PATIENT EVALUATION
Patients
referred to the Ahmanson-UCLA Cardiomyopathy Center will in most cases be
evaluated initially in the Heart Failure Center, where appointments are
available five days a week. At the time of first consultation, the Center
physician will discuss the patient with the referring physician and plans
will be made for further evaluation or follow-up. If desired by the
referring physician, subsequent diagnostic procedures will then be
arranged either on an outpatient basis or in the inpatient Advanced
Cardiac Evaluation (ACE) Unit, depending upon the severity of illness.
Patients with advanced heart failure that are unstable or unable to be
discharged from the hospital may be transferred to UCLA Medical Center on
an urgent basis at any time by calling (310) 825-6068.
All patients referred
will be screened for potentially reversible causes of disease, such as
active myocarditis, metabolic disease, and primary valve disease. Those
patients with coronary artery disease and low ejection fraction will be
studied with positron emission tomography (PET) to quantify the areas of
viable myocardium amenable to revascularization with angioplasty or bypass
surgery despite low ejection fraction.
Once etiology has been
addressed, patients will be assessed for functional status. For those
patients in whom symptoms and the results of cardiopulmonary exercise
testing with gas exchange analysis indicate minimal functional impairment,
their risk profile for subsequent events is determined.
Patients with major
symptoms of heart failure despite empiric standard therapy will be
admitted to the Advanced Cardiac Evaluation (ACE) Unit (see below) and
will in some cases be evaluated for complex revascularization or cardiac
transplantation, in collaboration with the
UCLA Cardiothoracic Surgery Service. Further details regarding
criteria for evaluation and protocols for post-transplant care can be
obtained by calling (310) 825-8816.
The process of
determining the patient’s tailored therapy in the Advanced Cardiac
Evaluation (ACE) Unit generally requires three to seven days. Measurements
of filling pressures, valvular regurgitation, and flows are taken shortly
after admission, in some cases during exercise as well as while resting.
After defining the baseline conditions, rapid intravenous drugs are used
to achieve the desired goals quickly. Then a regimen of oral drugs is
created to match the optimal conditions.
We have learned from
our experience that maintaining the benefit of this tailored therapy
requires extensive patient education, which is best provided by an
integrated team approach that includes the Cardiomyopathy Physicians, the
Cardiomyopathy Advance Practice Nurses, and the dietitian. Prior to
discharge, each patient views our videotape and receives personal
instruction sessions regarding the goals of therapy, the medication
schedule, and diet. In addition, they receive an exercise prescription,
usually based on the results of cardiopulmonary gas exchange analysis
during various activity levels in the Exercise Laboratory.
