes ways in which CHF is treated, including information on:

Medications

Most heart failure patients take one or more medications. They can have different effects, such as strengthening the heart’s pumping ability, expanding the blood vessels, decreasing the heart’s workload, reducing scar or fibrosis of the heart, and decreasing water and sodium in the body. Other medications may be used to treat abnormal heart rhythms, high blood pressure, and coexisting medical conditions.

Taking heart failure medications as prescribed is one of the most vital aspects of managing heart failure. It is important to know the names of your medications, how they work, how much to take, and when to take them. You should take your medications at the same time every day. Do not stop your prescribed medications or begin taking over-the-counter or herbal medications without first speaking with your physician.

Common heart failure medications include:

 

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II-receptor blockers (ARBs)
  • Beta blockers
  • Aldosterone antagonists
  • Diuretics
  • Vasodilators/nitrates
  • Potassium or magnesium supplementation
  • Digoxin
  • Calcium channel blockers (for heart failure with preserved ejection fraction only)
  • Inotropic therapy (intravenous medication for severe forms of heart failure only)

This section includes information on:

ACE inhibitors

ACE inhibitors dilate blood vessels and increase blood flow, allowing blood to flow more easily and efficiently. ACE inhibitors (along with beta blockers, see below) are the first line of defense in systolic heart failure. They may also be prescribed for the treatment of heart failure with preserved ejection fraction.

Every prescription drug has a generic name and a trade, or brand, name. The same drug is often marketed under different trade names. Common ACE inhibitors include:

 

Generic Name Trade name(s)
Benzapril Lotensin
Captopril Capoten, Capozide
Enalapril Vaseretic, Vasotec
Fosinopril Monopril
Lisinopril Prinivil, Prinzide, Zestril, Zestoretic
Moexipril Uniretic
Perindopril Aceon, Univasc
Quinapril Accuretic, Accupril
Ramipril Altace
Trandolapril Mavik

 

These drugs should not be taken if you are pregnant or have any of the following medical conditions: a high level of blood potassium, severe kidney problems, severe bilateral (right and left) renal artery narrowing or stenosis, or very low blood pressure.

Every medication has benefits and risks. One rare side effect of these drugs that requires immediate medical attention is swelling of the tongue, lips, and throat or difficulty breathing. Other more common side effects include a cough, dizziness, or a salty, metallic taste in the mouth. These side effects may require a change in medication or dosage, or more frequent monitoring by your doctor. Some side effects diminish over time.

Do not take any over-the-counter medications without discussing them with your doctor. Antacids such as Rolaids and Maalox should be avoided; they limit the absorption of ACE inhibitors, especially captopril. Individuals taking a number of different medications, such as older people being treated for several conditions, need to ask about potential drug interactions that might increase the severity of side effects or lessen the effectiveness of the medications.

You may experience side effects other than the ones already mentioned. For more information about this medication and its side effects, ask your doctor, nurse, or pharmacist, or search the National Library of Medicine MedlinePlus database.

Angiotensin-receptor blockers

Angiotensin-receptor blockers, or ARBs, may be given as a substitute for an ACE inhibitor when patients develop a cough and cannot tolerate the ACE inhibitor or, less commonly, in addition to an angiotensin-converting enzyme (ACE) inhibitor. ARBs are used to decrease blood pressure and reduce levels of hormones that cause salt and fluid retention.

These drugs should not be taken if you are pregnant or have any of the following medical conditions: a high level of blood potassium, severe kidney problems, severe bilateral (right and left) renal artery narrowing or stenosis, or very low blood pressure.

Every medication has benefits and risks. One rare side effect of these drugs that requires immediate medical attention is swelling of the tongue, lips, and throat or difficulty breathing. Other more common side effects include a muscle pain, back pain, dizziness, or insomnia. These side effects may require a change in medication or dosage, or more frequent monitoring by your doctor. Some side effects diminish over time.

You may experience side effects other than the ones already mentioned. For more information about this medication and its side effects, ask your doctor, nurse, or pharmacist, or search the National Library of Medicine MedlinePlus database.

