Miniature electronics that power smartphones and gaming consoles are sparking new innovations in cardiology. Wireless devices monitor the heart 24/7 to save lives in specialized hospital units. Now, the sophisticated gizmos are standing watch over heart patients after they go home.

Today’s tiny implants monitor blood flow or heart rhythm, among other key measures. Then, when something goes wrong, the device signals a medical professional and alerts the patient to seek help immediately. Research proves that implanted heart failure monitors reduce hospitalizations and improve outcomes. Pacemaker and defibrillator monitors with wireless communication features routinely perform checkups without a trip to the doctor’s office.

On the horizon: an early warning system to detect heart attacks before symptoms occur, ensuring the best, most timely treatment possible. Clinical trials of the AngelMed Guardian device (the ALERTS study) are recruiting patients at nearly 80 study locations nationwide.

Innovations in Heart Health The Saturday Evening Post

A: Ten premature beats per minute is a fair amount that can be perfectly harmless. However, we now know that premature beats sometimes cause heart failure and shortness of breath, and can be eliminated by a heart catheterization ablation procedure. I suggest consulting a cardiologist or electrophysiologist (hrsonline.org).

Heart Is Skipping Beats The Saturday Evening Post

“I was always a very active person,”

Narracci says. “But all of a sudden, my energy level started waning. The simplest physical activity—showering—wore me out.”

A battery of tests confirmed that the then 67-year-old was living with cardiomyopathy, or heart failure—a condition affecting about 5 million Americans—which leaves the heart weakened and unable to pump blood efficiently. One clinical tool used to assess heart function is the ejection fraction—a measurement of how well the heart is pumping. Normal ejection fraction is greater than 50 percent. However, if the heart is damaged, it can be significantly lower.

“I had an ejection fraction of 20,” the former teacher says. “My heart was not pumping enough blood or oxygen. I couldn’t do anything and lived like that for four years.”

Narracci was at a crossroad.

“I was in such a state of depression that I felt life just wasn’t worth living anymore,” he recalls. “I told my wife that I had to find a better way to live—if one even existed.”

The road to recovery began on the Internet, where he discovered that scientists were utilizing adult stem cells to treat heart failure, and that this promising approach was under way close to his Florida home. Moreover, the lead researcher—Zannos Grekos, M.D.—was delivering a seminar in nearby Naples. Narracci eagerly attended the presentation, spoke with former patients, then called that same day to schedule an appointment.

Adult Stem Cells: A Primer

More than a decade ago, Dr. James Thomson, director of regenerative biology at the Morgridge Institute for Research of the University of Wisconsin, derived the first stem cells from human embryos. At the time, scientists said the cells could be induced to turn into any type of tissue in the human body, and the medical world was abuzz with talk of a “human spare-parts kit.” Futurists predicted that repairing hearts and regenerating withered brain regions would be as easy as snapping LEGO bricks into place.

But because the extraction of those cells destroyed the embryos, an ethical and political firestorm arose. Since then, researchers like Dr. Grekos have worked to develop regenerative therapies from adult stem cells harvested from mature human tissue—no embryo required. What’s more, patients can often be treated with their own adult stem cells so there is little danger that their immune systems will reject the cells. If adult stem cells live up to their potential, that vision of snapping new body parts into place might not be so farfetched after all.

There’s a lot of high-profile back-and-forth between proponents of different types of stem cells. But where do various lines of stem cells come from, and what distinguishes them from one another?

Embryonic stem cells. Regenerative science’s basic building blocks, embryonic stem cells are extracted from a cluster of cells which gives rise to an embryo. Some think the cells will revive dying brain cells, repair damaged heart tissue, and mend damaged spinal cords. Critics say mining a developing embryo for stem cells is equivalent to murder.

Cord blood stem cells. Originally touted as a way to bypass ethical concerns associated with embryonic stem cells, stem cells extracted from babies’ umbilical cords haven’t panned out as researchers hoped. In part, that’s because the cells can’t be used in as many therapies as other types. But cord blood stem cell transplants can be a welcome alternative when doctors can’t find a bone marrow donor match for patients who suffer from leukemia.

