Sotatercept, sold under the brand name Winrevair, has been shown to increase exercise capacity, reduce symptoms that affect day-to-day activities and lower the risk of clinical worsening from the condition.

The FDA approved sotatercept in March under its expedited approval process after determining sotatercept was a “breakthrough drug” that could be a significantly better treatment for a life-threatening condition such as pulmonary arterial hypertension. The condition’s name is sometimes shortened to PAH.

“There’s no cure for pulmonary arterial hypertension, which is why new and better therapies like sotatercept are so important for PAH patients” said John W. McConnell, M.D., a principal investigator in the clinical trial that led to sotatercept’s approval. Dr. McConnell is a pulmonologist with Norton Pulmonary Specialists and medical director of Norton Healthcare’s pulmonary hypertension program.

As a principal investigator in the recently concluded sotatercept clinical trial, Dr. McConnell has extensive experience treating patients with the drug. He is also the principal investigator in two additional studies of sotatercept in combination with other medicines for pulmonary arterial hypertension.

Pulmonary arterial hypertension is rare condition that gets worse over time and is ultimately life-threatening. The condition can lead to right heart failure and can be deadly after a few years.

Pulmonary hypertension is a broad term for high blood pressure that’s localized in the lungs, unlike more widespread hypertension, which is high blood pressure throughout the body. Pulmonary arterial hypertension is the term used to describe rarer instances when the condition is the result of narrowed or blocked pulmonary arteries.

Pulmonary arterial hypertension results from the excessive growth and dysfunction of cells that line the arteries carrying blood from the heart to the lungs. Smaller arteries in the lungs thicken and narrow, restricting blood flow and contributing to high blood pressure in the lung that can damage the heart and restrict physical activity. A right heart catheterization measures pulmonary artery pressure and is a critical part of an accurate diagnosis.

Sotatercept works by inhibiting the cell overproduction and allowing the pulmonary artery and smaller arteries to revert to a healthier structure. It’s the first drug to do this.

Pulmonary arterial hypertension is most common in women between the ages of 30 and 60, according to the American Lung Association. Because the cause of pulmonary arterial hypertension isn’t known, it is sometimes called idiopathic pulmonary arterial hypertension. The condition may have a genetic component, and some conditions increase risk for the disease. Congenital heart disease is a risk factor for the disease, according to the American Heart Association, along with  connective tissue disease, including scleroderma and lupus.

Sotatercept is delivered by an injection that the patient can administer every three weeks. The medication is expensive. Even with insurance, some pulmonary arterial hypertension patients need help with the copay, according to Dr. McConnell. Nurses at Norton Pulmonary Specialists are available to help patients with the process of signing up for the drug once it’s prescribed and applying to sources of copay assistance, according to Dr. McConnell.

Pulmonary arterial hypertension affects an estimated 40,000 people in the United States. As many as half of them may be eligible for sotatercept. Shortness of breath during exercise is a symptom of pulmonary arterial hypertension, according to the National Heart, Lung, and Blood Institute. Symptoms tend to get worse over time and may include dizziness, swelling of the ankles or legs, chest pain, and a racing pulse.

By making the heart work harder to pump blood through the lungs, pulmonary arterial hypertension puts a significant strain on the heart. Over time, the heart muscle becomes weak from the extra effort, leading to heart failure.

Pulmonary arterial hypertension also affects quality of life. Many people with pulmonary arterial hypertension need a continuous infusion therapy administered by a pump that they must carry with them at all times. Oxygen therapy delivered by a constantly present tank may be required as disease progresses.

Clinical trial findings

The clinical trial compared patients who received the new therapy with those who received a placebo.

Among the findings, treatment with sotatercept:

• Resulted in an improvement in day-to-day function for almost a third of people taking the drug, double the number of those who improved taking the placebo
• Led to bigger improvements in six-minute walking distance
• Made it easier for the heart to pump blood through the blood vessels in the lungs
• Reduced the chances of worsening events or death by 84%

Serious side effects were rare, but sotatercept did increase the chance of serious bleeding. This was more likely in patients who also were receiving prostacyclin infusion, were on blood thinners or had low platelet counts. Sotatercept also may increase hemoglobin, which could lead to erythrocytosis, a thickening of the blood that makes it less able to travel through blood vessels and organs.

The most recently completed clinical trial tested the drug in patients who met the World Health Organization criteria for functional class II or III, meaning they had no symptoms while resting, but had varying severity of symptoms while physically active.

A study currently underway at Norton Pulmonary Specialists is testing the safety and efficacy of the drug in patients who are in class III or IV and at high risk of death.

Sotatercept is given along with conventional background medication for pulmonary arterial hypertension. Lung transplant is also a treatment for advanced stages of the disease.

