Dr. Kevin Landolfo, MD

• Angina, which is chest pain that occurs when the heart does not receive enough blood flow.
• Heart attack, which happens if the arteries leading to the heart are completely blocked.
• Arrhythmia, or irregular heartbeat, which can develop if the heart does not have enough blood supply.
• Heart failure, which may occur if a heart attack damages the heart and it becomes too weak to pump enough blood to the rest of the body.

Certain factors may increase risk for the disease, like smoking, lack of exercise, being overweight, high cholesterol, high blood pressure, and diabetes. CAD tends to develop over decades, so it can go undetected until it has become quite severe. A diagnosis may be established using such tests as:

• Electrocardiogram (ECG), which records the heart's electrical activity over a period of time. ECGs can detect whether there is enough blood flow to the heart or if a heart attack has occurred.
• Echocardiogram (echo), which creates images of the heart using sound waves. Echos can show whether the heart is able to pump blood normally.
• Stress tests, where an ECG or echo is combined with exercise, like riding a stationary bike or walking on a treadmill. This test is done to find out if the heart can function properly while performing a strenuous activity.

Treatments for the disease include medications such as vasodilators, like nitroglycerin, which dilates (widens) the coronary arteries. CAD may also be treated by a procedure called angioplasty with stent placement, where a balloon is inflated inside a diseased artery to flatten the plaque deposits against the artery walls, creating more room for blood to flow.

In some severe cases of the disease, multiple arteries may be blocked, and an open heart surgery called coronary artery bypass surgery may be necessary. This operation transplants a vessel from another part of the body to form a graft that goes past the narrowed arteries, thus enabling blood to flow around those arteries.

Contrary to popular belief, lung transplant is rarely used to treat lung cancer. It is a more common treatment for patients with other advanced lung diseases, such as cystic fibrosis, sarcoidosis, pulmonary fibrosis, and chronic obstructive pulmonary disease (COPD). Lung transplant is a serious operation and is generally used as a last resort for patients who have only a short time to live without surgery.

During a transplant, an incision is made on the side of the chest (for a single lung) or in the middle (for both lungs). Patients may be hooked up to a heart-lung bypass machine, which will do the work of moving blood and oxygen through the body during the procedure. After the diseased lung is cut away from the main airway and blood vessels, the donor lung is stitched into place. Surgery may take as long as twelve hours, and a hospital stay of two to three weeks after surgery is not uncommon. For the first hours or day after surgery, patients use a ventilator, or a machine to help them breathe. Tubes will be inserted into the chest to help drain excess air and fluid. During recovery, physical therapy and breathing exercises are used to help the new lung work as well as possible.

Lung capacity is carefully monitored for several months after surgery. Patients who have had a transplant will also have to take anti-rejection drugs for the rest of their lives. These drugs stop the body's immune system from attacking the new lung. The main risks after a transplant are infection and rejection (when the immune system attacks the 'foreign' lung). A healthy lifestyle, including maintaining a diet high in vegetables and lean protein, not smoking, and getting enough exercise, is important to keeping the lungs functioning as well as possible. With proper care, many patients can live ten or even twenty years after a lung transplant.

There are several different kinds of VAD. While the controller and power source are always outside of the body, the pump itself can be internal or external. Most pump blood with a rhythm, like a human heart does, but some pump blood continuously. A VAD is usually placed in the left ventricle (to move blood to the body) but can be placed in the right ventricle (to move blood to the lungs) or on both sides of the heart.

VADs with external pumps are for short-term use and can be inserted in different ways. Some are mounted on a catheter (a thin, flexible tube) that is attached to the external pump and motor. This requires minor surgery to thread the catheter through a vein in the groin. Other VADs with external pumps require a larger incision on the chest, where inflow and outflow tubes are inserted. These tubes are connected to the external pump and power source. The chest remains open but covered with sterile material until the patient receives his or her heart transplant, which usually occurs within ten days. The patient must remain in the hospital during this period.

Implantable VADs have pumps that are placed within the chest cavity during open heart surgery. Two tubes are attached to the pump, which is implanted in the upper part of the abdomen. One of the tubes is inserted into the heart, pulling blood into the pump, which then sends the blood into the aorta. The other tube goes out of the abdominal wall to the outside of the body and is connected to the power source, which is worn around the waist. Since placing an implantable VAD requires open heart surgery, both the surgery and recovery are longer and more difficult than for VADs with external pumps. However, implantable VADs have a huge benefit in that they are not hooked up to a large machine -- patients are free to move around after being fitted with one. For this reason, they are more common when heart support is needed long-term. They may be used for patients who are waiting for a heart transplant, or as a permanent treatment for those who do not qualify for a transplant.

VADs come with their set of challenges. For instance, placement of the device can take several hours, and recovery can take as long as two months. Often, people who need VADs have experienced heart failure, and their weakened heart and lungs need careful monitoring and support. Patients with VADs that have external pumps need to sacrifice their mobility, while those who have implantable VADs must learn how to keep their device clean, safe, and working properly. Despite any difficulties of adjusting to life with a VAD, they can be lifesaving devices for those who need them.