Beta blockers

Beta blockers can improve the heart’s ability to relax and decrease the production of harmful substances produced by the body in response to heart failure. Over time, beta blockers improve the pumping ability of the left ventricle and reduce some symptoms of congestive heart failure. Beta blockers are essential for patients who have mild to moderate congestive heart failure. Certain beta blockers also have been shown to lower CHF deaths, such as carvedilol (Coreg), metoprolol succinate (Toprol), and bisoprolol (Zebeta). Whether patients with severe congestion and symptoms should take beta blockers is still unclear, and a patient’s individual characteristics are considered when determining if this is an appropriate treatment option. Some patients may be able to tolerate beta blockers better than others.

Every medication has benefits and risks. Fatigue, dizziness, and lightheadedness are the most common side effects of beta blockers. If you feel dizzy or lightheaded, get up more slowly when you rise from your bed or a chair. Fatigue, bradycardia (a slow heart rate), impotence, and worsening of depression also are common side effects. These may require a change in medication or dosage or more frequent monitoring by your doctor. Fatigue frequently diminishes over time, and so your physician may request that you continue the medication for several months before stopping it. Beta blockers can also cause or aggravate bronchospasm or wheezing, so people with significant lung disease such as severe emphysema or severe asthma may not be able to tolerate these drugs. Also, individuals with diabetes should be aware that beta blockers can mask the symptoms of low blood sugar.

You may experience side effects other than the ones already mentioned. For more information about this medication and its side effects, talk your doctor, nurse, or pharmacist, or search the National Library of Medicine MedlinePlus database.

Aldosterone antagonists

Aldosterone antagonists, also known as mineralocorticoid (a class of steroid hormones) blockers, such as spironolactone or eplerenone, have been shown to improve survival in patients with heart failure. The results of the Emphasis-HF trial were presented at the American Heart Association (AHA) Scientific Sessions in 2010. The study, which is published in the New England Journal of Medicine, showed that the aldosterone antagonist eplerenone resulted in a 37 percent reduction in death from cardiovascular causes or hospitalization for heart failure in patients with milder forms of heart failure. Because of this study, it is anticipated that spironolactone or eplerenone, along with beta blockers and ACE inhibitors (or ARBs), will be more commonly prescribed as part of the standard medication regimen for patients with heart failure.

The main side effects of this group of medications are high levels of potassium and worsening kidney function. Thus, it is absolutely imperative that there is close follow-up with the physician after this drug is started. This follow-up includes laboratory blood work, usually within one week after drug initiation, and subsequent care as the physician determines to be appropriate.

Aldosterone antagonists are also potassium-sparing diuretics, see below.

Diuretics

Diuretics, commonly known as “water pills,” cause the kidneys to flush excess fluid from the body. These drugs make it easier for your heart to pump and are used to treat high blood pressure. There are different types of diuretics, but all affect levels of potassium, sodium, magnesium, and other electrolytes in your body. Your doctor will choose a diuretic for you after considering the other medical conditions you may have and the other medications you take. One class is thiazide diuretics (examples: Diuril, Hydrodiuril, Renese, Zaroxolyn). Another class is loop diuretics (including Lasix and Torsemide). Both classes can deplete potassium, causing weakness and fatigue.

Physicians also prescribe potassium-sparing diuretics, called aldosterone blockers (examples: Midamor, Dyrenium, Aldactone, Inspira), to eliminate excess sodium and pooled fluid. Before taking any of these drugs, patients need to tell their doctors whether they are allergic to sulfa or any other drugs, whether they have diabetes, gout, or kidney or liver disease, whether they are pregnant or nursing, and what other prescription drugs and vitamin supplements they are taking.

Because these drugs cause potassium to be retained, salt substitutes, which are rich in potassium, should be avoided. Too high a level of potassium, a condition called hyperkalemia, can be dangerous. Call your doctor immediately if you experience severe nausea and vomiting—including vomiting blood—unusually rapid weight loss, fatigue, drowsiness, or confusion. If your heartbeat becomes irregular or your pulse is slow, weak, or absent (be sure you are taking it correctly), call 911 or go to the emergency room because these symptoms need immediate attention.

You may experience side effects other than the ones already mentioned. For more information about these medications and their side effects, consult your doctor, nurse, or pharmacist, or search the National Library of Medicine MedlinePlus database.

