5 Questions to Ask Your Doctor About a Heart Transplant
Atrial fibrillation is one heart problem that can lead to heart failure. Find out when a heart transplant could be needed to save your life.
By Chris Iliades, MD
Medically Reviewed by Farrokh Sohrabi, MD
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Atrial fibrillation causes your heart to work overtime. And, if this isn't controlled over time, it can lead to a weakening of your heart and a condition known as heart failure. A heart transplant may be needed to treat this atrial fibrillation (afib) complication, according to the National Heart, Lung, and Blood Institute (NHLBI).
“A heart transplant may be recommended for someone with advanced heart failure after medications, weight loss, diet, and everything else has been tried first,” says Robert Higgins, MD, chairman of the Department of Surgery and director of the Ohio State Comprehensive Transplant Center at Ohio State University's Wexner Medical Center in Columbus. “Only people with advanced-stage heart failure are considered for heart transplant.”
To better understand atrial fibrillation, heart failure, and heart transplantation, discuss these questions with your doctor.
1. How do I know that I have heart failure?
“Uncontrolled afib over a long period of time is a common contributor to heart failure," Dr. Higgins says. "Shortness of breath, ankle swelling, palpitations, chest pain, and fatigue are all symptoms of a failing heart muscle."
The American Heart Association says that most doctors rate heart failure on a scale from I to IV. At stage I, you have symptoms, but they don't limit your activities. At the other extreme, stage IV, you may have symptoms even when you're resting, and they can keep you from everyday activities.
2. What are the benefits of having a heart transplant?
“Because we are better at selecting patients and taking care of them after surgery, benefits have improved," Higgins says. "You can assume an extended life and a high-quality life. Most people can return to a normal, active lifestyle. About 90 percent of patients survive one year, 70 percent survive five, and 50 percent survive 10 years.”
3. What are the risks of having a heart transplant?
The biggest concern after a heart transplant is that your body may reject it. To try to prevent this, you'll take medications to suppress your body’s immune system for the rest of your life. However, tampering with your immune system raises your risk for infection.
“During the first year after surgery, doctors, patients, and family members must all vigilantly watch for signs of infection or rejection,” Higgins says.
According to the NHLBI, transplant rejection signs include:
- Trouble breathing
- Fatigue, fever
- Less urine output
- Fluid retention
Report any of these signs or any signs of infection to your doctor right away — like fever, coughs, sore throats, sores, or flu-like symptoms.
If your body starts to reject your new heart, your team may change your medications. If severe, you can go back on the waiting list for another heart. “It is basically starting the process over again," Higgins says. "A second transplant is done but rarely, less than 3 percent of cases."
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4. How do I get on the transplant list?
Not only must you have advanced heart failure, but you must also be deemed able to survive and do well after the surgery. If your doctor refers you to a transplant center, the transplant team -- will evaluate you very carefully, according to the NHLBI. This team includes a cardiologist, heart surgeon, social worker, psychiatrist, and transplant coordinator.
Several factors are likely to prevent you from getting on the transplant list:
- Being older than 70
- Having any irreversible disease or history of cancer
- Having poor blood circulation.
- Being unable to follow a lifelong care plan after surgery
5. Once on the list, how long is the wait?
The waiting list is called the Organ Procurement and Transplantation Network (OPTN). “OPTN is a computerized system that makes sure hearts are given out fairly," Higgins says. "We need this system because there are not enough hearts to go around."
According to the NHLBI, about 2,000 hearts are available for transplant every year. On any given day, though, there are about 3,000 people on the waiting list. Wait times may range from days to months. You move up the list the longer you wait, but you may be taken off if your health gets worse. If a heart donor is found, you will need to prepare for surgery very quickly. A donor heart is only viable for about four hours.
While you're waiting for a donor heart, you will still be treated for heart failure. One device that helps is a ventricular assist device (VAD). “VAD is a mechanical pump that helps support your heart," Higgins explains. "A VAD can extend the time you can wait and may also get you in better shape for surgery while you wait."
Chances are that atrial fibrillation won't progress to the point of needing a heart transplant, but heart failure is one possible complication. Talk to your doctor about the connection between atrial fibrillation and heart transplantation. The more you know, the better prepared you will be.
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