THE HEART MAY BE THE ONLY ORGAN IN OUR BODY THAT NEVER SLEEPS.

THIS SHOULD BE A CLUE THAT WE NEED TO PROTECT IT.

STAY WITH US AS WE TALK WITH CARDIOLOGIST Dr. STEPHANIE MOORE ABOUT HEART FAILURE NEXT ON "KENTUCKY HEALTH."

JRK.

THE PRIMARY FUNCTION OF THE HEART IS TO PUMP BLOOD TO ALL THE OTHER ORGANS IN THE BODY.

AS A PUMP, OUR HEARTS ARE QUITE EFFICIENT BEATING 100,000 TIMES A DAY AND PUMPING 2,000 GALLONS OF BLOOD A DAY.

HOWEVER, LIKE ANY PUMP, THE HEART MAY FAIL.

WHEN THIS HAPPENS CIALS BLOOD BACKS UP AND THE FLOW TO THE REST OF THE BODY IS INSUFFICIENT TO MAINTAIN NORMAL FUNCTION.

IT IS ESTIMATED THAT NEARLY 6.5 MILLION AMERICANS OVER THE AGE OF 20 HAVE HEART FAILURE.

ABOUT 50% OF THESE PATIENTS WILL LIVE FIVE YEARS, BUT HOW WELL THEY DO IS DEPENDENT UPON THE SEVERITY OF THEIR CONDITION AND THE ADEQUACY OF THEIR TREATMENT.

COMMON RISK FACTORS FOR HEART FAILURE INCLUDE DIABETES, HIGH BLUEPRINT, OBESITY, OTHER CARDIAC DISEASE AND SMALL PARTICULATE AIR POLLUTION.

THERE ARE SOME SIMPLE THINGS THAT WE CAN DO TO KEEP OURSELVES OUT OF TROUBLE.

TO HELP US GET A BETTER UNDERSTANDING OF HEART DISEASE AND HOW WE MAY VE PRENT, TREAT AND MITIGATE THE CONSEQUENCES OF HEART FAILURE, WE HAVE AS OUR GUEST Dr. STEPHANIE MOORE.

Dr. MOORE STARTED OUT AS A PHARMACIST AND RECEIVED HER PHARMACY DEGREE FROM THE OHIO STATE UNIVERSITY, THE OHIO STATE, TO BE EXACT, BEFORE GETTING HER M.D.

DISEASE FROM THE UNIVERSITY OF CINCINNATI MEDICAL SCHOOL.

RESIDENCY IN INTERNAL MEDICINE AT THE UNIVERSITY OF CINCINNATI AND THEN FELLOWSHIP IN CARDIOVASCULAR DISEASE AT THE UNIVERSITY OF UTAH.

SHE IS CURRENTLY THE MEDICAL DIRECTOR OF THE ADVANCED HEART FAILURE THERAPIES PROGRAM IN THE DEPARTMENT OF MEDICINE AT THE UNIVERSITY OF LOUISVILLE.

Dr. MOORE, STEPHANIE, THANK YOU VERY MUCH FOR BEING WITH US.

>> THANK YOU SO MUCH FOR HAVING ME.

>> HEART FAILURE, THAT'S-- IT SOUNDS SCARY.

>> IT CERTAINLY DOES, DOESN'T IT?

>> TELL ME WHAT IS GOING ON WITH THAT.

>> WE DON'T HAVE A BETTER NAME FOR IT OTHER THAN HEART FAILURE.

WHEN SOMEBODY TELLS YOU YOU HAVE HEART FAILURE, THAT SHOULD GRAB PEOPLE'S ATTENTION.

WE NEVER WANT THAT ORGAN TO FAIL.

LIKE YOU SAID, AS IF YOUR CAR WAS IN THE GARAGE, AND YOU KNOW HOW YOU TURN IT OFF EVERY DAY AND DURING THE DAY YOU TURN IT BACK ON AND GET GOING, THERE IS NO TURNING OFF YOUR HEART.

THERE ARE YOUR HEART CANNOT FAIL.

THAT'S HOW I WANT PEOPLE TO THINK ABOUT THAT.

SO IF YOU HAVE THE RISK FACTORS THAT YOU JUST MENTIONED, MOSTLY DIABETES AND HYPERTENSION, AND LET'S ADD A FAMILY HISTORY OF HEART FAILURE,MOM, DAD, AUNTS, UNCLES, BROTHER, SISTER, WERE EVER TOLD THEY HAD HEART FAILURE, WE NEED TO PAY ATTENTION AND TELL YOUR PRIMARY CARE DOCTOR YOU HAVE A HISTORY OF HEART FAILURE AND IF YOU HAVE DIABETES OR HYPERTENSION, HOW CAN I NOT GET HEART FAILURE.

>> LET'S GO BACK OVER THAT.

TELL ME ABOUT THIS FAMILY HISTORY.

THAT FAMILY HISTORY WAS IMPORTANT.

ANY PARTICULAR MECHANISM GOING ON.

>> BACK IN THE DAY, WE USED TO SAY YOU RAN INTO A VIRUS, OR IDIOPATHIC, NOT SURE WHY YOU HAVE HEART FAILURE.