Your doctor will tell you your specific dosage, when to take your medications, and side effects you may have. Patients who take diuretics will need to follow a special diet and check their blood pressure and weight regularly. It’s also important to keep appointments for labwork and with your doctor, who will monitor your response to the medication.

Other congestive heart failure drugs

Digoxin (including Lanoxin or Digitoxin) helps to restore a normal, steady heart rhythm and improve circulation by strengthening the force of a heart muscle’s contractions. This medication is used less commonly today, but for patients who are already taking the drug, the treatment is generally continued. Digoxin is particularly useful for patients who require multiple admissions to the hospital because of fluid overload due to their heart failure. For those who have heart failure along with an irregular heart beat, digoxin can also be used to help control the heart rate.

Every medication has benefits and risks. Many side effects of digoxin are nonspecific—including nausea, vomiting, loss of appetite, and fatigue—making it difficult to determine if they are related to the drug. If you experience changes in vision, such as difficulty distinguishing between yellow and green or seeing a halo effect or flickering lights, notify your physician. These side effects may require a change in medication or dosage, or more frequent monitoring by your doctor. Once your dosage is adjusted, it is unlikely that you will experience side effects if you take digoxin exactly as prescribed.

Vasodilators, like hydralazine and nitrates, are used to treat heart failure and control high blood pressure by relaxing the blood vessels so blood can flow more easily through the body. Vasodilators are generally prescribed for patients who cannot take ACE inhibitors or ARBs, but adding these medications to a regimen that already includes ACE inhibitors or ARBs has been shown to improve survival among African American patients. Most people tolerate hydralazine well. But occasionally, lupuslike symptoms (such as fever, joint or chest pain, sore throat, facial skin rash, and swelling of the joints) crop up. If this happens, you should seek immediate medical attention. Common side effects of nitrates include headache, dizziness, or lightheadedness. If you feel dizzy or lightheaded, stand up more slowly when getting out of bed or a chair. These side effects may require a change in medication or dosage, or more frequent monitoring by your doctor.

You may experience side effects other than the ones already mentioned. For more information about these medications and their side effects, consult your doctor, nurse, or pharmacist, or search the National Library of Medicine MedlinePlus database.

Prescription medications that can worsen heart failure

Your doctor needs a complete list of your current medications and their dosages. Some heart drugs can worsen congestive heart failure or change the effect of your heart failure medications, among them antiarrhythmics (examples: quinidine, flecainide, propafenone, sotalol, moricizine), calcium channel blockers (examples: verapamil, diltiazem, amlodipine, nifedipine), and certain beta blockers. Women may be asked to avoid estrogens. Viagra, Levitra, and Cialis should not be used if you are taking nitrates (examples: Isordil, Sorbitrate, Imdur, Monoket, nitroglycerin).

It is important to keep a list of your medications with you. If you go to any additional doctors, dentists, or specialists, make sure they are aware of all of your medications, including over-the-counter medications, vitamins, herbal medications, and dietary supplements.

Nonprescription medications that can worsen heart failure

Just because over-the-counter drugs can be obtained without a prescription does not mean they are harmless. Certain ones can aggravate heart failure symptoms, worsen kidney function, or alter the effect of your medications. If you have headaches, muscle pain, or some other problem that calls for relief, consult your doctor before taking any pain reliever or anti-inflammatory drug (examples: ibuprofen, aspirin, Advil, Nuprin, Motrin, Naprosyn, and Feldene, and cox-2 inhibitors such as Celebrex and Bextra).

Some nonprescription drugs are high in sodium, which can cause fluid retention (examples: Alka-Seltzer, Vicks cough syrup, Bisodol, Fleets enema). Read every label before using a product. Most decongestants contain stimulants such as epinephrine or pseudoephedrine. They can stress the heart by elevating the heart rate, and so they should be avoided.

How herbal, vitamin, and dietary supplements affect you may vary according to your age, gender, family history, general nutritional status, other health conditions, and how these conditions are being treated. Be sure to let your doctors know ahead of time if you are thinking about taking any of these sorts of supplements. Even if your physicians do not request this information, bring it up.

