DR. SALGO: HEARTS POWER BODIES LIKE ENGINES POWER CARS. BUT WHAT HAPPENS WHEN YOUR BODY'S ENGINE NEEDS A TUNE UP, OR EVEN A REPLACEMENT PART? HEART TRANSPLANTS ARE KEEPING PEOPLE ALIVE, BUT WHETHER OR NOT YOU CAN GET A NEW HEART DEPENDS ON EVERYBODY ELSE. OUR HEALTHCARE TEAM TACKLES THE CASE, NEXT ON SECOND OPINION.

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE. WITH ADDITIONAL SUPPORT FROM THE FOLLOWING.  THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.

DR. SALGO: WELCOME TO SECOND OPINION, WHERE EACH WEEK WE SOLVE A REAL MEDICAL MYSTERY. WHEN WE CLOSE THIS CASE FILE A HALF AN HOUR FROM NOW, YOU'LL NOT ONLY KNOW THE OUTCOME OF THIS WEEK'S CASE, YOU'LL BE BETTER ABLE TO TAKE CHARGE OF YOUR OWN HEALTH CARE. I'M YOUR HOST DR. PETER SALGO. TODAY, OUR CASE FILE CONTAINS THE STORY OF LYNN. AND AS ALWAYS, WE'VE ASSEMBLED A HEALTH CARE TEAM TO TACKLE THIS CASE. SOME ARE DOCTORS, SOME ARE NOT, AND NO ONE ON THE PANEL KNOWS THIS CASE EXCEPT FOR ELISSA ORLANDO, OUR CIVILIAN OVER HERE. HI ELISSA. AND THIS WEEK'S PRIMARY CARE PHYSICIAN IS DR. LOU PAPA. HOW ARE YOU DOING, LOU? ALL RIGHT, LET'S GET RIGHT INTO THE CASE. THIS WEEK'S CASE IS A CASE INVOLVING LYNN. LYNN IS 42 YEARS OLD, SHE'S IN GOOD SHAPE, SHE'S USED TO EXERCISING ALL THE TIME, BUT SHE JUST DELIVERED HER THIRD BABY ONE MONTH AGO AND SHE'S NOT BOUNCING BACK FROM THIS EXPERIENCE THE WAY SHE'S USED TO BOUNCING BACK FROM HER OTHER TWO. SHE'S FATIGUED, SHE CAN'T SLEEP, SHE'S UPSET ABOUT IT, SHE HAS NO APPETITE, SHE SAYS, SHE HAS NO ENERGY, AND SHE SAYS SHE'S RETAINING WATER SO SHE FINALLY GOES TO HER DOCTOR BECAUSE, QUOTE SHE CAN'T GET RID OF THIS PERSISTENT COUGH THAT SHE'S GOT. AND IT'S GETTING WORSE AT NIGHT. IT GETS BETTER WHEN SHE SITS UP, GETS WORSE WHEN SHE LIES DOWN. SHE THINKS SHE HAS BRONCHITIS. LOU, YOU SEE HER IN THE OFFICE.

DR. PAPA: WELL I'M CONCERNED, SHE'S JUST DELIVERED HER BABY, AND SHE HAD ORIGINALLY SOME SYMPTOMS OF WHAT CONCERNS ME OF POST-PARTUM DEPRESSION, BUT THE FLUID AND THE COUGH HAVE ME CONCERNED, ESPECIALLY THE POSITIONAL COUGH. THAT SHE HAS FLUID, EXTRA FLUID ON, INCLUDING IN HER LUNGS CAUSING HER SHORTNESS OF BREATH AND I'M CONCERNED ABOUT HER HEART.

DR. SALGO: SO INTO THE OFFICE SHE COMES, BECAUSE LOU YOU ASKED HER TO COME INTO SEE YOU RIGHT? AND I'LL TELL YOU WHAT HE FINDS. THE DOCTOR DISCOVERS THAT LYNN'S BLOOD PRESSURE IS 90/50, HER PULSE IS 126, HER RESPIRATORY RATE IS 26. SHE'S GOT BIG NECK VEINS, SWOLLEN ANKLES, AND WHEN HE LISTENS TO HER CHEST, THERE'S THESE RATTLING NOISES IN HER CHEST WHEN SHE TAKES A DEEP BREATH. AND SHE SAYS SHE REALLY CAN'T CATCH HER BREATH. WHAT'S GOING ON HERE GUYS?

DR. GOLDSCHLAGER: SHE'S GOT HEART FAILURE.

DR. SALGO: HEART FAILURE? HOW DO YOU KNOW?

DR. GOLDSCHLAGER: HEART FAILURE. HOW DO I KNOW? I KNOW FROM THE INFORMATION YOU JUST GAVE ME. THE COUGH THAT SHE HAS, THE POSITIONAL BREATHLESSNESS AT NIGHT, THAT GOES TO THE LEFT SIDE OF THE HEART NOT PUMPING ITS BLOOD VERY WELL, THE RIGHT SIDE OF THE HEART NOT PUMPING IT'S BLOOD VERY WELL, WILL RESULT IN THIS FULLNESS IN HER NECK, HER NECK VEIN DISTENTION. SO BOTH OF HER VENTRICLES ARE NOT WORKING PROPERLY.

ORLANDO: SO SHE COULD WALK INTO YOUR OFFICE WITH HEART FAILURE? I MEAN, HOW LONG HAS SHE BEEN HAVING HEART FAILURE, I THOUGHT THAT WAS MORE LIKE AN ISOLATED EVENT. HEART FAILURE, HER HEART'S BEEN FAILING FOR A LONG TIME?

DR. PAPA: WELL THAT DEPENDS ON WHAT CAUSES IT. THERE'S LOTS OF DIFFERENT THINGS THAT CAN CAUSE THE HEART TO FAIL. IN HER SITUATION GIVEN THE FACT SHE'S SO YOUNG AND SHE'S JUST DELIVERED ONE OF THE THINGS WE'RE WORRIED ABOUT IS POST-PARTUM CARIOMYOPATHY.

