South Florida Hospital News
Monday October 26, 2020
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September 2006 - Volume 3 - Issue 3
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The Future of Cardiac Rehabilitation

Cardiac surgery, as we all know, can be a very complex and daunting affair. The advice frequently proffered during my training years at Columbia University by the Chief of Cardiac Surgery, a pioneer of the profession, went something like this: "the best way to get out of trouble is not to get into trouble." Pithy and unsatisfying though these words may seem, they convey a certain wisdom regarding not only the vigilance necessary to avoid trouble, but also perhaps the path out.

Cardiovascular disease is the leading killer of men and women in this country. Fortunately, through scientific and technological advances, the mortality from this lethal disorder has been declining steadily over the past decade. The remarkable truth that has emerged from research is that this illness is, to a certain extent, both preventable and reversible. Awareness and control of risk factors such as family history and diabetes -which cannot be prevented but can be managed, and those such as hypertension, obesity, smoking, inactivity, hypercholesterolemia - which can be treated and overcome—is the key to prevention. Therefore, from a certain point of view, the emergence of clinical disease ("dis" "ease") represents a severe imbalance in the control and/or prevention of risk factors. It is for this reason the Florida Heart Research Institute has been so proactive in our community in the area of cardiovascular risk screening and education.

Therefore, for those who, in one form or another, have succumbed to cardiovascular disease, whether it be heart attack (myocardial infarction), congestive heart failure, arrhythmic sudden death, and through the benefits of modern medical care have survived, it is necessary to plot a course to return to health. Unfortunately, the patient may have suffered severe damage to the heart—damage which at present may not be reversible. Nonetheless, the first approach to rehabilitation is a focus on control and maximization of those risk factors which ushered in the problem in the first place. An appropriate regimen of diet, exercise and medication is the obvious initial approach.

Fortunately, current research now enables us to look beyond these frontiers toward some very promising future therapies, which may transform "rehabilitation" from a process of living and coping with a damaged or failing heart, to one of actually restoring or "rehabilitating" the heart itself to a more nearly normal performance. The past two decades have yielded an enormous amount of information regarding the physiology and biochemistry of congestive heart failure, regardless of the specific predisposing cause. As a result, there has been a virtual revolution in the medical therapies for this scourge which afflicts 5 million Americans. Based on a more thorough understanding of the hemodynamics of failure, there are a number of promising surgical approaches under investigation—ventricular restoration, external restraint devices, and even ventricular assist devices. Stem cell therapy, whether bone marrow or embryonic, unlocks the possibility of repairing or even regenerating the injured human heart. Perhaps most intriguing of all is the potential for multi-modal therapy—to place a failing heart on an assist device, use that interlude of rest and healing to alter, with medications and/or genetic therapy, the biochemical milieu of the cells, and then to introduce a supply of fresh or regenerative stem cells, resulting in a more functional heart which can now be weaned off the device, restoring the patient to a normal life. Voila—cardiac rehabilitation for the year 2020! Perhaps. For now, best to listen to the Chief, and try our utmost to control the risk factors and try to lead a healthy life.

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or DoctorWu18@aol.com.
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