Heart Failure

Aquapheresis, or ultrafiltration, is a safe and effective therapy that removes excess salt and water from patients who are suffering from fluid overload due to heart failure. Your doctor may prescribe a low-sodium diet, fluid restriction, or other therapies to help reduce fluid, such as a water pill or diuretic.

A patient is considered diuretic resistant when:

• Patient is > 10 pounds over dry weight
• Previous hospitalizations with ineffective diuretic effect
• Patient cannot achieve a goal of -2 liters at 24 hours
• No significant difference in patient’s global assessment of symptoms in 24 hours.

The goals of aquapheresis include the reduction in hospital readmission, a shorter stay in the hospital if aquapheresis is started early (less than 24 hours into admission), and to establish stable renal function.

Cardiac amyloidosis is a rare disease that occurs when either the bone marrow or the liver produces an abnormal protein called amyloid. This protein can cause problems as it builds up in various organs and soft tissues. There are different types of amyloidosis and the symptoms can vary.

Common types of amyloidosis includes:

• AL amyloidosis (Light Chain): This is the most common type of amyloidosis. It is caused by a bone marrow disorder and often treated with either chemotherapy or stem cell transplant. We work closely with our hematology/oncology colleagues to determine the best treatment plan for these patients.
• Hereditary transthyretin amyloidosis (hATTR): This type of amyloidosis is caused by a gene mutation and involves an amyloid protein produced in the liver. Certain therapies can stabilize this protein or halt its production entirely, preventing further damage and progression of the disease. These infusions and injections can be prescribed and administered in our center.
• Wild-type ATTR amyloidosis: This type of amyloidosis is caused by a deposition of a normal amyloid protein over time. Related to aging, wild-type ATTR amyloidosis can ultimately lead to heart failure. An oral regimen is the most common type of treatment.

Common symptoms of amyloidosis include:

• Bicep tendon rupture
• Bilateral carpal tunnel syndrome
• Chronic GI issues, such as diarrhea
• Dizziness
• Fatigue
• Heart failure symptoms (shortness of breath, swelling)
• Muscle weakness

Amyloidosis screening and diagnosis

Diagnosis can be a lengthy process. Symptoms vary and affect people differently. That is why it is important to see a doctor who has experience diagnosing and treating amyloidosis. Your signs and symptoms will determine what tests are ordered for you.

• Autonomic testing, including functions like heart rate, body temperature, breathing rate and digestion
• Biopsy of the skin, nerves, muscle, heart, liver or abdominal fat pad, the examination of a sample of tissue under a microscope
• Blood tests including genetic testing
• Cardiac MRI
• Echocardiography – an ultrasound of the heart
• Technetium Tc-99m pyrophosphate (PYP) scan of the heart

OHI performed one of the first procedures in Tulsa using the CardioMEMS HF System, a miniaturized, wireless monitoring sensor to manage heart failure. CardioMEMS is the first and only FDA-approved heart failure monitoring device that has been used to significantly reduce hospital admissions for patients with heart failure. 

The CardioMEMS HF System measures the pressure with which your pulmonary arteries pump blood out of the heart and into the lungs. When your heart is too weak or stiff to pump blood effectively, fluid can build up and cause increased pressure in the heart and lungs. By monitoring pressure changes in your pulmonary arteries, CardioMEMS allows your doctor to detect worsening heart failure before you experience any life-threatening symptoms.

The CardioMEMS HF System includes a tiny pressure-sensing device inserted into the pulmonary artery. You will also have a home unit which is about the size of a queen-size pillow that allows PA pressure readings to be sent directly to a secure website your clinician can access on a regular basis. Every day, you lie down on the provided home unit which is approximately the size of a queen size pillow and press the start button.

The CardioMEMS sensor is designed to last the lifetime of the patient and does not require batteries. There is no pain or sensation for the patient during the readings, which only take a few minutes each day. CardioMEMS allows providers with the ability to detect worsening heart failure sooner and adjust treatment to reduce the likelihood that the patient will be hospitalized.

Cardiopulmonary exercise testing (CPX) helps physicians understand how well your lungs, heart, and skeletal muscles work together to process oxygen. This test may be recommended if you have trouble catching your breath or need to rest often while doing daily activities. If you have heart failure, CPX is a helpful tool that helps your doctor understand the severity of your condition, and determine a treatment plan that’s right for you.