DR. SALGO: THAT'S A VERY LONG PHRASE, POST-PARTUM CARIOMYOPATHY. IN ENGLISH, WHAT DID YOU JUST SAY?

DR. PAPA: IT MEANS FOR SOME REASON, AFTER A DELIVERY, IT'S RARE, BUT IT CAN OCCUR, YOUR HEART CAN GO INTO FAILURE.

DR. GOLDSCHLAGER: WHAT THE CASE IS ILLUSTRATING IS A HEART FAILURE PROBLEM, WHICH HAS REMAINED WITHOUT SYMPTOMS UNTIL NOW. SO WE'RE TRYING TO SAY THAT IT DIDN'T JUST OCCUR THAT DAY THAT SHE PRESENTED HER CASE.

DR. SALGO: YOU'RE THE ONLY ONE SITTING HERE TO THE BEST OF MY KNOWLEDGE WHO'S ACTUALLY EXPERIENCED THE SHORTNESS OF BREATH DUE TO HEART FAILURE. WHAT DOES THAT FEEL LIKE?

MORREALE: THERE'S A LOT OF PAIN WITH IT. YOU'RE GASPING FOR AIR, REALLY, YOU'RE ALMOST LIKE YOU'RE FORCING YOURSELF TO BREATHE, AND YOU JUST, YOU'RE TRYING TO EASE IT UP. WHAT I USED TO DO, IS I'D JUST SIT BACK AND JUST KIND OF PUT MY HEAD BACK JUST A LITTLE BIT AND THAT WOULD KIND OF EASE IT, OR I WOULD HAVE TO WALK.

DR. MOSS: I'M NOT SURE WHAT YOU MEAN BY DISCOMFORT, PAIN. JUST THAT IT'S HARD? IT'S HARD WORK TO BREATHE?

MORREALE: IN MY CASE WHAT IT WAS, IS IT'S JUST AS IF YOUR WHOLE CHEST IS JUST ACHING, YOU FEEL LIKE THERE'S A LOT OF PRESSURE THERE. AND YOU DON'T KNOW WHAT TO DO TO RELEASE IT.

DR. SALGO: THAT SOUNDS PRETTY NASTY.

MORREALE: YOU'RE TRYING TO MOVE YOURSELF AROUND, YOU'RE TRYING TO GET YOURSELF INTO A POSITION WHERE IT EASES UP.

DR. SALGO: LYNN'S DOCTOR IS VERY, VERY WORRIED ABOUT ALL OF THIS AND HE ARRANGES FOR HER TO GO IMMEDIATELY TO THE EMERGENCY ROOM. AN AMBULANCE TAKES HER THERE. NORA, IF YOU WERE CATCHING THIS CASE IN THE EMERGENCY ROOM, WHAT WOULD YOU DO?

DR. GOLDSCHLAGER: I'D TAKE A HISTORY AND I'D VERIFY THAT THERE WERE NO OTHER PREDISPOSING FACTORS OTHER THAN THE PREGNANCY.

DR. SALGO: THERE WERE NONE.  JUST THE PREGNANCY. THAT'S ALL.

DR. GOLDSCHLAGER: IF AS YOU INDICATED SHE CAN'T GIVE ME A FULL SENTENCE, I'LL DO A VERY QUICK, VERY FOCUSED PHYSICAL EXAMINATION.

DR. SALGO: AND IT'S UNCHANGED FROM WHAT WE TOLD YOU. THE NECK VEINS, THE FUNNY SOUNDS IN HER LUNGS, THE RAPID HEART RATE. YOU'RE GOING TO GIVE HER OXYGEN?

DR. GOLDSCHLAGER: I AM GOING TO GIVE HER OXYGEN.

DR. SALGO: START AN IV?

DR. GOLDSCHLAGER: I'M GOING TO START AN IV, FOR ACCESS PURPOSES.

DR. SALGO: BLOOD TESTS?

DR. GOLDSCHLAGER: I WILL GET BLOOD TESTS,BUT I'M GOING TO SIMULTANEOUSLY DO A NUMBER OF THINGS.

DR. SALGO: TELL ME WHAT THOSE ARE.

DR. GOLDSCHLAGER: ASK FOR AN ELECTROCARDIOGRAM. I'M GOING TO DRAW SOME BLOOD FOR ELECTROLYTES AND OTHER POTENTIAL CONTRIBUTING FACTORS TO THIS CLINICAL PICTURE. I'M GOING TO BE ALMOST CERTAINLY ORDERING A DIURETIC, A WATER PILL, TO ALLOW THE FLUID IN THE LUNGS TO DECREASE, SO THAT SHE CAN TALK TO ME.

DR. SALGO: WELL HER DOCTORS ORDERED ALMOST ALL OF THE THINGS YOU WANTED SO HERE'S WHAT THEY FOUND. HER CHEST X-RAY SHOWED CONGESTED LUNGS, HER BLOOD TEST SHOWED LOW SODIUM, LOW OXYGEN, LOW CARBON DIOXIDE IN HER BLOOD. UP IN THE CORONARY CARE UNIT THEY DID AN ECHOCARDIOGRAM WHERE THEY PUT HER BY THE WAY, WHERE SHE WAS GOING TO STAY. HER EJECTION FRACTION, THE PERCENTAGE OF HER HEARTBEAT THAT REMAINS, IS 15%. HER IRON, THYROID, FOLATE, ALL THAT CAME BACK NORMAL AND SHE HAS A NATRIURETIC PEPTIDE OF 980. THAT'S A LOT OF STUFF TO DIGEST. GIVE US THE BULLET POINTS ON THIS, ART. WHAT DOES THIS TELL US?