Device therapy

Damage to the heart muscle can cause changes in the electrical system of the heart and thus how the heart beats. There are three different types of devices that can be used in the treatment of heart failure to correct an abnormal heartbeat.

Pacemakers:

The traditional pacemaker has two parts: lead wires and a pulse generator, which houses a battery and a tiny computer. The lead wires sense the heart’s electrical activity, and when the computer determines that the heart rhythm is off, it responds by sending electrical impulses to the heart muscle to correct its rate. Pacemakers are usually used to treat heart rhythms that are too slow. But they can also be used to treat fast rhythms or to increase the heart rate in response to changes in the patient’s activity level.

Biventricular pacemakers:

In the normal heart, the heartbeat originates in an area of specialized cells in the wall of the right atrium and spreads through the atria (top chambers of the heart), causing them to squeeze blood into the ventricles (bottom chambers of the heart), which then contract, pumping blood to the rest of the body. In a patient with heart failure, the right and left ventricles often fail to pump together, a condition known as dysynchrony. When this occurs, the heart has less time to fill with blood and is unable to pump enough blood out into the body, which eventually worsens the degree of heart failure. Biventricular pacemakers are devices that use an additional lead wire to sense atrial contractions and send an electrical impulse to the two ventricles so that they contract at the same time. Called cardiac resynchronization therapy (CRT), this therapy can improve symptoms of heart failure, reduce hospitalizations, increase a patient’s tolerance for exercise tolerance, and lengthen life.

To be eligible for a biventricular pacemaker, patients must be suffering from severe or moderately severe heart failure symptoms even though they are taking medications to treat it. The ejection fraction, which is an estimate of the percentage of blood the heart pumps out with each heart beat, must be less than 35 percent to qualify for this type of pacemaker. A normal ejection fraction is above 55 percent. In addition, they must be experiencing delayed electrical activation of the heart, such as “intraventricular conduction delay” or “bundle-branch block.” Patients also need to be aware that the implanting procedure may be technically challenging and has a 10 percent failure rate.

Internal cardioverter defibrillator (ICD):

Patients with heart failure are at risk for life-threatening arrhythmias, such as ventricular fibrillation. This is particularly true of patients who have an ejection fraction of less than 35 percent, have survived sudden cardiac arrest, or have a history of ventricular tachycardia (a fast ventricular arrhythmia). The ICD senses electrical activity and sends a shock to the heart if it detects a dangerous heart rhythm. A study called “Sudden Cardiac Death in Heart Failure Trial,” published in the New England Journal of Medicine, found that implantable cardiac defibrillators reduce the risk of death from sudden cardiac arrest by 23 percent in patients with heart failure. Many people think that an ICD can improve heart function, but it does not. An ICD can be thought of as an “emergency room” inside your heart. If your heart develops a fatal arrhythmia, the ICD will deliver a shock—sometimes several, if needed—to restore a normal heart rhythm.

Patients may be treated with all three devices or just one or two, depending on the patient’s individual medical condition. Ask your doctors about the risks and benefits of these devices and the follow-up care you would need if one or more were used to treat your heart failure.

Surgical options

If medications, strict lifestyle revisions, and a pacemaker or other devices are not enough, surgery may be necessary to prevent further damage to the heart and maintain its ability to function.

Possible procedures include:

Coronary artery bypass

The most common surgery for heart failure is the coronary artery bypass. If the arteries supplying blood to the heart become narrowed, the heart muscle becomes starved for oxygen-rich blood, a condition called ischemia. If those arteries become severely narrowed or totally blocked, a heart attack can occur, causing damage to the heart muscle. For many heart failure patients with ischemia, bypass surgery will relieve symptoms and prevent further damage.

In coronary artery bypass graft surgery, a blood vessel graft bypasses one or more blocked coronary arteries to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest, leg, or arm. The graft goes around the clogged artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.

Bypass surgery usually lasts three to five hours. It can be done in different ways. This section includes information on:

Traditional coronary artery bypass

In this procedure, the surgeon makes an incision 6 to 8 inches long down the center of the chest, cuts through the sternum (breastbone), and opens up the rib cage to get direct access to the heart. After the surgery, the surgeon closes the breastbone with special chest wires and the chest with internal or external stitches.