Current clinical trials for pulmonary arterial hypertension at Norton Pulmonary Specialists

The post Sotatercept: A new pulmonary arterial hypertension treatment appeared first on Norton Healthcare.

Stephanie received a pacemaker and implanted defibrillator, and lived a full life until five years ago, when she began being shocked repeatedly by her defibrillator.

“This is a sign that the heart is trying to die,” said Kelly C. McCants, M.D., executive medical director of Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program and executive director, Institute for Health Equity, a Part of Norton Healthcare.

At that point, Stephanie was referred to the UK HealthCare Heart Transplant Program. As a UK HealthCare affiliate network member, Norton Healthcare works closely with UK to provide patients access to transplant care. In 2019, she received a heart transplant and has returned to living life to its fullest.

Two journeys converge

Fast-forward to 2023, when 38-year-old Holly Cole came to Norton Heart & Vascular Institute after moving from Michigan to Louisville. Just like Stephanie, Holly had been diagnosed with cardiomyopathy, but as an infant. And just like Stephanie, the same diagnosis took Holly’s father’s life years ago.

During Holly’s visit with Dr. McCants, she learned it was time to make the referral to UK HealthCare to put her on the heart transplant list.

“It was an extremely emotional clinic visit,” said Susan Spayd, R.N., clinical manager of the Advanced Heart Failure & Recovery Program, who knew Stephanie’s story. “Holly broke down crying when she heard this news.”

Susan was struck by the similarities in the two women’s stories and asked Holly if she could introduce her to Stephanie.

The two connected by phone, then agreed to meet for dinner. Shortly after, Stephanie introduced Holly to another friend, who would also play a key role in walking with Holly along her transplant journey. The three developed a fast friendship and made plans to help with whatever was needed before and after Holly’s transplant.

The blessing came in August 2023. Holly called her friends to tell them to “get to Lexington ASAP. A donor heart is available!” Holly’s friends and support system immediately hopped in their cars to make the trip.

Holly is now on her way to a long and full life thanks to the generous gift she received and the support of her new friends.

“I’m loving getting out and walking my dog,” she said.

What started as an ask for emotional support from one experienced person to another has blossomed into a deeper friendship. An unexpected blessing was the added appreciation Stephanie gained from making the connection.

“It was so eye-opening to be on the other side. It really helped me understand what my family and friends went through during all the stages of my own transplant journey,” she said.

Wherever their journeys take them, Stephanie and Holly are committed to being there for one another. They agree a strong heart is a powerful and lifechanging gift — but so is a strong friendship.

“You can’t do this on your own,” Holly said. “I’m glad to have this friendship and close bond with Stephanie.”

Working together for healthier hearts

UK HealthCare in Lexington, Kentucky, and Norton Heart & Vascular Institute began a collaboration in 2021 to expand complex heart care, including heart transplant services, to Kentuckians. UK HealthCare Transplant & Specialty Clinic, located on the campus of Norton Audubon Hospital, allows cardiologists from UK and Norton Healthcare to evaluate patients for heart transplants and ventricular assist device care.

Treatments for advanced heart failure are expanding rapidly. The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program offers sophisticated treatments and a new way to look at the management of heart failure.

Be a part of the gift of life

According to the American Heart Association, at any given time up to 3,000 people nationwide are waiting for the lifesaving gift of a heart. Their waits range from days to months to years. You can help by:

• Registering as an organ donor at your local motor vehicle department

• Signing up through your state’s online registry at OrganDonor.gov

• Letting your family know of your wish to be an organ donor

• Making a gift to Norton Heart & Vascular Institute at NortonHealthcareFoundation.com

The post Women form lasting bond over shared heart transplant journeys appeared first on Norton Healthcare.

Heart failure is a condition that means your heart can’t pump blood as well as it should. The Centers for Disease Control and Prevention (CDC) estimates that about 6.2 million American adults have heart failure. Heart failure was mentioned on the death certificates of 379,800 people in 2018.

Heart failure can be caused by or made worse by many factors, including weight, smoking, other health conditions and physical activity level. Even though heart failure can limit your ability to move your body, it doesn’t have to stop you completely. In fact, getting regular exercise can help strengthen the heart muscle, protect against future damage and improve your overall health and well-being.

If you have heart failure, you may be afraid to exercise, but you can if you follow some guidelines.

“You can absolutely still be active with heart failure,” said Natalie K. Kendall, APRN, cardiology nurse practitioner with Norton Heart & Vascular Institute. “It’s important to do that safely.”

What does exercise do for your heart?