IF YOUR ARTERIES WERE CLEAN, YOU HAD NO DIABETES OR HYPERTENSION YET YOU HAD HEART FAILURE, MEAN THE MUMPING PUNKS OF YOUR HEART IS LESS THAN 50%, WE SAID YOU PROBABLY HAD A VIRUS AT SOME POINT OR IT'S IDIOPATHIC.

AS THAT TURNS OUT,WE HAVE DONE GENE STUDIES THROUGHOUT THE PAST 20, 30 YEARS, AND NOW WE ARE ABLE TO IDENTIFY CERTAIN AMOUNT OF GENES THAT ARE PATHOLOGIC FOR HEART FAILURE.

AND NOW WE CAN IDENTIFY THEM.

WE CAN ACTUALLY SAY THAT IT'S ACTUALLY NOT A VIRUS.

IT'S NOT IDIOPATHIC.

SOME OF IT IS GENETIC.

A THIRD OF THE PATIENTS WHO DO NOT HAVE HYPERTENSION, DIABETES, YOU KNOW, TYPICAL RISK FACTORS WHO JUST SHOW UP WITH HEART FAILURE, WE FIND A GENE THAT IS THE PROBLEM.

>> DOES THIS GENE CAUSE OTHER CARDIAC PROBLEMS OR IS IT SPECIFICALLY JUST LEADS TO PUMP FAILURE?

IS.

>> SPECIFICALLY PUMP FAILURE, SOMETIMES ASSOCIATED PROBLEMS BUT USUALLY JUST PUMP FAILURE.

JUST BECAUSE HAVE YOU THE GENE DOESN'T MEAN YOU ARE GOING TO HAVE HEART FAILURE.

YOU MAY HAVE THE GENE BUT THE GENE NEEDS TO TURN ON.

NOSE WHO SHOW UP WITH DECREASED PUMPING FUNCTION, DID YOUR MOM, DAD, AUNT, MOTHER BROTHER, SISTER DIE YOUNG WITH NO CAUSE?

IF THEY SAY YES, WE SWAB THE INSIDE OF THEIR MOUTH, SEND IT OFF.

GET THEIR GENE PROFILE BACK IN THREE WEEKS.

>> NO WAY.

>> YES.

>> AND YOU CAN SAY YOU EITHER DON'T HAVE THE GENE OR YOU DO HAVE THE GENES ASSOCIATED WITH HEART FAILURE.

THE NEXT TRICK IS TO SAY HOW DOES THE GENE TURN ON OR OFF?

IF THEY HAVE HEART FAILURE, IT HAS BEEN TURNED O.

YOU ALLUDED TO THINGS THAT TURN GENES ON.

A HEALTHY CLEAN LIFESTYLE CAN HELP KEEP IT OFF.

>> THAT'S...

SCARY.

>> BACK IN THE DAY, I USED TO SAY IT WAS A VIRUS OR IDIOPATHIC.

NOW WE DO KNOW THERE IS SOME GENETIC PROCLIVITY TO HEART FAILURE.

>> SO GO OVER AGAIN FOR US.

THE OTHER RISK FACTORS, AND BY THE WAY, BEFORE WE DO, HOW COMMON IS THE GENE?

IS IT THE MOST COMMON CAUSE OF HEART FAILURE?

IS IT IN THE MIX?

>> HALF THE PEOPLE WITH HEART FAILURE HAVE TRADITIONAL RISK FACTORS.

>> STILL HALF.

>> HALF THE PEOPLE WITH TRADITIONAL HEART FAILURE DOZEN NOT HAVE RISK FACTORS.

>> THAT MAY BE THE GENETIC COMPONENT.

>> THAT'S HUGE.

>> MOST PEOPLE WHO GO ON TO TRANSPLANT HAVE DILATED CARDIO MY CARDIOMYOPATHY WITHOUT RISK FACTORS.

>> THAT MEANS... >> THEY MAY OR MAY NOT HAVE THE GENE WE HAVEN'T DISCOVERED.

>> AND THAT IS A NICE WAY OF SAYING YOU HAVE.

>> DILATED CARDIOMYOPATHY, HEART FAILURE WITHOUT CORONARY DISEASE OR VALVE DISEASE, WITHOUT A KNOWN REASON.

SO IDIOPATHIC MEANS IT JUST HAPPENED.

>> JUST WANT TO MAKE SURE WE ARE ALL... >> IT'S A FANCY DOCTOR WORD, RIGHT?

>> EVERYBODY HAS GOAL NOW SO IT'S BAD ENOUGH THEY COME WITH Dr. GOAL.

>> I WANT PEOPLE TO PAY ATTENTION TO THEIR FAMILY HISTORY.

>> I WAS FLOORED RECENTLY PROPOSAL BY THE INCIDENTS OF HEART FAILURE.

PLEASE TELL US HOW COMMON IS THIS PROBLEM?

>> SO LET ME ASK YOU THIS.

IF I TOLD YOU YOU HAVE A ONE IN 30 CHANCE OF WINNING POWER BALL, WOULD YOU BUY A TICKET?

>> ABSOLUTELY.

>> WHAT IF I TOLD YOU YOU HAD A ONE IN 15 CHANCE.

BUYING A TICKET.

>> WHAT IF I SAID YOU HAD A ONE IN FOUR CHANCE.

>> I BOUGHT A BUNCH OF TICKETS.

>> THERE YOU GO, THE INCIDENTS IS ONE IN FOUR PEOPLE IN THEIR LIFETIME WILL BE DIAGNOSED WITH CONGESTIVE HEART FAILURE.