DR. MOSS: THE BULLET POINTS ARE THAT SHE IS IN SEVERE HEART FAILURE WITH A VERY COMPROMISED CONTRACTION PATTERN OF THE HEART. ALMOST SURELY THIS IS WHAT GOES UNDER THE CATEGORY OF A POST-PARTUM WHAT LOU SAID, HEART MUSCLE DISEASE, IT'S CALLED A CARDIO-MYOPATHY. WE BREAK CARDIOMYOPATHY DOWN INTO WHAT'S CALLED ISCHEMIC, DUE TO CORONARY DISEASE, SHE DOESN'T HAVE THIS. THIS IS A NON-ISCHEMIC, NOT DUE TO CORONARY DISEASE, MUSCLE DISORDER. SHE WILL RESPOND TO APPROPRIATE DECONGESTIVE THERAPY, TO GET RID OF THE FLUID, SHE'LL ALSO IMPROVE WITH A...

DR. GOLDSCHLAGER: DECONGESTIVE, BE A LITTLE CLEARER BECAUSE DECONGESTIVE...

DR. MOSS: YOU'VE ALREADY GIVEN HER DIURETICS AND SHE IS GOING TO PUT OUT A LOT OF FLUID AND AT THE SAME TIME THAT YOU'RE GIVING DIURETICS, THERE ARE A NUMBER OF OTHER MEDICATIONS THAT REDUCE THE WORKLOAD ON THE HEART SO THE HEART FUNCTION WILL START TO IMPROVE AND SHE WILL BE STABILIZED WITHOUT ANY QUESTION.

DR. SALGO: WHAT WE HAVE IS A YOUNG WOMAN, NEW MOTHER FOR THE THIRD TIME, WHO'S IN HER FORTIES WHO HAS HEART FAILURE. WHEN THEY TOLD YOU THAT YOU HAD HEART FAILURE, HOW DID YOU FEEL?

MORREALE: AT FIRST I REALLY DIDN'T KNOW WHAT THEY WERE ACTUALLY TELLING ME...YOU HAVE HEART FAILURE AND I SAID OK, AT THAT POINT WHEN I FIRST DIAGNOSED IT, I WASN'T FEELING THAT BAD. IN FACT I HAD CARDIOMYOPATHY FOR ALMOST 15 YEARS. AND THEN ONCE THEY STARTED TO DESCRIBE WHAT THIS ENTAILED...

DR. SALGO: DID IT THROW YOU FOR A LOOP?

MORREALE: YES, ESPECIALLY IN MY CASE WHEN THEY SAID, "YOU'RE IN LINE FOR A HEART TRANSPLANT."

DR. SALGO: OH MY. 

MORREALE: SOMEWHERE DOWN THE LINE, THEN EVERYTHING STARTED TO HIT HOME.

DR. SALGO: WHAT CAUSES HEART FAILURE? WHAT DOES THAT MEAN, SHE'S HERE WITH A HEART THAT IS FAILING OUT OF THE BLUE, WHAT CAUSES IT?

DR. GOLDSCHLAGER: WELL, ART HAS GIVEN YOU TWO MAJOR CATEGORIES. WHAT HE CALLED ISCHEMIC WHICH IS A CHRONIC LACK OF OXYGEN TO THE MUSCLE DUE TO CORONARY ARTERY DISEASE, AND NON-ISCHEMIC WHIS NOT THAT. AND UNDER THE NON-ISCHEMIC CATEGORIES, THERE'S A WHOLE SLEW OF CAUSES, SOME OF WHICH ARE CHRONIC, AND SOME OF WHICH ARE RELATIVELY ACUTE LIKE THIS ONE.

DR. SALGO: UNDER THE NON-ISCHEMIC CATEGORY NOT RELATED TO A HEART ATTACK, WHAT ARE YOU GOING TO THROW IN THERE?

DR. MOSS: WELL THE MOST FREQUENT AND COMMON CAUSE IS A VIRUS, THAT'S THE MOST COMMON CAUSE.

DR. SALGO: COULD SHE HAVE A VIRUS?

DR. MOSS: WELL SHE COULD HAVE A VIRUS, ALTHOUGH THERE IS THIS CONDITION FOLLOWING PREGNANCY THAT'S NOT RELATED TO A VIRUS WHERE THERE IS PROBABLY SOME TYPE OF MUSCLE DESTRUCTION. MAYBE IT'S AN ALLERGIC REACTION FROM THE DELIVERY, ETC. THERE ARE MANY, MANY CAUSES SO THERE CAN BE INFECTIONS, VIRAL, NON-VIRAL.

DR. PAPA: THE OTHER THING THAT'S IMPORTANT IS CERTAIN HABITS ARE INVOLVED. YOU KNOW, A 42-YEAR-OLD WOMAN, YOU NEED TO ASK ABOUT ALCOHOL USE, YOU NEED TO ASK ABOUT COCAINE USE, THOSE ARE OTHER THINGS THAT ALSO CAN PLAY A ROLE.

DR. GOLDSCHLAGER: I WANT TO MAKE ONE POINT ABOUT THAT LANDRY LIST YOU WANTED. THERE'S A HIGH PERCENT OF THESE CARDIOMYOPATHY PATIENTS IN WHOM THERE IS NO IDEOLOGY.

DR. SALGO: NO CAUSE.

DR. GOLDSCHLAGER: AND THAT'S IMPORTANT FOR EVERYBODY TO KNOW. WE CALL THAT IDIOPATHIC. WHAT DOES THAT MEAN? THAT MEANS WE DON'T KNOW.

ORLANDO: YOU DON'T KNOW.

DR. MASSEY: WE DON'T KNOW. 

DR. SALGO: BUT I WANT TO TAKE SOME TIME TO SUM UP SOME KEY THINGS TO REMEMBER HERE BEFORE WE MOVE ON. HEART FAILURE MEANS THAT THE HEART MUSCLE HAS LOST ITS POWER TO DO THE WORK IT NEEDS TO DO. THAT'S ALL IT MEANS. THAT PHRASE DOES NOT TELL YOU WHAT'S CAUSING THE HEART FAILURE. IT CAN BE CAUSED BY CHEMICALS THAT NATURALLY ARE FOUND IN YOUR BODY DURING PREGNANCY. IT'S UNCOMMON, BUT DOES HAPPEN. CORONARY HEART DISEASE, CONGENITAL HEART DISEASE, VIRUSES, DYSTROPHIES, SOME DRUGS, SOME INFECTIONS. THE PROBLEM IS RIGHT NOW WITH THIS YOUNG WOMAN, AND SHE IS YOUNG, THAT WE'VE COME TO THIS END POINT OF ALL OF THESE CAUSES AND SHE IS NOW IN HEART FAILURE. BUT RIGHT NOW SHE'S IN THE HOSPITAL. I KNOW THAT DR. DR. MOSS TALKED ABOUT THIS A LITTLE BIT. WHAT ARE YOU GOING TO DO, WHAT COCKTAIL, WHAT DRUGS, WHAT ARE YOU GOING TO START HER OFF?