Induced pluripotent stem (iPS) cells. Though not naturally occurring stem cells, these cells are proof that time travel is possible—at least in a biological sense. Here, scientists train regular adult cells to behave like stem cells. The recipe: Take a culture of normal adult cells (skin or blood cells, for example) and use a modified virus to insert one of several pluripotency genes that are active in embryonic stem cells, turning the developmental clock back to zero. When these modified adult cells are cultured, they can—like embryonic and adult stem cells—turn into other kinds of tissue, including cardiac cells.

Nonembryonic stem cells (adult stem cells). Our body produces these cells for use in everyday processes—fracture healing, tissue regeneration, and new skin growth. Researchers are finding ways to harvest these cells from patients, multiply them in culture, and use them to induce targeted regrowth of failing body tissues.

It was Leonard Narracci’s hope that research in this area could help his weakened heart.

Renewed Hope

In November 2008, Narracci met Dr. Grekos, associate clinical professor at Nova Southeastern University and director of the cardiology and vascular disease branch at Regenocyte—an independent biotechnology firm exploring the potential of adult stem cells. By treating the patient’s stem cells with specific growth factors that the body already uses, the research team was creating a new cell population “educated” to target the damaged area.

“In the past 10 years, we realized that the body’s stem cells possess the ability to regenerate damaged

tissue,” Dr. Grekos explains. “We’ve applied this technology to patients with heart damage.”

The procedure, which is international in scope, takes about one week. “We do the blood draw,” explains Dr. Grekos, who has performed more than 400 of these procedures. Five days after a blood draw, the transplant team reintroduces the stem cells back into the patient’s heart.

In December 2008, Dr. Grekos released findings from a small trial on the potential of adult stem cells in heart failure. “Before treatment, the average ejection fraction in participants was roughly 28 percent,” Dr. Grekos says. “After treatment, ejection fraction reached 40 percent or more. I should add that we have found that patients treated in the early course of their disease fare better.”

Some patients may require additional treatment, but to date, no harmful side effects have been noted.

Quality of life also improved.

“Patients now can walk to the beach, go grocery shopping, and play with grandkids,” Dr. Grekos reports. “We also reduced hospitalization due to congestive heart failure in treated patients by more than 80 percent.”

As with any new radically different approach, reaction from professionals in the field is mixed.

“At first, patients sought us out because they had no other options and nothing to lose,” Dr. Grekos says. “More recently, we’re getting referrals from cardiologists and pulmonologists. It’s becoming more mainstream.”

Because the procedure remains experimental, patients must pay out of pocket for the procedure, which can cost about $64,500—and there’s no guarantee of results.

Delivering on the Promise?

While some specialists talk of adult stem cells as a biological and moral holy grail—able to perform regenerative feats without the ethical baggage that drags down embryonic stem cell research—others disagree. They argue that adult stem cells are less “programmable” than embryonic stem cells, for instance—less conducive to being transformed into a variety of different tissue types.

Scientific results, as always, will tell the story. In the next few years, expect to see large-scale human trials of adult stem cell therapies. Those trials will be the ultimate acid tests, determining whether adult stem cells will go down in history as a failed experiment or as the foundation for a golden age of regenerative medicine.

But Leonard Narracci isn’t waiting for the next few years to tell the tale. For him, the future has already begun.

“One week after the procedure, I was absolutely astounded,” he says. “I felt my energy coming back. At my one-year follow up, my ejection fraction was 52 percent. Now, I trim palm trees, do yard work, and exert myself without getting tired. Life is worth living again.”

To learn more about the promise of adult stem cells in treating Crohn’s disease and reconstructive surgeries, as well as Dr. Grekos’ research, visit saturdayeveningpost.com/stemcell..

Post Investigates: Adult Stem Cells The Saturday Evening Post

Lisinopril is a generic drug that is FDA approved for two brand name products—Prinivil and Zestril. It may be prescribed alone or with other medicines to treat high blood pressure and heart failure. Lisinopril may also be given to people who have suffered a heart attack. Left untreated, high blood pressure may damage the heart, kidneys, and eyes. Taking lisinopril helps relax the blood vessels and reduce the risk of heart attack and stroke.