CPX involves right heart catheterization — placement of a pulmonary artery catheter via the neck or arm vein — followed by supervised exercise on an ergometer. The patient then exercises until maximum effort is achieved with gas exchange, ventilation, and cardiac function measured at each stage. The data collected during this test will help your physician develop an effective treatment strategy tailored to your specific needs.

OHI is currently the only center in the state to offer this comprehensive testing and we welcome referrals for patient testing. Please call 918-574-9003 for more information.

Extracorporeal membrane oxygenation (ECMO) is a type of treatment administered to adult patients who are extremely sick due to heart and/or lung failure. The ECMO machine does not treat heart or lung failure, but instead pumps blood and oxygen through the body while the heart and lungs are allowed to rest. As blood is pumped from your body into the ECMO machine, the ECMO machine oxygenates the blood and removes carbon dioxide. The newly oxygenated blood is then pumped back into your body. In this way, ECMO temporarily acts as an artificial heart and lung, allowing your real organs a chance to rest.

Depending on the condition of the patient, they may stay on ECMO anywhere from just days to several weeks. During this time, the medical team is able to treat them with a variety of procedures, medicines or give them adequate time to recover.

ECMO is used to assist patients recovering from heart failure, lung failure, or heart surgery. It is also used for patients with the following conditions:

• Acute heart failure
• Blood clot in the lungs
• Burn injury to the lungs
• Chest trauma
• Drug intoxication
• Influenza
• Low body temperature
• Overwhelming infection
• Pneumonia

Additionally, ECMO is used during an LVAD procedure, and during high-rik cardiac catheterization lab procedures. For urgent inpatient ECMO referrals, please call 1-833-OHI-ECMO (644-3266) 

The LVAD is an implantable mechanical pump that supports a weakened left ventricle in your heart and helps pump blood to the rest of your body. This mechanical circulatory support device is a great therapy option for symptomatic patients with advanced heart disease caused by a weak left ventricle. LVAD therapy has been proven to extend life expectancy and improve the cardiac condition of patients who may not derive benefit from earlier stage therapy options.

OHI is the only hospital in northeast Oklahoma that offers this advanced therapy with the implantation of the HeartMate 3 LVAD as a bridge to transplant surgery or destination therapy. The HeartMate 3 pump fits in the area around the heart known as the pericardial space. The pump is connected directly to the heart at the bottom of the left ventricle. There, the left ventricle draws the oxygenated blood through the pump and pushes it into the aorta where the blood flows to the rest of the body. 

We are also proud to offer personalized support from a team of LVAD coordinators. Our LVAD coordinators educate and guide patients and their loved ones through the evaluation process, preoperative and post-operative treatment, and long-term care. No matter what stage of your treatment you are in, we will stand by you every step of the way.

For non-urgent outpatient referrals, please call 1-833-OHI-LVAD (644-5823).
Click here to view our LVAD decision guide to determine if this treatment is right for you.

View our home surgery checklist for LVAD patients.

View our LVAD Behavioral Contract

The Advanced Heart Failure Center at OHI accepts referrals for the evaluation, diagnosis and treatment of patients with suspected or confirmed pulmonary hypertension. Pulmonary hypertension is a life-threatening condition where the arteries between the heart and lungs are either narrowed or blocked. Treatments are available that can help reverse or prevent the progression of heart failure, and improve quality of life.

The team at our Heart Failure Center has expertise in echocardiography, cardiac MRI, right heart catheterization with vasodilator study, and both invasive and non-invasive cardiopulmonary exercise testing. These tests are critical to diagnosing and identifying the proper treatment for pulmonary hypertension patients as well as for assessing treatment response.

Pulmonary hypertension can be a daunting and confusing diagnosis. Pulmonary hypertension refers to increased resistance in the pulmonary vasculature that eventually leads to right-sided heart dysfunction. This commonly leads to worsening shortness of breath and/or difficulty with daily activities. Due to the subtle signs and symptoms, patients often experience a delay in their diagnosis and treatment initiation. There are many reasons for pulmonary hypertension, each requiring careful diagnosis and individualized treatment approaches.

At OHI, we specialize in diagnosis and treatment of pulmonary hypertension, which includes both medication and non-medicated approaches. We offer cardiac MRI, cardiopulmonary exercise testing and right heart catheterization to help tailor your individual plan. We are happy to develop a treatment plan to fit your lifestyle and restore your quality of life.