DR. PAPA: WELL AS DR. DR. MOSS HAD TOUCHED ON, WE'RE GOING TO GIVE THE DIURETICS TO ACUTELY MAKE HER FEEL BETTER AND THERE'S OTHER MEDICINES WE CAN GIVE HER TO MAKE HER HEART PUMP EASIER, MAKE IT MORE EFFICIENT FOR IT TO PUMP.

DR. SALGO: LIKE WHAT?

DR. PAPA: WELL THERE'S MEDICINES CALLED ACE INHIBITORS WHICH ARE A CLASS OF DRUGS THAT HELP REDUCE THE HEAD OF PRESSURE THE HEART HAS TO PUMP AGAINST AND IT HAS HORMONAL EFFECTS AS WELL. IT SEEMS TO MAKE THE HEART FUNCTION BETTER, IT MAKES THE MUSCLE WORK BETTER. THERE ARE BETA BLOCKERS THAT HELP REDUCE THE HEART RATE, REDUCE THE WORKLOAD ON THE HEART ITSELF.

DR. GOLDSCHLAGER: I THINK YOU HAVE TO BE VERY CAREFUL AT THIS STAGE OF HER DISEASE, BECAUSE I THINK IT IS NOT THE RIGHT THING TO DO, TO THROW 14 MEDICINES AT A PATIENT AT THIS TIME. THIS PATIENT'S GOING TO RESPOND VERY WELL INITIALLY TO JUST DIURETICS, SO THE ARMAMENTARIUM YOU WOULD USE BECOMES ADDED AS YOU GO ALONG, NOT EVERYTHING IS THROWN IN AT THE SAME TIME.

DR. SALGO: WELL I'LL TELL YOU SHE GETS A COCKTAIL OF DRUGS, SHE GETS AN ACE INHIBITOR, SHE GETS DIURETICS AND SHE'S PUT ON AN ASPIRIN, AND A BETA BLOCKER. AND IN TWO DAYS THEY SEND HER HOME WITH ALL OF THESE PRESCRIPTIONS, WHICH SHE DOES TAKE. SHE'S VERY GOOD AT IT, AND SHE'S FEELING BETTER SO NOW THAT SHE'S FEELING BETTER, WHAT ARE YOU GOING TO TELL HER? IS IT LIKELY SHE'S GOING TO BE OK, NORA?

DR. GOLDSCHLAGER: I CAN'T GUARANTEE A SPECIFIC KIND OF RESPONSE.

DR. SALGO: OK.

DR. GOLDSCHLAGER: IT WOULD BE FOOLISH TO TRY AND DO THAT.

DR. SALGO: I CAN'T EVEN BOX YOU INTO DOING THAT.

DR. GOLDSCHLAGER: YOU CAN'T DO IT.  SHE MAY ACTUALLY RETURN TO NORMAL. HER HEART FUNCTION MAY RETURN TO NORMAL, OR IT MAY NOT. AND AT THE TIME WE'RE SEEING LYNN, WE CAN'T TELL WHICH WAY IT'S GOING TO GO.

DR. MOSS: ONCE SHE HAS BEEN STABILIZED ON A COMBINATION ON MEDICATIONS, YOU CAN THEN MORE PROPERLY EVALUATE HER WITH A CARDIAC CATHETERIZATION, YOU CAN BEGIN TO THINK ABOUT REHABILITATION AND ACTIVITY TOLERANCE, UNDER SUPERVISION. SO ALL OF THESE THINGS COME ALONG IN A PROGRESSIVE NATURE. NOW IT MAY BE THAT YOU GIVE ALL THESE MEDICATIONS AND SHE ONLY GETS A SMALL IMPROVEMENT. THIS WOULD BE A VERY BAD PROGNOSTIC SIGN. IT WOULD NOT LOOK GOOD FOR THE FUTURE.

DR. SALGO: ALL RIGHT, WELL THREE WEEKS AFTER SHE GOES HOME, EVEN THOUGH SHE WAS FEELING WELL WHEN SHE WENT HOME, SHE STARTS TO FEEL BAD AGAIN AND SHE COMES BACK TO THE HOSPITAL. SHE WAKES UP IN THE MIDDLE OF THE NIGHT, SHE WAS SHORT OF BREATH, SHE WAS IN SEVERE RESPIRATORY DISTRESS. SHE ACTUALLY SAID, "MY LUNGS FEEL TOO STIFF TO MOVE AIR." LOU, SHE CALLED YOU. WHAT DO YOU THINK IS GOING ON?

DR. PAPA: SHE'S GOT TO GO BACK TO THE EMERGENCY ROOM AND IT SOUNDS TO ME LIKE SHE'S IN ANOTHER EPISODE OF HEART FAILURE, THAT SHE'S GOT FLUID ON HER LUNGS AGAIN.

DR. SALGO: SHE'S ON WHAT THE CARDIOLOGISTS LIKE TO CALL "MAXIMUM MEDICAL THERAPY" SHE'S GETTING INTO WORSE FAILURE, HER LUNGS ARE FILLING UP DESPITE EVERYTHING THAT THESE WELL-MEANING FOLKS, TALENTED FOLKS, ARE TRYING TO DO. ALL RIGHT, WELL I'LL TELL YOU WHAT HER DOCTORS DID. THEY CALLED THE TODD EQUIVALENT. WHAT DO YOU HAVE TO OFFER?