No doubt you’ve heard that exercise is good for you, but do you know why? There are many reasons moderate- to vigorous-intensity exercise is good for you, including:

• Strengthening the heart muscle so it can pump blood more effectively, which means more oxygen in your blood to be delivered to cells.
• Widening the blood vessels so more oxygen-filled blood can move through the body and waste can be taken away.
• Prompting muscles and tissues to demand more oxygen and nutrients, which makes the heart pump harder and faster. (Over time, this builds strength in the muscle so the heart can push more oxygen-rich blood out each time.)
• Reducing inflammation throughout the body.
• Lowering blood pressure by widening blood vessels and releasing endorphins, the body’s “feel good” chemicals

Your cardiovascular health affects your entire body, quality of life and well-being. Even small amounts of cardiovascular improvement can allow you to move through your day with less discomfort.

Can heart failure be reversed with exercise?

Heart failure cannot be reversed completely. It can, however, be managed. According to a small study in the journal Circulation, the heart can get stronger and have improved elasticity after a period of regular exercise.

“Since we don’t really have a cure we want to prevent it from happening in the first place, or we want to keep it from getting worse,” Natalie said.

Activities that can strengthen the heart and lungs and build stamina can ease the stress on the heart. Exercise also can help manage weight and blood sugar, which are both linked to heart failure. Physical activity also reduces the likelihood of hospitalization for heart failure, according to the British Heart Foundation.

The experienced team of heart failure specialists at Norton Heart & Vascular Institute can direct your care based on your specific needs. 

What are good exercises if you have heart failure?

As long as your health care team says it’s OK, you can begin with aerobic activity that will increase your heart and breathing rates a little. This could be moving to music or walking. You also could include some light weights or resistance training. Some activities like gardening may include both cardiovascular exercise and weight training. If standing is too tiring, chair-based exercises might be a good start for you.

“There are a few exercises we might not recommend to heart failure patients,” Natalie said. “That would be heavy weightlifting, body weight exercises like planks, and swimming pool-based activities like swimming laps.”

Is it safe to exercise with heart failure?

Never start an exercise program without talking to your health care provider first. They may recommend cardiac rehabilitation, which includes exercise guidance, counseling and education around heart failure and exercise.

Here are some guidelines for getting started with exercise if you have heart failure:

• Start slowly. Try for five to 10 minutes of slow walking and gradually increase as you are able. Your goal should be about 30 to 45 minutes per day total of exercise.
• Cool down at the end of the activity by doing the last few minutes more slowly than you had been.
• Rest when you need to, even if it means skipping an activity because you don’t feel well.
• Some shortness of breath or fatigue is normal at the beginning of any new exercise program, but stop activity if you have excessive shortness of breath, pain or fainting.

You can exercise with heart failure, and it has many benefits for your body, mind and overall health. Talk to your health care provider about starting an exercise program today.

The post How to exercise with heart failure appeared first on Norton Healthcare.

Heart failure does not mean the heart does not beat anymore. It is a condition in which the heart does not pump enough blood and oxygen to the organs and tissues of the body. As a result, the organs in the body do not get the blood they need. This leads to symptoms such as shortness of breath, fatigue and swelling. Left untreated, it can be life-threatening.

While no one can predict exactly how heart failure will affect someone’s life or how it may shorten a life, in general, more than half of all people diagnosed with congestive heart failure will survive for five years. About 35% will survive for 10 years. Average life expectancy for people with heart failure is based on data collected from large groups of people over time.

Other factors that affect life expectancy include:

• Age: The five-year survival rate for people under 65 is around 79%, while the rate is about 50% for those 75 and over.
• Race: For example, African Americans face higher risk for heart disease, which can lead to heart failure.
• Ejection fraction: The measure of how much blood a person’s heart pumps out per beat is known as the ejection fraction (EF).
• Other conditions: If you have other health conditions, such as coronary heart disease, it can affect life expectancy. These conditions include diabetes and chronic obstructive pulmonary disease.
• Risk factors: These include obesity, hypertension (high blood pressure), and a poor diet.

Congestive heart failure is not curable, but early detection and treatment may help improve life expectancy. Following a treatment plan that includes lifestyle changes may help improve quality of life.

It is possible to manage the symptoms of heart failure and make changes that will let you lead a full life. Some changes you can make include lifestyle adjustments, such as:

• Eating a diet of fresh fruits and vegetables, whole grains and lean meats, and limiting processed foods and sodium
• Monitoring your blood pressure
• Managing weight
• Stopping smoking
• Managing your diabetes

Your health care team may put you on medications to help protect your heart. These medications block the hormones that can damage the heart, and moderate heart rate.

While you can make some lifestyle changes, there are some factors you can’t change, including your age, genetic background and race.

Types of heart failure

There are different types of heart failure, and your prognosis will be different based on the kind of heart failure you have, as well as the stage and other factors.