The surgeon may choose to stop the heart so it is motionless before performing the bypass procedure. While the heart is stopped, the heart-lung bypass machine takes over for the heart and lungs, oxygenating blood and circulating it through the body. Alternately, the surgeon may opt to do the procedure on a beating heart—with or without the heart-lung machine. Your surgeon will talk with you about what procedure makes the most sense for you.

Minimally invasive direct coronary artery bypass (MIDCAB)

After reviewing your diagnostic tests, your surgeon will decide if you are a candidate for this procedure, which is performed between the ribs through a chest incision just a few inches long. Benefits include a smaller incision (and scar), shorter hospital stay (sometimes as few as three days), faster recovery, less bleeding during surgery, reduced possibility of infection, and less pain postoperatively and during recovery.

MIDCAB surgery usually is reserved for patients whose condition can be addressed by using an artery in the chest to bypass the large coronary artery called the LAD (for left anterior descending). Depending on the technique, the surgeon may choose to perform the surgery on a beating heart—with or without the heart-lung machine—or on a stopped heart—using the heart-lung machine.

Valve surgery

The heart’s four valves ensure that blood flows in one direction through the heart. Heart valve disease causes the valves either to not close properly (resulting in a leaky valve) or to not open fully (resulting in a narrowed valve opening). Both types of valve disease cause the heart to work harder, which over time may lead to heart failure.

Heart valve disease can be caused by infection, congenital heart disease (heart abnormalities at birth), previous exposure to radiation or chemotherapy, chest trauma, a progressively enlarging heart (thus causing physical separation of valve leaflets from closing completely), coronary artery disease and aging. If you require surgery, the surgeon may repair or replace one or more of your heart valves, depending on the type of disease you have. The purpose of surgery is to:

  • Preserve the natural anatomy of the heart
  • Improve cardiac function
  • Diminish symptoms
  • Extend your life
  • Lessen the possibility of complications and other cardiac risks

Ventricular surgery

Left ventricular reconstruction: A heart attack that occurs in the left ventricle leaves scar tissue in part of the wall, which can thin out and bulge with each heartbeat, adding to the ventricle’s workload. Your heart can handle this harder pumping initially, but as time passes, the left ventricle enlarges and pumps less effectively. Combined with other heart damage, this bulging area, or aneurysm, can cause heart failure.

Infarct exclusion surgery allows the surgeon to remove the dead heart tissue and the aneurysm, if possible, and reshape the left ventricle into a more efficiently functioning form. This procedure aims at relieving your heart failure and heart pain. It also may help your heart to pump more normally.

Left ventricular assist device (LVAD)

When all medical therapy has failed and a patient is in end-stage systolic heart failure, a left ventricular assist device (LVAD) may help the heart pump blood more effectively as a “bridge” until a heart becomes available for transplantation, or even as a permanent substitute—so-called “destination therapy.” The portable, battery-powered devices are manufactured by various companies, such as Novacor, Thoratec, Heartware, and Abiomed. To date, the most frequently implanted LVAD that is FDA-approved as both a bridge-to-transplant and as destination therapy is the HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA).

Implantation of an LVAD can allow patients to return home to a reasonable semblance of the life they want, sidestepping the challenges of organ shortages. It is possible that native heart function may completely improve, thus allowing the LVAD to be removed, but this is not common. Research and active investigation are underway to discover ways to improve the heart function of patients with an LVAD.

Heart transplant

In extremely severe heart failure, a heart transplant may be advised to improve the length and quality of life. If a heart does become available, a surgeon from the transplant center flies to the hospital where the donor has died to recover the donor heart, first examining it to make sure it is in good condition. The surgeon removes the donor heart and places it in a cooling solution in an insulated container for transport to the hospital where it will be implanted. The surgeons remove the diseased heart, leaving the back walls of the atria (the heart’s two upper chambers) intact. They sew the new heart into the chest, atria to atria, or more commonly, by connecting the major veins leading to the heart (bi-caval technique) and subsequently reconnect the other blood vessels. Blood can now flow through the new heart into the bodily organs needing it.