DR. MASSEY: WELL AT LEAST FROM A SURGICAL STANDPOINT AND SOMEONE THAT HAS POST-PARTUM CARDIOMYOPATHY, IF IT WAS ISCHEMIC WE WOULD POTENTIALLY TRY TO REVASCULARIZE THEM. WE TAKE THEM AND DO BYPASS SURGERY ON THEM IF YOU HAD CORONARY DISEASE.

DR. SALGO: WHAT THEY ASKED YOU IS, OR YOUR EQUIVALENT, CAN YOU GIVE HER AN ARTIFICIAL HEART?

DR. MASSEY: YES, I MEAN, WE CAN. WE DO HAVE THOSE DEVICES AVAILABLE.

DR. SALGO: FUNNY YOU SHOULD MENTION THAT BECAUSE WE RUMMAGED THROUGH YOUR BRIEFCASE BEFORE YOU CAME ON THE SET. DO YOU ALWAYS TRAVEL WITH ONE OF THESE THINGS?

DR. MASSEY: TYPICALLY.

DR. SALGO: OR DID IS IT JUST OUR GOOD LUCK TODAY? NOW, LET ME HAND YOU THIS THING. CAN YOU SHOW US IT A LITTLE BIT?

DR. MASSEY: OK, THIS IS A LEFT VERICULAR ASSIST DEVICE.

DR. SALGO: ELISSA, MAYBE YOU CAN HELP US OUT.

DR. MASSEY: ALL RIGHT ELISSA, IF YOU COULD JUST HOLD THAT.

DR. GOLDSCHLAGER: HOW MUCH DOES THAT WEIGH?

DR. MASSEY: IT WEIGHS ABOUT FIVE POUNDS, ACTUALLY. AND THE ACTUAL PUMP ITSELF IS IMPLANTED.  IT'S IMPLANTED IN WHAT WE CALL THE PREPERITONEAL SPACE, OR RIGHT IN THE ABDOMINAL, JUST RIGHT BEFORE THE ABDOMINAL CAVITY. SO THIS TYPICALLY YOU DO NOT SEE. IT GOES FROM THE LEFT VENTRICLE THEN TO THE ASCENDING AORTUM. BASICALLY TAKES OVER THE ENTIRE FUNCTION OF THE HEART.

DR. SALGO: SO THE BLOOD COMES IN HERE, THIS PUMPS IT AND IT GOES OUT HERE. 

DR. MASSEY: YES. AND THIS IS WHAT WE CALL THE DRIVE-LINE, WHICH ACTUALLY COMES OUT AND EXITS THE SKIN. AND THIS PORTION YOU WOULD SEE FROM HERE OUT. AND THIS IS...IT CAN...

ORLANDO: HOW IS IT POWERED?

DR. MASSEY: WELL, THIS IS A CONTROLLER AND IT'S RUN BY BATTERIES. AND BASICALLY THE CONTROLLER HAS A MICROCHIP IN IT SO IT CAN ACTUALLY RESPOND TO PEOPLE'S NEEDS. SO IF SOMEONE WAS OUT PLAYING GOLF WITH IT OR WHATEVER, IT WOULD INCREASE PUMP FLOW AND THAT SORT OF THING.

DR. PAPA: IS THIS A REALISTIC TREATMENT FOR A YOUNG LADY WITH A YOUNG CHILD AT HOME?

DR. MASSEY: PROBABLY NOT. WHAT WE WOULD DO WITH HER, SHE WOULD UNDERGO EVALUATION BY OUR HEART FAILURE TEAM, OUR TRANSPLANT SERVICE, TO SEE IF SHE WAS A CANDIDATE FOR POTENTIALLY HEART TRANSPLANT. IN HER CASE, ESPECIALLY IF MEDICALLY YOU CANNOT STABILIZE HER HEART FAILURE AND SHE WAS GOING TO DIE, THEN WE WOULD PUT THIS IN AS WHAT WE CALL A "BRIDGE TO TRANSPLANT," BUT JUST TO GET HER TO TRANSPLANTATION.

ORLANDO: CAN YOU HEAR IT OR FEEL IT?

DR. MASSEY: YOU CAN HEAR IT. IT'S FAIRLY LOUD.

DR. SALGO: PUT THE BATTERY IN.

DR. MASSEY: YES, JUST PUT THE BATTERY IN.

[ARTIFICIAL HEART BEATING]

DR. MASSEY: THE PATIENTS REALLY BECOME ACCUSTOMED TO THE SOUND, AND IT ACTUALLY BECOMES THEY WORRY MORE WHEN THEY DON'T HEAR IT THAN WHEN THEY HEAR IT.

DR. SALGO: SO LET ME JUST BE CLEAR ABOUT THIS. WE'VE GOT A 42-YEAR-OLD WOMAN WHO CALLED YOU. YOU'RE GOING TO PUT THIS THING IN TO KEEP HER GOING BECAUSE THE MEDICINES AREN'T WORKING AND YOU'RE GOING TO PUT HER ON A TRANSPLANT LIST. YOU'RE GOING TO TRANSPLANT THIS WOMAN EVENTUALLY?

DR. MASSEY: YES. 

DR. SALGO: AND AT THIS POINT I WANT TO STOP THINGS FOR JUST A MOMENT AND SUM UP SOME OF THE KEY THINGS TO REMEMBER HERE. HEART FAILURE IS TREATABLE THROUGH DRUGS OR MECHANICAL INTERVENTION, AND WHICH YOU CHOOSE AND HOW YOU DO IT IS OFTEN A SUBJECT OF DEBATE, BUT IN FACT WE HAVE THINGS TO OFFER YOU IF IN FACT YOUR HEART HAS REACHED THE POINT WHERE IT'S NOT WORKING AS WELL AS IT SHOULD AND WE'RE REACHING THEN END OF THE MEDICATION LINE.

ORLANDO: IT BRINGS UP A QUESTION THAT WHEN YOU JUST SAID THE WORDS "WHICH YOU CHOOSE" AND MY QUESTION IS DO YOU HAVE A CHOICE AS A PATIENT? I MEAN, YOU'RE ALL DOCTORS TALKING ABOUT WHAT SHOULD BE DONE, BUT CAN SOMEBODY LOOK AT ME AND SAY "WOULD YOU RATHER HAVE A HEART TRANSPLANT?"