Left-sided heart failure means the heart is working harder than usual because the left atrium and ventricle are damaged or not working properly. There are two types of left-sided heart failure:

• Systolic heart failure means a weakened or enlarged left ventricle prevents the heart from pushing enough blood out of the ventricle.
• Diastolic heart failure means the ventricle is pumping out as it should, but when it refills with blood, it can’t take enough new blood in.

Right-sided heart failure: Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure, but it is less common than left-sided heart failure.

Congestive heart failure:  When the heart isn’t pumping blood effectively, fluid can back up in the veins and tissues of the body.

Advanced heart failure: Sometimes called end-stage heart failure, this is the most severe variation of the condition.

Patients with left sided ischemic heart failure are eligible for Norton Heart & Vascular Institute’s Myocardial Recovery Program. The goal of this program is to strengthen your heart and possibly recover out of heart failure. The program includes:

• Frequent and close monitoring.
• Medication management.
• Working with a healthcare team to address all aspects of your heart failure and give you the best chance at recovery. 

Our Myocardial Recovery Program averages 50% recovery rate for those that participate, which is better than the national average of 10%.

If you have heart failure, there are ways to protect your heart and continue to live a full life.

The post How long you can live with heart failure depends on many factors — lifestyle, stage of the condition and more appeared first on Norton Healthcare.

Pastor Williams is an example for other African American men. He knows that his race puts him at increased risk for various health conditions, so he takes a proactive approach to his health.

“I was eating mostly healthy foods, I was exercising multiple times a week and very active, I was managing my stress as best I could, and I was seeing my primary care provider on a regular basis,” he said. “And every appointment when my blood pressure would be just a few digits higher, I would promise to do better. What I didn’t know is that I was causing damage to my heart.”

In May 2020, Pastor Williams had his annual physical; and while he was feeling more and more tired, he assumed it was normal for a busy leader of a large church, struggling through the early stages of the pandemic and traveling.

When his primary care provider, Handel A. Jones, M.D., Norton Community Medical Associates primary care in Crestwood, listened to Pastor Williams’ heart and heard something he described as “off,” he sent Pastor Williams for additional tests.

The results revealed Pastor Williams had nonischemic cardiomyopathy related to hypertension (high blood pressure). He was experiencing systolic heart failure as a result of blood pressure that was slightly elevated for several years. Pastor Williams was referred to Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program.

The term “heart failure” can sound terrifying.

“I remember thinking, ‘Heart failure? How is this possible and what do I tell my children, my wife and my church family?’” Pastor Williams said. “It was reassuring to walk in and see Dr. McCants — someone I know, someone I trust.”

Pastor Williams already had a relationship with the cardiologist he would be seeing. Kelly C. McCants, M.D., executive medical director, Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program, and executive director, Institute for Health Equity, a Part of Norton Healthcare, also is a member of Bates Memorial Baptist Church, where Pastor Williams is senior pastor.

Dr. McCants explained to Pastor Williams what exactly heart failure means, even drawing a diagram of the heart and explaining how it was functioning at only a fraction of its ability.

Systolic heart failure affects the left ventricle, which becomes too weak to pump blood to the body normally.

In the midst of the conversation, Dr. McCants said, “We can fix it.” This snapped Pastor Williams back into the moment.

“Dr. McCants told me there was a medication that would not only stop the process but rebuild the muscle and help heal my heart, but there is one catch: You have to stay on it for the rest of your life,” Pastor Williams said. “I said, ‘Sign me up!’”

“Pastor Williams is a textbook example for heart recovery,” Dr. McCants said. “His heart failure was caught early, and within weeks we were able to get him started on a medication, monitored him closely and now he is making a recovery.”

The incidence of heart failure in African American men under age 50 is three to four times higher than in men of other races and ethnicities. While Pastor Williams was a few years past his 50th birthday at the time of his diagnosis, his heart failure probably began in his mid-40s.

“High blood pressure does damage under the dark of night,” Dr. McCants said. “Many of the side effects, such as headaches, feeling tired and nosebleeds, go undetected — but destruction to the heart muscle continues to mount all the while.”

Blood pressure is considered to be elevated at 140/90. Most people can manage high blood pressure by taking medication, changing their eating habits and exercising more. But if you don’t know your blood pressure, you can’t manage it. That’s why regular visits with your primary care provider are so important.

Now with his heart on the mend, Pastor Williams is sharing his story. He advocates for friends, family and even strangers to find a primary care provider they trust and see them on a regular basis.

“Regardless of how you feel, go see your doctor routinely,” Pastor Williams said. “It was because of that routine visit that my heart failure was discovered.”