IT HAPPENS AS YOU GET OLDER.

ASSOCIATED WITH HYPERTENSION, CORONARY DISEASE, VALVE DISEASE, OLDER PEOPLE THINGS, RIGHT BUT MY LAST PATIENT I SAW PRIOR TO COMING HERE WAS 39 YEARS OLD.

SO IT CAN HAPPEN IN YOUNG PEOPLE.

IT'S ONE IN FOUR PEOPLE WILL DO THE DANCE WITH THE DIAGNOSIS OF CONGESTIVE HEART FAILURE.

SO WHAT I SAY IS THE OPPOSITE.

WE DON'T WANT TO BUY THAT TICKET.

>> NO.

>> RIGHT?

WE WANT TO PREVENT THAT TICKET.

OR IF YOU HAVE THAT TICKET, YOU WANT TO GET TREATED.

>> SO, BUT THE THINGS YOU MENTIONED, HYPERTENSION, DIABETES, AND.

>> CORONARY HEART DISEASE.

>> WELL, I WAS GOING TO SAY MOST OF THOSE THINGS GIVE RISE TO CORONARY ARTERY DISEASE.

AND ALL THOSE CONDITIONS, LIE BLOOD PRESSURE AND DIABETES AND OBESITY CAN GIVE RISE TO IT, THAT THE REAL CULPRIT.

>> NOT FOR EVERYBODY.

BECAUSE YOU CAN HAVE THOSE THINGS AND YOU MIGHT GET A TEST, A STRESS TEST.

>> YES.

>> OR YOU MIGHT GET A CATHERRIZATION.

WHERE WE LOOK AT THE ARTERIES OF THE HEARTS A VISUALLY IN THE CATH LAB AND SAY YOU DON'T HAVE ANY SIGNIFICANT BLOCKAGE.

YOU MIGHT GET A STRESS TEST AND YOUR DOCTOR WOULD SAY YOU DON'T HAVE ANY SIGNIFICANT BLOCKAGE.

THE STRESS TEST PICKS UP BLOCKAGES OVER 75%.

IT DOESN'T MEAN YOU DON'T HAVE CORONARY ARTERY DISEASE, OKAY.

YOU MIGHT HAVE A 30% BLOCKAGE, A 40% BLOCKAGE.

THAT'S NOT ENOUGH TO TRIGGER A POSITIVE STRESS TEST.

WE MIGHT DO A CATHER IZATION.

CATHERIZATION.

OR YOU HAVE ARTHROSCLEROSIS OR CORONARY ARTERY DISEASE.

THE SMALLER VESSELS THAT FEED YOUR HEART MUSSEL WILL, THEY GET BLOCKED UP SO THE TUNY INVEST WILLS-- TINY VESSELS HAVE DECREASED OXYGEN AND BLOOD FLOW AND OVER TIME YOUR HEART STARTS TO FAIL THAT'S WHY IT'S FOR TO PREVENT THAT.

>> WHEN YOU SAY ONE IN FOUR PEOPLE, ARE THESE INDIVIDUALS COMING IN VERY SICK OR ARE THESE PEOPLE WHO, AS AN INCIDENTAL FINDING WHEN THEY COME IN FOR THREE ROUTINE HEALTH EXAMINATION MIGHT PICK UP A LITTLE BIT OF FAILURE.

>> IT'S A SPECTRUM.

YOU ARE CORRECT.

IT MEANS THERE ARE DIFFERENT STAGES OF HEART FAILURE.

SOME PEOPLE HAVE HEART FAILURE AND THEY'RE WORKING FULL TIME JOBS, ABLE TO WALK THE GOLF COURSE.

SOME PEOPLE HAVE HEART FAILURE AND CAN BARELY GET TO THE COUCH TO THE REFRIGERATOR.

IT ENCOMPASSES EVERYBODY.

JUST BECAUSE HAVE YOU HEART FAILURE DOES NOT MEAN, YOU KNOW, THAT YOU ARE FAILING.

IT'S A CHRONIC CONDITION THAT NEEDS MEDICATION AND NEEDS ATTENTION.

AND IT'S VERY COMMON BECAUSE ALL OF THOSE RISK FACTORS ARE VERY COMMON.

BUT IT DOES NEED TO BE TREATED AND SO IT'S-- YOU HAVE ALL THE WHOLE SPECTRUM.

I WOULD SAY PROBABLY 15% OF PEOPLE WITH COULD BE JESSE TIFF HEART FAILURE HIVE WITH CONGESTIVE HEART FAILURE LIVE A LIFE HINDERED BY THEIR HEART FAILURE.

SOME PEOPLE IT'S DIAGNOSED IN THEIR OFFICE.

SOME PEOPLE IT'S DIAGNOSED WHEN THEY CAN'T BREATHE AND THEY SHOW UP IN THE EMERGENCY ROOM.

YOUNGER PEOPLE HAVE BEEN TREATED WITH BRONCHITIS THREE OR FOUR TIMES BEFORE IT'S FINALLY DIAGNOSED.

>> FUNNY YOU SAY THAT BECAUSE I REMEMBER A LONG TIME AGO WHEN GREEKS WERE STILL TREATING PEOPLE WITH BLOOD LETTING AND AS AN INTERN, A GUY CAME INTO THE EMERGENCY ROOM, CAME IN TWICE AND I KEPT DIAGNOSING HIM AS HAVING PNEUMONIA, MY SENIOR LEVEL PERSON KEPT SAYING HE HAS PNEUMONIA.

