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| Vol. 21, No. 21 |
| November 15, 1999 |
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Mobile IV Restores Health and Mobility to Heart Failure Patients by CHRIS FERRIS St. Luke's Episcopal Hospital
But researchers at the Heart Failure Center at St. Luke's Episcopal Hospital are currently studying a new technique - the first of its kind in the United States - that could dramatically improve the quality of life for heart failure patients. The technique uses an intravenous medicine that is worn by patients in a fanny pack around their waists with a tube that runs up their torso to their arm where the medicine enters their bodies. The medicine, milrinone, improves the strength of the heart's contractions and opens the smooth muscles of the arteries throughout the body, thereby lowering the amount of pressure the heart has to pump against. In the St. Luke's study, milrinone is used in conjunction with oral beta blockers, which reduce blood pressure and lower the heart rate, so the heart doesn't have to work as hard. The milrinone improves the heart function enough so that the beta blocker can then be tolerated. The beta blocker then helps the heart heal and repair over the long term and sustain the benefits of the milrinone long after it is stopped. In addition to this combination of drugs, the most unique aspect of this technique is the freedom it allows patients. By wearing the fanny pack and having a continuous drip of the medicine into their bodies, patients can resume most, if not all, of their daily activities. Monty Inman has experienced first-hand the difference the intravenous drip makes. Inman is a Baptist minister who has volunteered at St. Luke's Episcopal Hospital since 1989, providing pastoral care to Baptist patients. In the last 10 years he has seen more than 23,000 patients. But last year, at age 85, Inman found that he couldn't see as many patients as he used to. He had undergone open-heart surgery in 1988 and had needed a pacemaker since 1993. "Although the surgery and pacemaker had helped keep him alive," explains Dr. Reynolds Delgado, a cardiologist at St. Luke's. "Mr. Inman's heart was severely damaged and was not pumping strongly enough. It was probably pumping at less than 20 percent capacity." Inman could feel effects of his heart's limited capacity, as fatigue and weariness slowed him down considerably. "I was making only five to 10 visits a day," he recounts. "That was very frustrating. Previously I was able to see up to 35 people a day." When Inman started using the milrinone drip late in 1998 he noticed immediate results. "My energy levels rose," he says, "and at times I was almost hyper." Most importantly, Inman was able to return to volunteering at St. Luke's as well as serving as interim pastor at a local Baptist church on Sunday mornings. Today, Inman has been weaned off the milrinone drip, and still takes the beta blockers and other medications orally. He continues to have a high energy level and says he feels good. He recently celebrated his 10-year anniversary volunteering at St. Luke's and looks forward to continuing into his 90s. Like Inman, Armando Ghitalla found that his heart was no longer working well enough for him to continue his daily activities. Ghitalla found out in dramatic fashion last April while judging performances in his trumpet class at Rice University. "I passed out in the middle of class," he says. Ghitalla had undergone two bypass surgeries in 1981 and 1993, but had continued to play trumpet in the Boston Symphony Orchestra and later teach at the University of Michigan. Fatigue had slowly crept up on Ghitalla, however, and he was grateful when Rice offered him a job in which he only had seven students in his class. But after he collapsed in April, Dr. Delgado and other members of the staff at the St. Luke's Heart Failure Center concluded that Ghitalla needed intervention immediately. Ghitalla enrolled in the same study that had proved so successful for Inman. He was given a fanny pack to carry the medicine with him at all times and had a catheter inserted into his right arm to transport the milrinone to his blood stream. Using the medicine has meant some changes for Ghitalla. A nurse comes to his house three times a week to change the dressing on his arm and take his blood pressure. He monitors his weight daily to make sure he isn't retaining too much fluid and watches his diet carefully. But the additions to his daily routine are a small price for Ghitalla to pay. He recovers from exertion more quickly and is even able to work out at his gym three times a week. Indeed, the milrinone does more than just allow Ghitalla to return to his daily routine: "He literally might not live without the medicine," explains Cathy Eastwood, R.N., M.N., clinical coordinator of the heart failure program. "We hope to wean him off the milrinone eventually," says Eastwood. "Just as we were able to with Inman." Ghitalla, who is looking forward to getting back to the classroom when school starts in the fall, is eager to be free of having to carry his medicine in a pouch all day, every day. "We'll have a party when I'm done with the IV," he promises. Dr. Delgado and the heart failure staff will present the results of this new treatment strategy for severe heart failure this fall at the National Heart Failure Society meeting in San Francisco.
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