DR. MASSEY: YOU KNOW, TYPICALLY, THESE DECISIONS ARE UP TO THE PATIENT. I MEAN, WE ONLY PRESENT OURSELVES AS COUNSEL TO THE PATIENTS. NOW THEY'RE GOING TO THE HEART FAILURE TEAM TYPICALLY COMES UP WITH A TREATMENT REGIMENT. WHETHER YOU ACCEPT THAT OR NOT THAT'S UP TO THE PATIENT.

DR. SALGO: LYNN'S GOT THIS DEVICE. THE QUESTION IS HOW LONG WILL THIS DEVICE LAST? I'M SURE THIS IS RUNNING THROUGH HER HEAD AT THIS POINT AND IS SHE NOW FIXED? IS SHE BETTER?

DR. MASSEY: YES, I MEAN, ONCE THE DEVICE GOES IN, PEOPLE REALLY TELL THE DIFFERENCE. ESPECIALLY PEOPLE WHO HAVE BEEN IN CHRONIC HEART FAILURE.

DR. PAPA: WHAT DOES SHE MEAN BY FIXED? WHAT DO YOU MEAN--BECAUSE YOUR DEFINITION OF FIXED IS GOING TO BE DIFFERENT FROM HER DEFINITION OF FIXED. IF SHE MEANS FIXED LIKE, "I HAVE A NORMAL HEART NOW, I'M GOING TO HAVE A WONDERFUL LIFE LIKE EVERYONE ELSE," I THINK THAT NEEDS TO BE CLARIFIED TO HER BECAUSE I THINK A LOT OF PATIENTS MAY THINK "FIXED" MEANS BETTER, COMPLETELY, CURED.

ORLANDO: AND YOU CALL THIS A BRIDGE. YOU SAID THE ARTIFICIAL HEART WOULD BE A BRIDGE TO SOMETHING ELSE.

DR. MASSEY: WELL, THESE HAVE ACTUALLY--AND EVEN THIS DEVICE HAS GONE A LITTLE BIT FURTHER. IN THE PAST WE WERE RESTRICTED TO IMPLANTING THIS DEVICE IN ONLY PEOPLE WHO QUALIFIED FOR CARDIAC TRANSPLANT. THAT'S NO LONGER THE CASE. THE FDA AND ACTUALLY MEDICARE HAVE APPROVED THIS DEVICE FOR PEOPLE WHO ARE NON-TRANSPLANT CANDIDATES.

DR. SALGO: WELL LYNN IS PUT ON THE TRANSPLANT LIST AND SHE'S WAITING FOR A HEART. NOW YOU'VE BEEN ON THAT LIST.

MORREALE: YES.

DR. SALGO: TELL ME ABOUT THAT. HOW LONG IS THE WAIT? WHAT DOES IT FEEL LIKE? HOW DO YOU GET THROUGH THE DAY WAITING FOR A HEART?

MORREALE: ORIGINALLY, WHEN I WAS FIRST PUT ON THE LIST, I WAS DOING WELL ENOUGH WHERE I WAS ON THE LIST WAITING, BUT I REALLY WASN'T GOING TO RECEIVE A HEART. THEN IN 2001 THAT'S WHEN I ACTUALLY GOT REALLY SICK AND I ENDED UP STAYING IN THE HOSPITAL WAITING FOR A HEART.

DR. SALGO: SO THAT LIST REALLY DOES DEPEND TO SOME DEGREE ON HOW SICK YOU ARE. HOW DO OU PRIORITIZE PEOPLE ON THE LIST? NORA? TODD?

DR. MASSEY: WELL, I CAN TELL YOU TYPICALLY, WHEN YOU LOOK AT HEART TRANSPLANT, IT'S A LITTLE BIT DIFFERENT THAN SOME OF THE OTHER ORGANS THAT ARE TRANSPLANTED. LIKE IF WE WERE TO LOOK AT LUNGS. LUNG TRANSPLANT IS BASED JUST ON TIME ON THE LIST. HEART TRANSPLANT IS ACTUALLY STRATIFIED DUE TO SEVERITY OF ILLNESS.

DR. SALGO: THE SICKER YOU ARE, THE HIGHER UP YOU GO.

DR. MASSEY: THE HIGHER UP YOU GO. SO YOU'RE TYPICALLY MATCHED-WE HAVE TO MATCH PEOPLE BASED ON SIZE. YOU WOULD NOT WANT TO PUT A 6-FOOT-6 MAN'S HEART INTO HER. IT JUST WOULDN'T WORK WELL. AND ALSO ON BLOOD TYPE. THOSE ARE SORT OF THE PRELIMINARY THINGS. THEN YOU HAVE A 1A STATUS. THIS IS THE SICKEST PATIENT POPULATION. AND THEY TYPICALLY ARE GOING TO BE DEAD WITHIN ABOUT TWO WEEKS.

DR. SALGO: THERE WERE REALLY QUESTIONS EARLY ON WITH LIVERS, WITH KIDNEYS, AND ALSO WITH HEARTS ABOUT, CAN YOU BEAT THE SYSTEM? CAN YOU JIGGER THE LIST? ARE SOME PEOPLE MORE EQUAL THAN OTHERS? IS THERE NOW A RIGID ETHICAL FRAMEWORK FOR THIS OR ARE THERE SOME PEOPLE WHO, BECAUSE THEY KNOW A DOC, THEY'RE IN THE RIGHT AREA, CAN GET A HEART EARLIER?

DR. MASSEY: NO, IT IS IMPOSSIBLE FOR THAT TO HAPPEN. THE NATIONAL MATCHING LIST, WHICH IS RUN BY UNOS, IS AN INDEPENDENT ORGANIZATION THAT HAS FEDERAL OVERSIGHT. THERE'S STRICT CRITERIA THAT WOULD QUALIFY YOU WAS AS A 1A PATIENT.

