Janie Seigler thought she had a terrible case of bronchitis. Symptoms of the respiratory condition started in December 2012 and persisted well into the summer months. “I couldn’t stop coughing,” she recalls. “I couldn’t catch my breath. I had to rest while carrying a chair from my car to the beach.” This was greatly out of character for the Portsmouth, Va., resident, who was 66 at the time she fell ill. Janie prided herself on being a fit, active woman who still competed in triathlons.
Thinking she might have asthma, Janie’s primary care doctor sent her to a pulmonary specialist. That doctor decided the problem was Janie’s heart, not her lungs. He sent her to a cardiologist who diagnosed her with heart failure after conducting an ultrasound and heart catheterization.
Although Janie started heart medications in October 2013, her condition quickly deteriorated. “I was vomiting nonstop,” she says. “I didn’t have the strength to brush my teeth.” By November, Janie needed a wheelchair to get around. That’s when her doctor referred her to Dr. John Herre, a cardiologist at Sentara Heart Hospital.
“Janie’s case was typical of many heart failure patients,” Dr. Herre says. “They’re told they have a respiratory condition like bronchitis, pneumonia or asthma when in fact their hearts are failing.” Vomiting is also a classic, overlooked sign of heart failure, he says. “When your heart isn’t pumping efficiently, you fill up with fluids, which makes you feel nauseated.”
A heart catheterization showed that the ejection fraction of Janie’s heart (a measurement of how well the heart pumps blood) was only at 20 percent. The normal range is between 55 and 70 percent. Janie was at high risk of dying from advanced heart failure.
Immediately, the Sentara Heart team began the process of getting Janie listed for a heart transplant and evaluating her for a ventricular assist device (VAD), which would serve as a bridge to transplant until a donor heart became available.
In the meantime, Dr. Herre started Janie on an infusion of milrinone lactate, a powerful medication that opens up blood vessels. The results were dramatic. The blood pumping function of Janie’s heart improved by 15 percent after just five days of treatment.
It was enough of an improvement to keep Janie off the heart transplant list.
After 12 days in the hospital, Janie went home with new heart medications. In order to satisfy Medicare requirements for a heart device, Janie needed to continue medication therapy for three months. During this time, she wore a defibrillator called a LifeVest that protects people at high risk for sudden cardiac arrest. Tests conducted in April 2014 showed little improvement in Janie’s heart function, and she received a biventricular defibrillator.
This combination pacemaker and implantable cardioverter defibrillator (ICD) stimulates both the right and left ventricles of the heart to help it beat more efficiently. “We used this combination device because Janie also had left bundle branch block, a condition that impedes electrical impulses in the heart,” Dr. Herre says. Bundle branch block sometimes makes it harder for the heart to efficiently pump blood to the rest of the body.
Janie was able to go home the same day she received the device. Tests conducted in May 2015 showed that her heart’s ejection fraction, or blood pumping ability, is now at 50 percent, just slightly below the low end of normal. “I’m now back to walking about two miles every day,” Janie says. “It’s a relief to feel like my old self again.”
Janie’s outcome is exactly what the heart teams at Sentara strive for when treating patients. “Transplants and VADs are absolutely lifesavers for many people,” Dr. Herre says. “But we much prefer to use medication therapy and less invasive means to treat someone who has heart failure. It’s about helping our patients enjoy the best quality of life possible for as long as possible.”