HE WAS IN CONGESTIVE HEART FAILURE.

>> YOUNGER PEOPLE FOOL YOU.

>> I LEARNED THAT LESSON.

>> YOU DON'T THINK ABOUT IT AND UNTIL IT'S TREATED PROPERLY, THAT PERSON IS STILL GOING TO BE SHORT OF BREATH AND KEEP SHOWING UP AND IT'S ASTHMA OR BRONCHITIS THAT WON'T GO AWAY.

BE YOUR OWN ADVOCATE.

IS THIS MY HEART?

>> WHAT OTHER SYMPTOMS ARE THERE OF HEART FAILURE?

>> SHORTNESS OF BREATH WHEN YOU WALK, SHORT LESS OF BREATH WHEN YOU GO UP A FLIGHT OF STAIRS.

SHORTNESS OF BREATH WHEN YOU LIE DOWN FLAT, HAVE YOU TO PROP YOURSELF UP.

YOUR LUNGS GET FILLED UP.

SO YOU PROP YOURSELF UP A LITTLE BIT.

IF YOU WAKE UP IN THE MIDDLE OF THE NIGHT AND YOU FEEL LIKE YOU ARE GASPING FOR AIR A LITTLE BIT, THOSE ARE THE COMMON SYMPTOMS.

OTHER SYMPTOMS ARE SWELLING IN YOUR ANKLES AND SWELLING IN YOUR BELLY.

>> AND THE BELLO ALSO-- THE BELLY ALSO?

>> SOME PEOPLE HAVE SKINNY ANKLES AND SWELL IN THEIR BELLY.

THEY'RE BELLY BLOATERS OR LOWER ANKLES GET SWOLLEN.

IT'S VERY CHALLENGING.

IT'S TRICKY WHERE FLUID CAN HIDE.

IF YOU HAVE SWELLING IN YOUR BELLY OR ANKLES, BY THAT POINT YOU ARE PRETTY FULL OF WATER.

>> DO THESE PEOPLE GET UP A LOT AT NIGHT TO URINATE?

>> NOT EVERYBODY.

THAT'S JUST KIND OF A HUMAN THING.

AS YOU GET OLDER, ACTUALLY THE BLOOD FLOW TO YOUR KIDNEYS IS BETTER WHEN YOU ARE LYING FLAT AND YOU YOUR BLADDER CAN'T HOLD AS MUCH.

>> HOW DO YOU MAKE THE DIAGNOSIS.

>> CLINICAL DIAGNOSIS.

PHYSICAL EXAM.

WE LOOK AT YOUR NECK.

HERE IS TOM VAIN-- THE ONLY VEIN WITHOUT A VALVE.

THE DOCTOR IS GOING TO COME IN, CARD CARDIOLOGIST AND SAY WHY AREN'T THEY LISTENING TO MY HEART.

I LOOK AT YOUR NECK TO SEE YOUR WATER LEVEL AND WE LISTEN TO YOUR LUNGS, YOUR HEART, TAKE YOUR PULSE.

DO OUR EXAM AND YOUR HISTORY.

AND YOU SHOULD BE ABLE TO TELL BY PHYSICAL EXAM IF A PERSON HAS HEART FAILURE AND THERE ARE LABORATORY TESTS AS WELL.

YOUR DOCTOR SHOULD ORDINARY AN ULTRASOUND OF YOUR HEART.

>> ULTRASOUND.

WHAT IS THAT AND WHAT ARE YOU LOOKING FOR.

>> ECHOCARDIOGRAM.

SO IT'S EASY TO REMEMBER.

ECHO, IF SOMEBODY THINKS YOU HAVE HEART FAILURE LOOKING FOR THE SQUEEZE OF THE HEART.

SO THE NORMAL SQUEEZE TO CREATE EVERY PULSE TO GET EVERYTHING TO THE BODY, YOU KNOW, EVERYBODY WANTS THEIR BLOOD, THE KIDNEY, SPLEEN, LIVER, BRAIN, EVERYBODY WANTS A DELIVERY, RIGHT, EVERY 10 SECONDS THEY WANT A DELIVERY.

SO THAT SQUEEZE HAS TO BE 50% OR HIGHER.

>> SO THE AMOUNT OF BLOOD THAT IS MOVED WITH EACH SQUEEZE SHOULD BE AT LEAST 50%.

>> SO WHEN YOU GET THAT REPORT OR YOU ASK YOUR DOCTOR WHAT WAS MY SQUEEZE?

WHAT WAS MY EJECTION FRACTION?

THAT'S THE WORD YOU WANT TO KNOW FROM YOUR ECHO, YOUR ULTRASOUND OF THE HEART, YOU WANT TO KNOW IT'S ABOVE 50%.

NOW THERE IS A VARIANT OF HEART FAILURE WHERE YOUR SQUEEZE IS PRESERVED.

IT'S JUST THICK AND WON'T RELAX AND YOU STILL FILL UP WITH FLUID.

SO YOU NEED TO KNOW DO I HAVE HEART FAILURE AND WHAT IS MY EJECTION FRACTION.

THAT PUTS NEW TWO DIFFERENT BUCKETS FOR TREATMENT.