He also encourages people to keep a positive perspective:

“If you have something you need to deal with, then you deal with it. Stop putting it off, because if you don’t want to handle it, it will handle you.”

The post From heart failure to recovery: Medication helps rebuild pastor’s heart appeared first on Norton Healthcare.

“I began to notice the tiredness getting more frequent,” Bob said. “To the point that I found myself winded between bowls and had to take a seat to finish a frame.”

Bob recalls initially being diagnosed with bronchitis that later became pneumonia. While the doctors were treating the respiratory illness, he just wasn’t getting any better. At the close of a weekend softball tournament, Bob was exhausted and new symptoms came on — he coughed up blood. That’s when he and Lucy decided it was time to go the emergency room.

At Norton Audubon Hospital, Bob was immediately admitted. After a battery of tests and lab work, his physicians determined Bob was in end-stage heart failure. His heart was functioning at 10% of its normal capacity.

“I remember the doctor using the term ‘frighteningly low,’ and it was like a bolt of lightning, shock to us,” Lucy said. “Bob is healthy and active, how can this be happening?”

“We measure blood flow through ejection fraction, which is the amount of blood your heart is pumping out with each heartbeat,” said Kelly C. McCants, M.D.,  executive medical director of the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program and executive director of the Institute for Health Equity, a Part of Norton Healthcare. “To put it in some perspective, the normal ejection fraction is 50% or higher. For Bob to be pumping out at only 10% was quiet alarming.”

For the next few months, Dr. McCants and the team treated Bob with medications, trying to improve his ejection fraction. But it was not working. Bob was experiencing “cardiac wasting,” meaning he had lost more than 40 pounds and his health was deteriorating. In January 2022, doctors told him he had six months to live — or he could consider an implantable left ventricular assist device (LVAD) that would keep his heart pumping on a battery pack. It would require him to be plugged into an electrical outlet or use a battery pack at all times. But the pump would keep his heart going at a normal ejection fraction.

By mid-February 2022, Bob had his LVAD implanted by Steven W. Etoch, M.D., cardiothoracic surgeon with Norton Heart & Vascular Institute, and he was on the mend. His heart was functioning at normal capacity, he was regaining some weight and participating in noncontact sports.

“I was limited to shooting pool and golf,” Bob said. “Life on the LVAD was cumbersome taking a battery pack everywhere, and I was restricted from swimming and strenuous activities; but I felt so much better.”

“Bob was doing great, and the LVAD could have carried him through life as a destination therapy,” said Bassel Alkhalil, M.D., heart failure cardiologist and medical director of mechanical support devices at Norton Heart & Vascular Institute. “But we knew Bob was a great candidate for a heart transplant, and living the rest of his life with the LVAD would be very limiting to a person who used to know no limits.”

Dr. Alkhalil and Srikanth Seethala, M.D., heart failure cardiologists at Norton Heart & Vascular Institute, consulted with the transplant team at UK Gill Heart & Vascular Institute. Everyone was in agreement: Bob was an ideal candidate.

For Bob and Lucy, the risk was scary.

“The team prepares you for the worst. This is a dangerous operation; there are risks and complications,” Lucy said. “We had a lot to think about.”

In early November Bob decided he was going to list himself for transplant. With Bob being over 6 feet tall, the transplant team prepared him that there could be a significant wait. Finding a donor is a challenge, let alone a male donor similar to his body build. But as fate would have it, Bob got the call that he has a donor heart just nine days into his wait.

“I was shocked. We were shocked, the transplant team at UK was shocked and the heart failure team at Norton was shocked,” Bob said. “We had three hours to drop everything and rush to Lexington for a surgery that would forever change my life.”

Success and sincere thank-you

Two weeks after his transplant in November 2022, Bob left UK HealthCare with a new heart. He has slowly started returning to the sports he enjoys and is working out five days a week, three of those days at cardiac rehabilitation at Norton Audubon Hospital. He follows up with the transplant team at UK HealthCare as well as with the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery program. Everyone is amazed by his progress.

“We’re honored to be a part of Bob’s journey,” said Navin Rajagopalan, MD, director of UK HealthCare’s Gill Heart and Vascular Institute Affiliate Network. “Patients do better when they get the care they need close to home. Our partnership with Norton Heart & Vascular Institute through the Gill Network is vital to providing patients with that care. We’re working closely with Bob’s team at Norton to ensure he has the best possible start to his new life.”

Bob is forever grateful to the heart donor’s family.

“Their gift of a loved one’s organs changed my life forever,” Bob said. “I had six months to live, and now I have my life ahead of me because of their sacrifice.” As part of the recipient process, Bob is writing a letter to thank the donor’s family. He and Lucy hope to meet the family someday.