DR. SALGO: NOW, WHY DO WE NEED THIS LIST AT ALL? IS IT JUST THAT THERE ARE NOT ENOUGH HEARTS AVAILABLE? IS IT A LACK OF DONORS? AND WHY DOES THAT HAPPEN?

DR. MASSEY: IF YOU LOOK IN THIS COUNTRY, IN THE UNITED STATES ALONE, THERE ARE PROBABLY ABOUT 4,000 PEOPLE THAT ARE ON THE LIST CURRENTLY.

DR. SALGO: 4,000?

DR. MASSEY: 4,000.

DR. SALGO: HOW MANY HEARTS DO YOU GET A YEAR?

DR. MASSEY: WE TYPICALLY GET ABOUT 2,200 PER YEAR. SO WE'RE GETTING MUCH LESS THAN WE NEED. THE THING ABOUT HEART TRANSPLANT, IT DEFINITELY IS STILL THE GOLD STANDARD FOR END-STAGE HEART FAILURE THAT ARE UNRESPONSIVE, AND WE JUST DO NOT HAVE ENOUGH ORGANS TO GO AROUND. IF I HAD HEARTS THAT I HAD ON A SHELF, I WOULD BE BASICALLY PUTTING THEM IN ALL DAY AND ALL NIGHT. AND IT'S INTERESTING IN THE FACT WHEN YOU LOOK AT DONATION, OF THE PEOPLE WHO WOULD QUALIFY AS DONORS, IF EVERY ONE OF THOSE PEOPLE DID DONATE THERE WOULD ABSOLUTELY BE NO NEED AT ALL. YOU COULD TRANSPLANT EVERYONE ON THAT LIST.

ORLANDO: SO IF I SIGN MY CARD OR CHECK MY DRIVERS LICENSE OR WHATEVER THEN I'M AN ORGAN DONOR RIGHT?

DR. MASSEY: NO, THAT ONLY REPRESENTS YOUR WISHES TO YOUR FAMILY. IF YOU'VE NOT DISCUSSED IT WITH THEM OR WHATEVER IN ADVANCE AND THAT...BY NO MEANS BINDS YOU TO DONATING. YOUR FAMILY IS STILL ABLE TO MAKE THE CALL ON THAT.

DR. SALGO: ISN'T THAT AN ETHICAL ISSUE THAT DOES COME UP, WHICH IS THE POTENTIAL DONOR HAS INDICATED HIS OR HER WISHES AND I'VE SEEN THIS HAPPEN IN MY HOSPITAL, I THINK WE'VE ALL SEEN THIS, THAT THE TIME TO DONATE COMES, THERE'S SOME UNFORTUNATE EVENT, AND THE FAMILY STILL SAYS NO. IS THAT ETHICAL?

DR. MASSEY: I MEAN, WE LOOK AT IT AND THERE HAS BEEN A LOT OF DEBATE IN THIS COUNTRY. IS THERE CERTAIN WAYS THAT YOU COULD IMPROVE ORGAN DONATION? SHOULD YOU BE REIMBURSING FAMILIES WHO DONATE? SHOULD YOU POTENTIALLY BE TAKING OVER THE FUNERAL COSTS? AND IT IS REALLY LOOKED AT AS AN ALTRUISTIC GIFT THAT SOMEONE MAKES. AND THAT HAS SORT OF BEEN THE HEART AND SOUL OF ORGAN DONATION. AND I'LL TELL YOU AFTER ALL THE DEBATE THAT WAS WHAT WAS DECIDED TO LEAVE IT THAT WAY.

DR. SALGO: SO THERE'S WHERE WE ARE. I WANT TO STOP RIGHT HERE FOR JUST A MOMENT BECAUSE I WANT TO SUM UP JUST A FEW KEY THINGS TO REMEMBER. WE'VE AGAIN COVERED A TREMENDOUS AMOUNT HERE. HEART TRANSPLANTS DO WORK. WE DO THEM EVERY DAY ALL OVER THE COUNTRY. HOWEVER, THERE ARE NOT NEARLY ENOUGH DONORS OF HEARTS OR OTHER ORGANS. AND HERE I GET TO GO ON MY SOAPBOX A LITTLE BIT. YOU CAN HELP SAVE LIVES DIRECTLY. YOU CAN BE AN ORGAN DONOR. AND IT'S IMPORTANT NOT JUST TO FILL OUT YOUR DRIVER'S LICENSE, THIS DONOR CARD. YOU'VE GOT TO TALK TO YOUR FAMILY, LET THEM KNOW WHAT YOUR WISHES ARE. SO IF SOMETHING HAPPENS, UNFORTUNATELY, THEY'RE NOT LEFT WONDERING WHETHER YOU REALLY MEANT IT OR WHETHER THEY REALLY HAVE A CHOICE. IF YOU WANT TO GIVE YOUR ORGANS YOU'VE GOT TO LET THE FOLKS AROUND YOU, WHOM YOU LOVE AND WHOM YOU DEAL WITH EVERY DAY, IN ON WHAT SHOULD NOT BE A SECRET. VERY, VERY IMPORTANT. I'LL LET YOU KNOW WHAT HAPPENS TO LYNN. GO AHEAD ELISSA. 

ORLANDO: I HAVE A QUESTION FOR BOB THOUGH. I HAVE ABOUT A MILLION QUESTIONS FOR BOB NOW THAT I'VE HEARD THE INFORMATION ABOUT HEARTS. WHAT KIND OF A HEART DID YOU GET? I MEAN WHOSE HEART?

DR. SALGO: YOU GOT A HEART. YOU'RE SITTING HERE WITH A HEART TRANSPLANT. CONGRATULATIONS BY THE WAY.

MORREALE: THANK YOU.

DR. GOLDSCHLAGER: AND HE LOOKS WONDERFUL.

DR. SALGO: YOU LOOK GREAT. HOW LONG HAVE YOU HAD THE HEART?

MORREALE: I'LL BE THREE YEARS THIS AUGUST.

DR. SALGO: CONGRATULATIONS.

ORLANDO: WHAT KIND OF A HEART DID YOU GET? DID YOU KNOW WHO IT WAS?