IF IT IS ABOVE 50%, CHANCES ARE YOUR HEART IS A LITTLE STIFF.

IF IT'S BELOW 50%, THAT MEANS THAT YOUR HEART EITHER HAS GENETIC COMPROMISE, HAS HAD HEART ATTACKS, HAS HAD RHYTHM ISSUES, VALVE ISSUES, AND SO WE TRY TO DO EVERYTHING WE CAN TO FIX THE UNDER LYING CAUSE.

AND THEN THERE IS FOUR BASIC IMMEDIATE CAUTIONS THAT WE USE.

>> FOUR?

>> IT'S NOT LIKE CANCER.

IN CANCER YOU NEED EXACTLY WHAT TYPE OF CANCER TO GIVE THE RIGHT KEEP CHEMO.

HERE IT IS THE SAME FOUR.

>> I WANT TO GO BACK TO ONE THING.

IF THE EJECTION FRACTION IS NORMAL BUT YOU SAID YOU CAN STILL HAVE... IS THAT A FAILURE BECAUSE THE BLOOD IS NOT GETTING BACK INTO THE HEART AS IT SHOULD?

>> IT'S A FAILURE BECAUSE YOUR HEART USED TO RELAX AND IT NEEDS TO SQUEEZE.

IN ORDER TO FILL UP, IT NEEDS TO RELAX AND LET BLOOD GET INTO THE CAVITY AND SQUEEZE THE BLOOD OUT.

IF IT CAN'T RELAX, LESS BLOOD GETS IN THE CAVITY AND THEN WHEN IT SQUEEZES, IT ALL DOESN'T GO FORWARD, SOME OF IT GOES BACKWARDS.

>> SO THAT COULD BE A VALVE PROBLEM?

>> IT'S A VALVE PROBLEM, BLOOD PRESSURE PROBLEM OR AS WE AGE, OUR HEART GETS STIFFER.

>> EVERYTHING GETS STIFFER AS WE GET OLD.

JOINTS GET STIFFER.

>> YOU KNOW WHAT?

KEEP GOING.

IT'S GOING TO HAPPEN.

WEAR AND TEAR.

BUT YOU CAN PREVENT, YOU KNOW, THE AILMENTS OF AGING.

KEEP MOVING, EAT A VEGETABLE, STOP SMOKING OR DON'T START SMOKING.

THAT'S BY BIG THING.

YOU CAN PREVENT SOME OF THOSE THINGS AND WE'LL GET TO TALKING ABOUT... >> TELL ME, YOU MENTIONED FOUR MEDICATIONS.

WHAT KIND OF MEDICATIONS?

>> SO WHEN YOUR HEART STARTS FAILING, THE REST OF THE BODY WANTS THEIR DELIVERY, RIGHT?

EVERY 10 SECONDS.

THEY NEED SOMETHING, RIGHT?

OKAY.

THEY WANT 60 BEATS A MINUTE.

THEY WANT THEIR DELIVERY.

SO WHAT THE KIDNEYS DO THE MOST IS THEY SEND OUT HORMONES TO THE HEART AND SAY COME ON.

GET GOING.

SO THESE HORMONES MAKE THE HEART SQUEEZE MORE.

AND THE HEART IS SHAPED LIKE A FOOTBALL.

IN ORDER TO GET THIS DELIVERY, YOU KNOW, EVERY FIVE TO 10 SECONDS OUT TO THE WHOLE BODY, IT HAS TO SQUEEZE, IT HAS TO TWIST, IT HAS TO TORQUE, IT HAS TO PUMP, IT HAS TO ROCK, ALL THESE MOTIONS.

IF I GAVE YOU A WET RAG AND I SAID WAYNE, GO AHEAD AND GET ALL THE WATER OUT YOU CAN IN FIVE SECONDS.

YOU WOULDN'T JUST LIKE LIKE THIS.

YOU WOULD TWIST IT, TORQUE IT.

FIVE SECONDS, I'M GOING TO GET THIS OUT.

HEART DOES THE SAME THING.

WHEN IT STARTS FAILING, IT BECOMES DISORGANIZED, ALL THE LITTLE CELLS BECOME DISORGANIZED AND IT CAN'T DO ALL THE MOTIONS.

THE KIDNEYS ARE THE CULPRIT.

THEY SEND OUT NOR EPINEPHRINE OR MESSAGES TO HEART TO SAY I WANT MORE BUT IT CAUSES MORE DISORGANIZATION IN THE HEART SO THE HEART JUST STARTS DILATING AND BECOMES SHAPED LIKE A BASKETBALL AND IT CAN'T DO ALL THE MOTIONS SHAPED LIKE A BASKETBALL.

THAT'S WHY IT'S CALL DILATED CARDIOMYOPATHY.

AT A POINT IT DILATES TO THE POINT WHERE I CAN'T GIVE YOU WHAT YOU WANT AND YOU START BACKING UP WITH FLUID, IT BACKS UP IN THE LUNGS, IT BACKS UP IN YOUR BELLY, IN YOUR LEGS AND THEN THE KIDNEYS AREN'T GETTING THE DELIVERY SO YOU START HAVING KIDNEY PROBLEMS AND THAT'S WHEN PEOPLE SHOW UP TO ME.

>> GOTCHA.