The post LVAD patient Bob Wilson gets a heart transplant and resumes his life appeared first on Norton Healthcare.

With her fourth pregnancy, she knew she risked damaging her heart further but wanted to do all she could to carry the baby.

Alexis’ heart condition — advanced cardiomyopathy — was diagnosed just one year earlier, after the birth of her third child.

“At 25 years old I was struggling to do everyday things,” Alexis said. “I was short of breath. It was difficult to walk up stairs, and I struggled to carry my kids and play with them outside.”

Alexis started working with Kelly C. McCants, M.D., executive medical director of the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program. Dr. McCants and Natalie K. Kendall, APRN, nurse practitioner with the Advanced Heart Failure & Recovery Program, started Alexis with intravenous infusions of medication. They would manage her symptoms for a time, but it became clear medication wouldn’t be a long-term solution.

Ready for an artificial heart pump, then a pregnancy is discovered

Dr. McCants, who is also executive director, Institute for Health Equity, a Part of Norton Healthcare, is board certified in cardiovascular disease, advanced heart failure and transplant cardiology. He and the team recommended Alexis turn to an increasingly common long-term solution.

“We felt that she was going to require more for her heart, which would be an artificial heart pump,” said Kendall.

The pump, otherwise known as a left ventricular assist device, or LVAD, would be surgically implanted into Alexis’ heart, taking over the work of the damaged left ventricle that was no longer pumping sufficient amounts of freshly oxygenated blood throughout her body.

On the day she was scheduled to get the LVAD, Alexis learned of her fourth pregnancy through pre-surgical testing. Alexis knew the risks this presented for herself as well as the baby. She was only about 10 weeks along in her fourth pregnancy and was faced with a very difficult decision.

READ MORE: When to worry about breathing issues during pregnancy — what to watch for and what it might mean

“I still wanted to have my baby,” she said. “When I told Dr. McCants and Natalie that I’d rather chance it and carry the baby to term, they were both supportive and ready to face the challenge with me.”

The team set up weekly appointments — some in person, some held via Norton Telehealth video visits. They managed her medications and monitored her heart rate, weight gain and blood pressure.

“We knew it was going to be a very big challenge to keep mom and baby healthy,” Natalie said. “Alexis’ situation was quite unique. There is little to no literature or research to reference such a case, which meant we were entering unknown territory.”

Nearly seven months after canceling her LVAD surgery, Alexis gave birth to a baby girl.

The baby’s birth weight was low, and she was admitted to the Norton Children’s Hospital neonatal intensive care unit (NICU).

“The baby was very healthy and required minimal NICU intervention,” Natalie said. “And Alexis did very well during the delivery and recovery. We were able to support her heart with medications to manage the stress of carrying the baby and delivery.”

With a 5-month at home, Alexis gets an LVAD

Five months after the baby was born, Alexis was able to reschedule her LVAD surgery through the UK Gill Heart & Vascular Institute’s Gill Affiliate Network. Today, she is on the mend and better able to get back to being a mom.

“I’m able to take care of my kids; I’m able to play with them. I’m able to walk up the stairs — but I notice that I have to go slower,” she said.

Though her symptoms have vastly improved, this isn’t the end of Alexis’ heart-healing journey.

“The LVAD is currently allowing Alexis to have improvements to symptoms and quality of life but the best long-term solution for a young female would be a heart transplant,”  Natalie said. “This is our ultimate goal for her.”

Alexis continues working with the Advanced Heart Failure & Recovery Program team to strengthen her heart and take the steps necessary to qualify for a transplant.

“They’re really great,” she said of the heart team. “They call. They check up on me. They make sure I get to the doctor.”

If she needs transportation, they find a way for her to get to the clinic. If she doesn’t have child care, they make accommodations for her children to come along on her office appointments. And if she has other health questions or concerns, they provide resources.

“I feel like if I had gone somewhere else, they wouldn’t have given me the care that Norton has provided,” she said.

Photos courtesy of Mary Helen Nunn for Today’s Woman magazine

The post Alexis’ heart was giving out after her 3rd pregnancy — a long-term solution would have to wait for baby No. 4 appeared first on Norton Healthcare.

In his late 20s, DeAndr’e was diagnosed with nonischemic cardiomyopathy, a condition that deteriorated his heart muscle. At that time in his life he had two young children, and was exhausted trying to work a full-time job in a factory and keep up with his kids.

DeAndr’e continued working with his cardiologist in Elizabethtown, Kentucky, for 13 years, but his heart failure continued to worsen. In 2020, he was coughing up fluid, his legs were swollen and he was having a very hard time simply breathing. When he was admitted to Norton Hospital, physicians found his heart was functioning at about 20% of capacity and that the medication that had kept him alive so far had worn his body down to the point of kidney failure.

