Enlarged heart and failing brain

When I was a student there were a few facts that the lecturers enjoyed teaching; I won’t describe them all, as you can imagine, for facts, there were many; yet, two stand out and have reflected on a comment from Freda I received following my recent blog on heart rate.

‘One person I knew had enlarged heart? Apparently no treatment, then at least…’

 We were told that of the cells of the body, brain and heart were a kind of terminus. Once you become an adult – nominally, let’s say, 18 years old, the number of these cells in the body are fixed.

If something happens to brain – stroke, tumour or trauma or heart – infarction or other form of failure, the consequences are life-long.

A physiological determinism was accepted.

I remember as a young doctor seeing people dying from heart failure – they used to be referred to as blue-bloaters; a Victorian hangover that lasted into the 1990’s.

Such people, with failing hearts would become overloaded with fluid, struggling to move oxygen in and carbon dioxide out of their bodies, and with this, diminishing kidney function they would swell, bloat, suffocate and die.

This was round about the time that ACE inhibitors were discovered – ACE (other than being a very positive name) stands for Angiotensin Converting Enzyme Inhibitors (like being called George Best or Michael Winner); these are drugs that prevent the kidneys from raising blood pressure and retaining water.

I will not go into the pathophysiology now; I am sure Google can explain.

ACE inhibitors (medicines generally ending in ‘pril’ – Ramipril, Enalapril, Lisinopril, Fosinopril and so on) heralded a new era of medicine as not only are they very good at lowering blood pressure (and protecting kidneys from the complications of blood pressure and diabetes), they have another effect on the heart which can prevent a worsening of heart failure and with the right care and attention lead to recovery.

Hence, the statement above, was hopefully not recent.

I described a little in my previous blog, the relationship between heart rate and the amount of blood pumped-out.

This lead to a defined Cardiac Output that is, the amount of blood pumped out of the heart is dependent upon Heart Rate and Stroke Volume, this being the amount of blood in the heart just before it contracts.

As you can imagine there is a whole load of science in this and I don’t intend to get bogged-down in that, suffice it to say, to pump an adequate amount of blood round the body you need a healthy heart.

If your heart is not healthy, the muscle can deteriorate and consequently the amount of blood pumped-out reduce.

We call this heart failure.

And this, is the point.

We used to believe that a failing heart was the end. Only further failure and deterioration could happen.

Now, thanks to some amazing medicines (look at me, praising pharma!) and medical technologies, Cardiac Resynchronisation Therapy for example, I have seen people with failing hearts recover.

The same applies to those who have experienced a stroke.

One of my own patients, now eight months after his stroke, is starting to regain power in his arm and leg, both of which were initially paralysed.

Unfortunately, the funders of care don’t always see this potential and cut-off money for therapy after six months; my patient has proven them wrong – although he has had to pay.

This represents a phenomenon called neuroplasticity – this being the brain’s ability to form new cells, to regenerate and recover, when previously, like hearts we were taught, the end is the end.

Frustratingly, brain cells – neurones are quite slow to grow and do not necessarily keep pace with NHS funding cycles.

What else might be possible?

We are only at the start of the dawn of such technologies.

Whilst surgical procedures are still difficult and fraught (although robotic and keyhole seem to be the future), pills are incredibly straightforward.

Pop a pill and see what happens.

I guess the next question, for me at least, what would be the ideal pill?

Perhaps something to take me back to the agility of my early teens?

I doubt there will be a pill for every occasion.

The most obvious being, say, ageing.

One three times a day and you will be 21 again…

This is likely the point when we stop being human and transform into something (or someone) else.

The clock is ticking…