DR. MOSS: S A GOOD HEART!

ORLANDO: I GUESS SO.

MORREALE: IT WAS A GOOD ONE. MY DONOR WAS 18 YEARS OLD. A MALE.

DR. SALGO: AND THAT'S ALL YOU KNOW?

MORREALE: THAT'S ALL I KNOW.

DR. SALGO: HOW DO YOU FEEL RIGHT NOW?

MORREALE: I FEEL TERRIFIC. I'M ABLE TO DO JUST ABOUT ANYTHING I WANT TO DO, WITHOUT ANY RESTRICTIONS AT ALL.

ORLANDO: WHAT WAS IT LIKE AFTER YOU GOT THE HEART? I MEAN, WHEN YOU WERE IN THE HOSPITAL AND GOT IT, DID YOU IMMEDIATELY FEEL DIFFERENT? CAN YOU TELL ME WHAT IT WAS LIKE TO JUST COME OUT WITH A NEW HEART AFTER BEING SICK?

MORREALE: WELL, WHEN I FIRST CAME OUT OF IT I JUST HAD A SENSATION OF HEARING SOME POUNDING, WHICH WAS LIKE A "BOOM, BOOM, BOOM" AND I ASKED ONE OF THE ATTENDANTS THAT WERE IN THERE, I SAID, "WHAT'S THAT POUNDING NOISE?" AND THEY SAID, "THAT'S WHAT A REAL HEART SOUNDS LIKE".

ORLANDO: DO YOU FEEL DIFFERENT IN OTHER WAYS? I MEAN, YOU HAVE SOMEONE ELSE'S HEART IN YOU AND I HEAR STORIES OF PEOPLE WHO SOMETIMES GET ALLERGIES AFTER TRANSPLANTS AND THINGS LIKE THAT RELATED TO WHAT THE DONOR HAD. DO YOU HAVE ANY PARTICULAR FEELINGS OR DID ANYTHING CHANGE FOR YOU IN TERMS OF YOUR FEELINGS, TASTE, OR YOUR PHYSICAL BEING AFTER YOU HAD IT?

MORREALE: RIGHT AFTER THE TRANSPLANT, I'D SAY MAYBE ABOUT A WEEK LATER, I GOT A STRANGE CRAVING FOR STRAWBERRY ICE CREAM AND I CAN'T TELL YOU WHY.

DR. SALGO: DO YOU STILL HAVE IT?

MORREALE: NO, NO, BUT I DID THEN. I WAS NEVER A PERSON THAT WOULD TAKE A GALLON OF ICE CREAM OUT OF THE REFRIGERATOR AND JUST ALL AT ONCE YOU'RE GOING TO EAT A GALLON OF ICE CREAM, BUT AFTER THE TRANSPLANT I COULD VERY EASILY. BUT IT SLOWLY WENT AWAY. BUT IT WAS JUST A FUNNY REACTION--SOMETHING THAT I WAS CRAVING THAT I DIDN'T CRAVE BEFORE.

ORLANDO: 18-YEAR-OLDS LIKE ICE CREAM.

DR. SALGO: YOU KNOW, LYNN GOT HER TRANSPLANT TOO. BOB ALLUDED TO THE FACT THAT THERE WERE SOME PEOPLE WHO DIDN'T GET HEARTS AND I HAVE ONE VERY BRIEF QUESTION. HOW MANY OF THESE PEOPLE ACTUALLY DIE WAITING FOR TRANSPLANTS?

DR. MASSEY: IF YOU LOOK AT IT CURRENTLY, THE MORTALITIES ON A WAITING LIST ARE ABOUT ONE IN THREE.

DR. SALGO: 33%. THAT'S ENORMOUS, WHICH BRINGS US BACK TO THE DONOR LIST. I WANT TO THANK EVERYBODY HERE, ESPECIALLY YOU BOB FOR COMING IN AND SHARING THIS WITH US. IT'S NOT OFTEN WE GET TO TALK WITH SOMEONE WHO'S HAD A BRAND NEW HEART AND A CRAVING FOR ICE CREAM ON THE SAME SHOW. AGAIN THAT'S ALL THE TIME WE DO HAVE. THANK YOU ALL FOR BEING HERE. I WANT TO AGAIN GO THROUGH SOME OF THE POINTS THAT WE REALLY DO NEED TO REMEMBER BECAUSE WE COVERED A LOT OF GROUND TODAY. I WANT TO SUMMARIZE THE IMPORTANT THINGS TO TAKE AWAY FROM THIS. FIRST, HEART FAILURE MEANS THAT THE HEART MUSCLE HAS LOST ITS POWER TO DO THE WORK THAT IT NEEDS TO DO. IT CAN BE CAUSED BY A LOT OF DIFFERENT CAUSES. CHEMICALS NATURALLY FOUND IN YOUR BODY DURING PREGNANCY, AS WITH LYNN'S CASE, CORONARY HEART DISEASE, CONGENITAL HEART DISEASE, VIRUSES, DYSTROPHIES, DRUGS, INFECTION. HEART FAILURE IS TREATABLE THROUGH DRUGS OR AS IN THIS CASE, MECHANICAL INTERVENTION AND LED AGAIN TO A HEART TRANSPLANT. HEART TRANSPLANTS WORK. HOWEVER THERE ARE NOT NEARLY ENOUGH DONORS OR HEARTS OR OTHER ORGANS TO GO AROUND. YOU CAN HELP SAVE LIVES BY BEING AN ORGAN DONOR. ONE-THIRD OF THE PEOPLE WAITING FOR HEARTS WILL DIE WAITING BECAUSE THERE AREN'T ENOUGH HEARTS TO GO AROUND. OUR FINAL MESSAGE IS THIS.  TAKING CHARGE OF YOUR HEALTH MEANS BEING INFORMED, HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR. REMEMBER THAT. I'M DR. PETER SALGO AND I'LL SEE YOU NEXT TIME FOR ANOTHER SECOND OPINION.

SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE.  THE ADDRESS IS PBS.ORG.

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING.

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