Heart failure team brings new approach

The specialists with the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program quickly went to work evaluating DeAndr’e and his condition and putting together a customized care plan.

“I met DeAndr’e for the first time while he was in the hospital in August 2020 and instantly had a connection and established a strong rapport with him,” said Kimberly M. Vessels, APRN, a nurse practitioner and LVAD coordinator with the Advanced Heart Failure & Recovery Program. “I explained to him how we would use milrinone, a heart-failure medication, and if it worked, he would see a significant change in his health quickly. But remaining on the medication for an extended period could increase his risk of complications, so a transition to LVAD was recommended.”

The care team set DeAndr’e up on the IV medication, and he was able to go home within a few days. Since his heart was responding to the medication, the team knew based on clinical evidence that he would be a good candidate for the LVAD.

“This was a huge turning point, and it saved my life,” DeAndr’e said. “Meeting this team of specialists and working with them was a game-changer for me and my family.”

VAD implanted and life has changed

DeAndr’e received his LVAD implant Dec. 2, 2020. DeAndr’e was the first patient to be implanted with a ventricular assist device (VAD) at Norton Audubon Hospital under the newly established Norton Heart & Vascular Institute Mechanical Circulatory Support Program led by Bassel Alkhalil, M.D., heart failure cardiologist and medical director of the program. 

An LVAD is a mechanical heart pump that is implanted inside the left ventricle of a weakened heart to help it pump blood throughout the body. The device does not replace the heart, but helps the heart pump blood more effectively.

After a weeklong stay at Norton Audubon Hospital, DeAndr’e went home. His VAD comes with a portable, rechargeable battery pack for when he is on the go, and a plug-in power pack for when he is home for extended periods of time.

“It has been a transition, learning to charge my battery pack and taking a backup with me everywhere I go, but the benefits of being able to go and do everyday activities with my wife and younger twin children is worth it,” DeAndr’e said.

While the VAD is supporting his heart, DeAndr’e is working to improve his overall health. He exercises, enjoys cooking healthy meals for his family and spending time with his mother. He can live a long life on the VAD; however, he hopes he can work toward being eligible for a heart transplant in the next few years. Through an ongoing collaboration between Norton Heart & Vascular Institute and UK HealthCare’s Gill Heart & Vascular Institute, patients can receive a transplant at the Lexington hospital and return home for follow up evaluation and continued medical support.

DeAndr’e would encourage others experiencing heart failure who are considering an LVAD to “take that next step; don’t give up.”

According to DeAndr’e, it was overwhelming coming to terms with a future where he’d always need access to electricity, but it is manageable.

“There is a life with LVAD,” he said. “I’m proof of that, and I’m living a much better life now with the LVAD than I did for the 13 years leading up to it.”

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The wear and tear of elevated blood pressure, too much bad cholesterol and a busy life dealing with finances, raising children, handling a divorce and working a full-time job can take a toll on the heart muscle that keeps blood pumping through the body 24/7.

That was the situation for schoolteacher Pamela St. John. She didn’t know what the issue was, but she knew she was struggling to keep up with her students at school, struggling to breathe while walking — especially when using stairs — and was exhausted all the time. After a quick trip to see the school nurse, she headed to the hospital.

Pamela went to Norton Audubon Hospital’s emergency department and was admitted for a battery of tests and a complete evaluation. The official diagnosis: heart failure as a result of broken-heart syndrome or stress cardiomyopathy.

The stress that Pamela was under was causing her heart to fail. She had the classic symptoms of broken heart syndrome, including shortness of breath and exhaustion.

As the test results were coming in, so was a team of specialists who would quickly become lifesavers in Pamela’s eyes. Leading the team was Kelly C. McCants, M.D., executive medical director of the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program and executive director of the Institute for Health Equity, a part of Norton Healthcare. He explained that her heart was only functioning at 10%, whereas most people have about 60% to 70% percent heart function.

“Pamela needed our help. Her heart needed to recover from all the strain, and her body needed to recover as well,” Dr. McCants said. “We quickly started her on a regimen of daily medication while also starting to rebuild her stamina with a gradual, medically supervised exercise program.”

Reversing broken heart syndrome

Full heart recovery, or myocardial recovery, reverses heart failure with evidence-based treatments and procedures. The Myocardial Recovery Program, part of the Advanced Heart Failure & Recovery Program, gradually introduces appropriate medication, regular monitoring, cardiac rehabilitation and lifestyle changes to help recover the heart to its optimal efficiency. The program is designed to be initiated within three months of a patient’s diagnosis of systolic heart failure. Research has shown that the greatest benefit of improvement of the heart function within this time frame.