A heart transplant is extraordinarily demanding on many levels. Because there are so many more candidates for transplants than there are available hearts, the heart transplant list must be carefully screened. A multidisciplinary team of heart doctors, nurses, social workers, and bioethicists scrutinize the individual’s medical history, diagnostic test results, social history, and psychosocial evaluation. The questions are many. Can the patient survive the procedure—and even if the likely answer is yes, will the patient comply with the years of disciplined aftercare necessary? Transplant specialists often say that those who have had a transplant have to think of themselves as chronically ill. They will have to take many medications, visit the doctor for frequent checkups and heart biopsies, exercise faithfully, watch their diet, and be on guard for symptoms that could indicated their body is rejecting the donor heart.

If you are approved for the transplant list, you have to wait for an available donor. The wait is often long, and it is always stressful. A sturdy support network of family and friends is essential. A healthcare team must monitor you and closely control your heart failure. Your transplant coordinator explains how you will be notified should a heart become available and learns where you can be reached at a moment’s notice.

This section also includes frequently asked questions about heart transplantation.

Heart transplants—frequently asked questions.

Where does a donor heart come from?

Donor hearts are always anonymous. Grieving families may donate the organs of a young, healthy individual who has been declared brain dead, usually as a result of a head injury, a car or sports accident, or a gunshot wound, to give someone else a chance at life. Once someone has been declared brain dead and the family decides to donate the still-living organs, the information is entered into the United Network for Organ Sharing computerized list. The UNOS list contains blood type, body size, UNOS status (based on clinical status), and the length of time the person with heart failure has been on the waiting list. Neither the donor’s race nor gender has any bearing on the match. A computer network matches donors and recipients nationwide.

How long will I be in the hospital after a heart transplant?

How quickly you recover after a heart transplant depends on your age, overall health, and bodily responses to the transplant. Most patients are up and about within a few days of the surgery and home several weeks following the transplantation.

After the donor heart is transplanted, will it beat the way it did in its donor?

The donor heart comes with its own natural pacemaker and its own coronary arteries. When the heart is removed, the donor’s nervous system is disconnected and there is no way to link the heart to the recipient’s nervous system. The transplanted heart usually beats adequately but may sometimes need help from a pacemaker.

What is immunosuppression?

Your body’s defense system against foreign invaders such as bacteria and viruses is its immune system, which is composed primarily of white blood cells. Your white blood cells consist of different fighter cells, known as B and T cells. B cells fight germs by producing antibodies, which fight against infections and render germs harmless. T cells kill foreign invaders, such as germs and cancer cells, by engulfing them. Each time your body has an immune reaction, it memorizes the particular “fingerprint” of the invading foreign body—the antigen—so that the immune system can respond quickly when the same antigen invades again. Although your immune system helps protect you against “bad” invaders such as infections, it cannot distinguish between a “bad invader” and a “good invader,” such as a transplanted heart. As a result, your body’s immune system “thinks” the new heart is a foreign invader and attempts to destroy it. To stop this rejection of your heart transplant, you will need to take immunosuppressant medications for the rest of your life. Since immunosuppression makes you more vulnerable to infections, you will need to prevent exposure as much as you can.

What is rejection?

An attack on your transplanted heart by your immune system is a sign of rejection. To prevent damage to the heart, you and your doctors must be alert to signs of rejection and treat it quickly. After a transplant, your transplant team will teach you how to watch carefully for any symptoms of rejection and where to call if you recognize any such symptoms. Your doctor needs to check you regularly for any symptoms of rejection and perform regular heart biopsies that can detect any subtle rejection before symptoms occur. You will be on special medications—called immunosuppressants—to help prevent rejection for the rest of your life.

Can coronary artery disease return after a transplant?

There are two types of coronary artery disease (CAD) that can occur post transplant. The first type develops naturally over time (like CAD in patients without heart transplants) or as a result of residual disease from the donor heart that was not detected when it was harvested. The second, more common type is called transplant vasculopathy and can occur at any time after a transplant. Transplant vasculopathy is immune mediated and causes a narrowing of the coronary arteries that generally cannot be fixed by angioplasty or stenting. Treatment for CAD after a heart transplant is difficult, so prevention is the key: Transplant patients need to follow a heart healthy lifestyle and take medications to reduce their risk of CAD.

Original post  U.S News.com 

 

Last reviewed on 3/8/2011

 

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