>> AND I POUT PUT THEM ON THE FOUR MEDICATIONS THAT BLACK THE NOREPINEPHRINE AND I TELL THEM TO STOP BEATING UP THE HEART.

>> YOU ARE NOT TELLING THE HEART TO CONTRACT MORE.

>> THEY'RE TRYING TO.

>> BUT YOU ARE NOT DO THAT.

>> I'M BLOCKING THE HORMONE IS BECAUSE IF YOU PROTECT THE HEART A LITTLE BIT, IT CAN RESHAPE ITSELF.

>> AND BY THE WAY, I'M VERY IMPRESSED THAT A HOCKEY MOM WOULD USE BASKETBALL AND FOOTBALL.

>> MY MOM-- MY BOYS ARE GOING TO BE LIKE, MOM, YOU HAVE TO COME UP WITH SOMETHING ELSE.

>> I MAY BE JUMPING AHEAD.

TELL ME SOME OF THE WONDERFUL THINGS YOU ARE DOING AT THE ADVANCED HEART FAILURE PROGRAM.

>> SAY THE FOUR MEDICATIONS DON'T WORK.

LIKE I SAID, WE DON'T HAVE TO HAVE SPECIALIZED.

IT'S THE SAME FOUR MEDICATIONS WHETHER IT'S A VALVE, VIRUS, GENETICS, HYPERTENSION, CORONARY DISEASE.

YOU ARE GOING TO GET THE SAME FOUR MEDS FROM ME.

THAT'S THE BEAUTY OF IT.

LET'S SAY THAT DOESN'T WORK.

GREAT QUESTION.

WHAT WE WILL DO IS WE ARE GOING TO MONITOR YOUR ECHO, THE ULTRASOUND OF YOUR HEART AND LOOK AT YOUR EJECTION FRACTION.

IT MIGHT BE 10 OR 20 WHEN YOU SHOW UP TO ME BECAUSE THAT'S ABOUT WHAT IT IS WHEN YOU ARE GETTING THESE TERRIBLE SYMPTOMS AND THEN I'M GOING TO TRY TO GET IT UP ABOVE 50 BUT WHAT IF I GET STUCK AT 10 OR 20.

YOU FEEL BETTER BUT YOU ARE STUCK THERE AND YOU ARE 55 YEARS OLD.

YOU ARE LIKE I WANT TO LIVE ANOTHER 25 YEARS.

AM I GOING TO DO THAT?

WHAT WE WILL DO IS MONITOR YOU WITH A SPECIAL EXERCISE TEST ECHOS AND DO SOME THINGS IN THE CATH LAB, SOME TESTING, TO BE ABLE TO SEE WHERE YOUR TRAJECTORY IS.

AND IF YOU ARE HEADED NOT IN THE RIGHT DIRECTION OR YOU ARE VERY SICK, THE MEDS DIDN'T WORK.

YOU COULDN'T GET ON A HIGH DOSE.

SOMETHING HAPPENED, RIGHT?

WE HAVE TRANSPLANT AND ARTIFICIAL HEART PUMPS.

>> TELL ME ABOUT THE PUMP BECAUSE THAT IS ONE OF THE MOST AMAZING AND WEIRD SOUNDING THINGS THAT I'VE EVER HEARD.

>> IT IS, ISN'T IT?

SO IT'S A SMALL PUMP.

THE SIZE OF A D BATTERY, PUT INTO ASSIST, A LEFT VENTRICULAR ASSIST DEVICE SURGELY IMPLANTED INTO YOUR HEART AND IT HAS AN OUTFLOW GRAFT TO YOUR A OR THEA WHICH IS WHERE YOUR HEART TRIES TO PUMP THINGS TO THE BODY AND IT PROVIDES FIVE LITRES OF FLOW AND THE HEART MAY BE ABLE TO DO ONE OR TWO LITRES ON ITS OWN, IT'S A LEFT VENTRICULAR ASSIST DEVICE.

YOU RUN ON BATTERIES, YOU HAVE A FANNY BACK AND BATTERIES AND A VEST LIKE A FISHING VEST.

WE LADIES CAN USE JOGGER PANTS AND PUT THE BATTERY THERE SO WE CAN USE OUR CUTE OUTFITS.

I HAVE A BUNCH OF LADIES THAT HAVE BEDAZZLED BAGS.

WE ARE FASHIONABLE.

WE ARE FASHIONABLE.

SO IT DOESN'T STOP YOU FROM LIVING YOUR BEST LIFE.

THE ONLY THING YOU CANNOT DO IS YOU CANNOT SWIM BUT YOU CAN TAKE A SHOWER.

YOU CAN TRAVEL.

I'VE HAD PEOPLE TRAVEL ACROSS THE COUNTRY, GO ON CRUISES.

YOU ARE UNSTOPPABLE.

YOU HAVE TO TAKE A FEW PILLS.

SOME BLOOD THINNER OR BLOOD PRESSURE PILLS.

DIURETIC.

THREE OR FOUR PILLS AND IN THE FIRST THREE OR FOUR MONTHS YOU SEE US QUITE A BIT AND AFTER THAT IT'S ONCE EVERY THREE MONTHS.

>> THIS USED TO BE CONSIDERED A BRIDGE FOR SURGERY.

IT SOUNDS LIKE YOU ARE SAYING THIS IS NOT A BRIDGE BUT MAY BE THE THERAPY YOU NEED.

