Transplant Center

End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body, and in which all other available treatments are no longer helping to improve the heart's function. End-stage heart failure is the final stage of heart failure. Heart failure, also called congestive heart failure, or CHF, is a condition that occurs when the heart is unable to pump blood sufficiently. Despite its name, a diagnosis of heart failure does NOT mean the heart is about to stop beating. The term "failure" refers to the fact that the heart muscle is failing to pump blood in the normal manner because it has become weakened.
Some causes of Congestive Heart Failure (CHF), or weakening of the heart muscle, may include, but are not limited to, the following:

• heart attack (Also called myocardial infarction, or MI.)
• high blood pressure (hypertension)
• valvular heart disease
• congenital (present at birth) heart conditions
• cardiac arrhythmias (irregular heartbeats)
• pulmonary hypertension (elevated blood pressure within the lung's blood vessels)
• alcoholism or drug abuse
• chronic lung diseases, such as emphysema or chronic obstructive pulmonary disease
• cardiomyopathy (an enlargement of the heart muscle)
• anemia (low red blood cell count)

CHF may appear suddenly after an acute episode (such as a heart attack) that severely damages and weakens the heart muscle, or it may progress over a much longer period of time. Symptoms of CHF may include:

• fatigue
• edema of the feet, ankles, and/or abdomen
• frequent cough
• inability to lie flat for any length of time; having to sleep on two or more pillows
• chest pain
• palpitations
• markedly decreased exercise tolerance
• dizziness
• shortness of breath
• loss of appetite

CHF is most often treated medically. That is, the patient with CHF is followed closely by the physician and treated with several different types of medications that are used to accomplish the following:

• strengthen the heart
• relax the blood vessels so that the heart does not have to work as hard
• remove extra fluid from the body
• replace certain minerals which may be removed from the body by diuretics (medication used to remove extra fluid from the body)

In addition, diet modification is used to help decrease sodium (salt) and fluids in the body. Other important components of CHF treatment include:

• elimination of caffeine and tobacco
• an exercise program tailored for the patient's activity tolerance
• daily monitoring of body weight
• ongoing patient education to assist the CHF patient and his/her family to maintain the highest possible level of functioning and quality of life

In cases of severe CHF, heart transplantation may be an option. Many factors are considered when assessing a patient for heart transplant, so it may not always be an option for any given patient. Evaluation for heart transplant is a very thorough, detailed process. This detailed process is necessary because a donor heart must be found in order for a heart transplant to be performed.