Mom’s No Longer Looking at Heart Transplant After Aggressive Medical Therapy
Complicated heart condition requires multidisciplinary care
Sherita Smith knew something was wrong. The 34-year-old Milwaukee woman had just had a baby in 2008, when she began feeling weak and tired. She was also having palpitations, where her heart would start racing, but then stop on its own.
"Then, in the beginning of 2009, everything just went downhill for me. At first, I had a really bad cold, and I couldn’t breathe. It felt like something was happening to my heart, and I didn’t know what was going on.”
She went to a local emergency room, and was transferred to Froedtert & The Medical College of Wisconsin because of the severity of her heart problems. There, she saw Mary Anne Papp, DO, FACC, Medical College of Wisconsin advanced heart failure and transplant cardiologist. Dr. Papp diagnosed Sherita with dilated cardiomyopathy, a condition where the heart muscle has become weakened and enlarged, and can’t pump enough blood to the body.
"She was transferred here because we have the full array of services to treat her with medication or through a mechanical ventricular assist device, or VAD, which is often used as a bridge to heart transplant but is gaining ground as treatment in itself," Dr. Papp said.
The Heart and Vascular Center
at Froedtert & the Medical College of Wisconsin provides a full range of cardiovascular services for patients with heart and vascular diseases.
Multiple Complications Need Multidisciplinary CareSherita was added to the heart transplant waiting list because of the severity of her symptoms. In addition to having a weakened heart, Sherita had ventricular tachycardia, a rapid heart rate that starts in the ventricles, and she developed blood clots in her stomach. Any of those conditions could have become life-threatening.
Sherita benefited from the multidisciplinary heart and vascular team. Dr. Papp prescribed an aggressive course of medications aimed at strengthening her heart muscle. Medical College of Wisconsin vascular surgeons worked to keep the clots from disrupting the blood supply to Sherita’s intestines. She also saw Marcie Berger, MD, FACC, Medical College of Wisconsin Director of Electrophysiology, about the rapid heart rate.
"If ventricular tachycardia doesn’t stop on its own or with treatment from medication or a shock of a defibrillator, it can cause cardiac arrest, where people collapse and die," Dr. Berger explained.
A defibrillator, a small device surgically implanted in the chest that shocks the heart if it goes into a dangerous rhythm, was one option to treat the ventricular tachycardia. But, some patients with Sherita’s diagnosis (dilated cardiomyopathy, which can cause the ventricular tachycardia) get better after a few months of appropriate medical treatment.
"There are clear criteria for defibrillator implantation including a waiting period of three months before implanting preventive defibrillators in patients with newly diagnosed dilated cardiomyopathy," Dr. Berger said. The rationale of providing three months of optimal medical therapy is to see if a patient's heart function improves before putting in a device.
Aggressive Medical TherapyAs part of her therapy, Sherita was on continual intravenous medication to strengthen her heart muscle. She wore a PICC line (peripherally inserted central catheter) 24 hours a day that pumped medication directly to her heart.
"We were aggressive with intravenous medication," Dr. Papp said. "But there was always the option that, if the medication did not work, we could utilize the full array of services are available here at an academic medical center, including VADs and cardiac transplantation."
Over the first few months of her treatment, Sherita suffered several other complications that brought her back to Froedtert & The Medical College. At one point, she went home wearing a LifeVest, an external defibrillator that could shock her heart back into a normal rhythm if necessary. When it was clear that Sherita was still at risk from the ventricular tachycardia, Dr. Berger performed surgery to implant a defibrillator.
"The defibrillator is there as an insurance policy to pace or shock somebody out of the life-threatening fast rhythm," Dr. Berger explained. "She has a one-wire defibrillator, and her device is there to protect her from a cardiac arrest."
Off the Transplant ListAbout a year after she was initially diagnosed, Sherita’s heart function had improved enough that she was taken off the intravenous heart medication, and even better, she was taken off the waiting list for a heart transplant.
She continues to take other medications for her heart and to prevent blood clots, and the defibrillator is still there as an insurance policy, but she’s feeling much better. She sees Dr. Papp every six months, and Dr. Berger’s team monitors the defibrillator’s performance.
"Things have been perfect compared to where I was before," Sherita said. "I try to stay on track with my sodium intake. Every time I go see Dr. Papp she's always showing me new exercise routines that I should be doing. I also try to eat healthier."
As a mom of three, including her now four-year-old son, Sherita stays busy and active. She’s grateful for the care she received from her team, including support from the nurses.
"It was a great experience because they made me feel comfortable,” Sherita said.
Author: Dustin Kehrmeyer
Last Review Date: Feb. 1, 2013