>> WE HAVE HAD SO MANY PATIENTS THAT LIVE OVER 10 YEARS.

>> 10 YEARS WITH THIS.

>> AND MAYBE MORE.

THIS PUMP, THE CURRENT ONE WE ARE USING, WE HAVE JUST STARTED IMPLANTING SINCE 2016-17.

WE DON'T KNOW HOW LONG IT CAN GO BUT I THINK IT CAN GO QUITE A DISTANCE.

SO I THINK THAT PATIENTS ARE GOING TO BE... AND THE BEAUTY OF IT IS, YOU TALK AWAY A LOT OF THE MEDS THAT YOU NORMALLY HAVE TO TABLING.

AND TRANSPLANT IS WONDERFUL.

I MEAN IT IS A GIFT, A MIRACLE.

BUT THERE IS IMMUNE SUPPRESSION.

THE PUMP DOESN'T REQUIRE ANY IMMUNE SUPPRESSION OR BISHOPS OR ANYTHING LIKE THAT-- ANY BIOPSY OR ANYTHING LIKE THAT.

WE HAD A PATIENT LIVE WITH HIS PUMP FOR SEVEN YEARS AND THEN GOT THE TRANSPLANT.

>> WHAT ARE THE INDICATIONS NOW FOR SOMEONE GETTING A CARDIAC TRANSPLANT?

>> RIGHT NOW FOR CARDIAC TRANSPLANT, YOU HAVE TO HAVE FAILED MEDICAL THERAPY.

THE SQUEEZE OF YOUR HEART IS USUALLY LESS THAN 25%.

WE DO A VERY SPECIAL EXERCISE TEST TO DETERMINE THAT YOU ARE EXERCISING AT-- YOUR BODY IS DELIVERING UNDER HALF OF WHAT IT SHOULD BE ABLE TO DELIVER FOR A FEMALE OR MALE AT THAT PERSON'S ABLE.

AND THEN WE DO A RIGHT HEART CATH RIZZATION TO MAKE SURE IT'S PERFECT.

FOR A TRANSPLABILITY TO BE SUCCESSFUL, YOU HAVE TO BE HEALTHY OTHERWISE.

NO CANCERS AND NO ACTIVE INFECTIONS AND WE ARE GOOD.

ARE PEOPLE SAYING I'LL SIT TIGHT WITH MY ASSIST DEVICE OR DO YOU SAY IT'S NOT CUTTING IT AND HAVE YOU TO GO.

>> WE'LL LET YOU KNOW MEDICALLY.

IT SUPPORTS THE LEFT SIDE OF YOUR HEART.

IF YOUR RIGHT SIDE IS UNDER THE WEATHER, THEN WE SAY YOU ARE GOING TO PROBABLY NEED TRANSPLANT.

IF YOUR KIDNEYS ARE A LITTLE BIT LIKE IF YOU NEED HEADING TOWARDS DIALYSIS OR SOMETHING LIKE THAT, WE DON'T WANT YOU TO A HEART PUMP OR DIALYSIS.

IF YOU ARE A CANDIDATE FOR BOTH, WEEKS PLAIN TO YOU BOTH AND LET YOU PICK.

>> I DON'T WANT AN ASSIST DEVICE OR A TRANSPLANT OR BE THE PERSON WITH THE WILLIE WONGA GOLDEN TICKET WITH THE HEART FAILURE.

WHAT ARE THE THINGS THAT WE CAN DO TO KEEP US FROM SITTING IN YOUR OFFICE?

>> IT'S REALLY MINIMAL, RIGHT?

EVERYTHING IN MODERATION.

GO FOR A WALK, WE SAY 10,000 STEPS A DAY.

IT'S CHALLENGING AND WE ARE SITTING.

WE ARE NOT WALKING AROUND INTERVIEWING EACH OTHER.

SO WE SIT A LOT.

BUT A LOT OF PEOPLE DON'T.

THEY'RE FORTUNATE TO HAVE JOBS WHERE THEY ARE UP AND WALKING.

YOU HAVE TO USE YOUR TENNIS SHOES.

YOU DON'T HAVE TO GO TO THE GYM AND DO A BIG WORKOUT.

SIMPLE WALKING, GETTING YOUR STEPS IN.

DO NOT BE SEDENTARY AND IF YOU DO HAVE DIABETES, BE AWARE AND START DOING THE LIFESTYLE MODIFICATIONS TO HAVE IT NOT BECOME FULL BLOWN DIABETES.

AND SO IT'S DIABETIC CONTROL, BLOOD PRESSURE CONTROL, RIGHT, DECREASE THE SALT IN YOUR DIET, AND EAT A VEGETABLE.

SO I TELL PEOPLE, RIGHT, GO FOR A WALK, EAT A VEGETABLE, DON'T SMOKE.

THAT'S MY MANTRA.

>> EASY LIKE THAT.

>> IT'S NOT-- I MEAN IT'S AMAZING.

IF YOU DO SOME OF THE STUFF IN 12 WEEKS, IF YOU-- SAY YOU CUT OUT SODA.

SAY YOU CUT OUT SNACKING.

SAY YOU SAY I'M GOING TO DECREASE MY SALT.

THAT'S NOT TOO HARD SAYING I'M GOING TO SWITCH OUT THE SODA FOR SELTZER WATER.

I'M GOING TO NOT SNACK.