“Patients in the recovery program also have the support of a social worker and nurse educator to help make changes to diet, exercise and other lifestyle choices. They’re there to help the heart recover and continue on that path,” Dr. McCants said. “And these patients will continue to be monitored by the heart failure team to ensure the muscle is functioning properly.”

Pamela is grateful to the heart failure recovery team for the care and compassion she received.

“We worked together,” she said. “They taught me how to live better. They gave me the medical tools I needed to reclaim my life, and I am so thankful.”

The post It’s not just a saying — you can die from a broken heart appeared first on Norton Healthcare.

For many, the left ventricular assist device (LVAD) option offered an alternative to a heart transplant.

Ten patients received an LVAD through Norton Heart & Vascular Institute’s Advanced Heart Failure & Recovery Program during its first year of inception. The program also provides care for another 11 patients whose LVADs were implanted at UK HealthCare (UKHC) through a collaboration established in fall 2020 with UK Gill Heart & Vascular Institute in Lexington, Kentucky

“For these patients, quality of life was impacted. Because their heart is not working properly, it is causing their breathing to be labored; they have severe swelling in the legs and feet and are just exhausted. Their everyday activities were limited — even the basics of grocery shopping, doing their hobbies or caring for loved ones,” said cardiologist Kelly C. McCants, M.D., executive medical director of the Advanced Heart Failure & Recovery Program and executive director of the Institute for Health Equity, a Part of Norton Healthcare.

Ventricular assist device pumps most commonly are used to treat patients with left-sided heart failure Patients eligible for LVAD consideration have reached the fourth stage of heart failure — severe limitations even while resting.

In their own words, these patients described how having an LVAD has improved their quality of life.

• Deandre, 42, from Radcliff, Kentucky, “… couldn’t do anything before getting the LVAD; now I can play with my kids more.”
• Bill, 68, of Westview, Kentucky, said the “best advice is not to wait to get the LVAD; all you are doing is suffering, and I’m not suffering anymore.”
• Christopher, 65, of Greenville, Indiana: “I was fighting for my life before; now I am celebrating my grandchildren’s birthdays.”
• Derrick, 68, of Shively, Kentucky: “I’m able to do the things that most people do every day like shopping and cleaning. I have more energy.”
• Patricia, 50, of Hardinsburg, Kentucky: “I’m now able to do more with my 11-year-old daughter and enjoy spending time with her.”
• Charles, 60, of Louisville, Kentucky: “With the LVAD I am breathing better and getting back to doing the things I love to do.”
• Mark, 74, of Louisville, Kentucky, “At just three months in the recovery process, I am still healing and hoping to get back to my everyday activities.”
• Conte, 46, of Shively, Kentucky: “I’m looking forward to doing more with my kids. Just a few months into my recovery and I can already tell a difference.”
• Dave, 58, of Louisville, Kentucky, is “just a few months into my recovery, and I am not hurting as much. I’m really starting to feel better.”

Building the team with the expertise needed to launch a certified VAD program has been a huge undertaking, especially during the COVID-19 pandemic, according to Dr. McCants. The program has been accredited by DNV Healthcare and the Centers for Medicare & Medicaid Services.

“We have a dedicated multidisciplinary LVAD team led by two outstanding cardiothoracic surgeons, Steven W. Etoch, M.D., and David H. Rosenbaum, M.D., in addition to a host of advanced heart failure cardiology providers and staff who really are the backbone of this program,” Dr. McCants said.

Physicians, advanced practice providers, nurse VAD coordinators, pharmacists, nutritionists, therapists, social workers and others provide crucial support to make a VAD program successful. Moreover, everyone who may interact with a patient during the hospital stay must have proper education and training in case an emergency arises.

Once considered solely a way to keep patients alive until a donor heart becomes available, a VAD is now often an alternative to a heart transplant. Two-year survival rates approach 90%. The devices are readily available, while transplantable donor organs are very limited.

The VAD is implanted during an open heart procedure, which typically lasts four hours and requires a hospital stay of at least 14 days. The 10 Norton Heart & Vascular Institute VAD patients in 2021 had an average hospital stay shorter than the national benchmark.

Following surgery, specially trained cardiac nurses and VAD coordinators monitor the patient, focusing on safety and education of the family and caregivers. Then the patient can go home and start resuming daily activities. Before and after surgery, advanced heart failure cardiologists including Bassel Alkhalil, M.D., and Srikanth Seethala, M.D., provide weekly and monthly care.

“Our mission is to assist these patients along their heart failure journey, whether it is medical management of heart failure, providing mechanical circulatory support, or collaborating with established heart transplant programs like the University of Kentucky. Our goal is to provide excellent care close to home as we continue to build on our outstanding program,” Dr. McCants said.

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