Help for a Weak Heart

Question: My husband just had a stress test. He has no blood vessel blockage, but he was told that his heart is weak. What does that mean for him?

Dr. Hibberd's Answer:

Our heart is a pump. When it functions efficiently, it offers good blood circulation to our brain, lungs, and vital organs, and that usually translates to good tissue and organ function and general well-being.

A stress evaluation simply loads up the pump and assesses it for reserve capacity. The tests offers an indirect estimate of blood supply to the heart under stress.

A deficient heart will not tolerate load, will beat more frequently, and produce EKG findings to support ischemic (lack of blood supply) changes that reverse when the heart is at rest.

The presence of silent coronary artery disease does not usually render the pump weak until it is placed under a stress load. At that point the pump may show irritability, not work efficiently, or show signs of a lack of oxygen delivery. It may not pump well but will rarely stop beating (cardiac arrest).

Restoration of adequate blood supply to a normal heart usually renders it back to desirable pumping function. No blockage implies that circulation to the heart muscle is good, but I am concerned about what else your husband’s doctor had to say.

A normal heart needs an intact specialized conducting system to propagate blood. It also needs an intact electrical pacemaker to coordinate chamber contraction, as well as healthy valves to guide the blood in the right direction without backflow.

Your doctor may be suggesting that your husband may be at risk for future heart problems or even heart failure not related to coronary artery disease. He should ask his doctor the following questions:

• Do I have a disease of the heart muscle (cardiomyopathy)?

• Has my heart become enlarged from uncontrolled hypertension or lung disease (ventricular hypertrophy)?

• Do I have conducting system disease of the heart (heart block)?

• Will I need a pacemaker one day?

• Do I have any valvular heart disease or malfunction (valve regurgitation, stenosis, or insufficiency)?

• Do I need an imaging study such as a 2-D echocardiogram or a MUGA scan to further assess my heart function and structure?

Above all, it is important for your husband to understand why his heart muscle is weak and what should be done to improve it. If you do not get answers with good supporting evidence, request a referral and cardiology consultation.