I'M GOING TO EAT MY MEALS.

USE PORTIONS, NOT GOING TO DENY YOU A SINGLE THING, JUST DO NORMAL PORTIONS AND YOU SAY EVERY DA DAY RHYME GOING TO WALK A MILE.

YOU WILL CHANGE IN 12 WEEKS.

IT'S AMAZING.

IT'S AMAZING HOW QUICKLY YOUR BODY WANTS TO BE HEALTHY.

IT REALLY IS DESIGNED-- BODIES ARE AMAZING.

WE DIDN'T HAVE MODERN MEDICINE.

THE FIRST ANTIBIOTICS WERE RIGHT AFTER WORLD WAR I, 1920s AND 30S THE SULFA DRUGS CAME ALONG.

WE HAVEN'T HAD ALL THIS.

THIS IS ALL BRAND NEW AND SOMEHOW WE SURVIVED.

SOMEHOW WE MADE IT.

SO OUR BODIES ARE DESIGNED TO SURVIVE IF WE LET THEM.

>> YOU MENTIONED SALT A COUPLE OF TIMES.

WHAT ABOUT THAT PERSON WHO HAS THE VENTRICULAR ASSIST DEVICE.

WHAT OTHER MODIFICATIONS MUST THEY MAKE TO LIFESTYLE?

YOU MENTIONED ABOUT NOT SWIMMING AND THINGS LIKE THAT.

ARE THERE OTHER DIETARY MODIFICATIONS?

>> NO ONE HAS TO MAKE A MODIFICATION BUT WE RECOMMEND LIKE TRYING TO BE HEALTHY.

LIKE HERE YOU WENT THROUGH A HEART SURGERY.

WE WANT YOU TO GO AS LONG AS YOU CAN, TRY TO BE HEALTHY BUT HONESTLY, THE PEOPLE WITH THE VENTRICULAR ASSIST DEVICE OR MECHANICAL HEART, THEY USUALLY COME OFF A LOT OF THEIR DIURETICS AND CAN EAT A LITTLE MORE SALT BECAUSE WE'VE-- THEIR PUMP IS NORMAL NOW.

SO THEY DON'T HAVE HEART FAILURE ANYMORE.

AND EVEN WHEN THEY HAVE THAT IN, WE GIVE THEM MEDICATIONS TO TRY TO RECOVER THEIR HEART.

THERE ARE VERY FEW PEOPLE WHO HAVE HAD HEART RECOVERY BUT IT'S POSSIBLE.

WE NEVER STOP LOOKING AND TRYING TO GET YOUR HEART BETTER.

SO IT IS PRETTY AMAZING.

AND SO THERE ARE SOME FOLKS THAT HAVE JUST HAD CANCER, RIGHT AND THEY DEVELOP HEART FAILURE, RIGHT?

THEY CAN'T GET IMMUNE SUPPRESSION BECAUSE THEY'VE HAD CANCER.

THE VENTRICULAR ASSIST DEVICE IS THERE.

WE HAVE COME SO FAR IN OUR TECHNOLOGY.

FOLKS WHO DON'T HAVE TIME ON THE WAIT LIST WHO CAN'T WAIT FOR AN ORGAN, WE HAVE MECHANICAL CIRCULATORY SUPPORT.

U OF L IS SO LUCKY.

WE HAVE BEEN TRANSPLANTING SINCE THE 1980s.

SO THIS AREA OF KENTUCKY IS VERY, VERY LUCKY TO HAVE THAT PROGRAM.

AND THEY HAVE BEEN PIONEERS IN MECHANICAL SUPPORT.

AND YOU KNOW, WE HAVE A GREAT TEAM.

WE WANT TO HELP PEOPLE.

AND, YOU KNOW, GO CARDINALS.

WE ARE FAMILY.

>> WELL, I MUST ADMIT, YES, WHEN YOU TALK ABOUT THE HISTORY, PEOPLE FORGET THAT THE FIRST ARTIFICIAL HEART WAS PUT IN HERE.

AND I REMEMBER PATIENTS WALKING AROUND WITH THESE SUITCASES OF VENTRICULAR DEVICES AND HERE YOU ARE TALKING ABOUT THESE LITTLE TINY THINGS.

>> IT'S AMAZING.

ONE OF MY FRIEND'S PATIENTS GOT MARRIED WITH HER ARTIFICIAL PUMP IN.

IT WAS TUCKED UNDER THE BOD IS OF HER WEDDING GOWN.

>> Dr. MOORE, THANK YOU VERY MUCH FOR EXPLAINING TO US WHAT HAS BEEN A COMPLEX PROBLEM FOR ME BUT MAKING IT SIMPLER FOR US TO UNDERSTAND.

THANK YOU VERY MUCH AND I WOULD LIKE TO THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU, LIKE ME, NOW HAVE A BETTER UNDERSTANDING OF WHAT HEART FAILURE IS, WITH THE CURRENT AVAILABLE 2R50E789 OPTIONS AND HOW TO PREVENT OR MITIGATE SOME OF THE ASSOCIATED COMPLICATIONS OF HEART FAILURE.

IF YOU WISH TO WATCH THIS SHOW AGAIN AND WATCHED AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A QUESTION ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH."

PLEASE TAKE GOOD CARE OF I DON'T ARE HEART.

EAT A VEGETABLE AND WALK.