Lisinopril is Good for the Heart The Saturday Evening Post

I am not certain about what is causing your symptoms. My first thought is that patients with heart failure are often more short of breath lying down than sitting or standing. A check by your cardiologist would resolve that issue. I assume that by “heart flutter” you mean atrial flutter, not just a fluttering feeling in your chest. If you had successful ablation of the AV node, then the atria (top portion of your heart) should not be conducting to the ventricles (bottom chambers), whether you have atrial fibrillation or atrial flutter. If there is conduction, then the atrial flutter can be ablated also. If my comments do not answer your questions, find out more about your condition from your doctor and write in again.

Ablation Helps Flutter, Too The Saturday Evening Post

Your left ventricular ejection fraction is indeed low, and it does not always correlate with symptoms, as you have found out. However, that amount of heart damage does put you in a high-risk category for a subsequent cardiovascular event, including sudden death. In fact, when the EF falls below about 35 percent, we generally recommend an implantable cardioverter defibrillator like the one Vice President Cheney received shortly after taking office. If your heart function remains stable and you continue to be asymptomatic, that (along with your medications) may be all that is necessary to do at present.

You don’t mention your age or the type of heart disease you have, both of which need to be considered before making any recommendations. However, should you experience further deterioration or become symptomatic and unable to function, a heart transplant or some other intervention might be considered.

Heart Weak But Stable The Saturday Evening Post

It sounds like you underwent an electrical cardioversion (a shock to the heart delivered through patches on the chest, or done with drugs) for atrial fibrillation, and your heart is now in a regular (sinus) rhythm. If that is not the case, or your heart is no longer in a sinus rhythm, perhaps the cardioversion needs to be repeated. Many heart murmurs are “functional,” that is, noises caused by swirling blood, and are unimportant. Also, some heart defects that cause a murmur at birth correct themselves over time. Regardless, you are now seventy-six, so it is possible that the heart murmur heard at birth is related to your present problem. A careful physical examination or echocardiogram would tell.

Swelling of the legs and knees is usually due to fluid that escapes from the blood vessels and leaks into the tissue, making them “puff up.” The most common causes of the edema you describe include heart problems such as heart failure, kidney troubles, and local leg problems such as phlebitis, or stasis—that is, legs in a dependent position (such as when you are sitting down) for prolonged time periods. The latter is common in older women who have had children. If the edema is due to stasis, the fluid is usually noticeably less in the morning after being recumbent during sleep. Sitting with your legs elevated on a hassock or something similar, and the use of elastic support hose available in most drugstores, can be helpful. If that doesn’t work, a mild diuretic can be tried. However, if the swelling is due to heart or kidney disease (atrial fibrillation can cause heart failure that can cause edema), you need to see your doctor and get professional advice from a specialist.

Leg Swelling The Saturday Evening Post

No genetic marker of which I am aware has yet been identified. Diastolic heart failure and congestive heart disease are linked to high blood pressure, so control of your BP would seem to be the most important thing you can do. Genetics load the gun, but environment pulls the trigger. Therefore, you can escape the bullet by changing the environment with adequate BP control.

Dodging DNA Destiny The Saturday Evening Post

Mechanical heart valves usually last the life of the patient, while tissue valves last an average of five to fifteen years, with the shorter span occurring in younger patients. You don’t say which kind you have, but regardless, at your age and barring complications, you should not need a valve replacement. The pain in your legs may be caused by peripheral vascular disease, a process of plaque buildup that also may have occurred in your coronary arteries, and which is now obstructing blood flow to the muscles in your legs. A treadmill stress test is used to uncover blockages in arteries supplying the heart with blood. Walking up an incline can stress the muscles in the legs. The exercising muscles need more blood, and if there are obstructions preventing this increase, they become ischemic (starved of blood) and cause pain. This problem should be evaluated by your doctor.

It is difficult for me to prescribe how much exercise to do without knowing more about your condition. Generally I tell my patients to “listen to your body.” When your body “talks to you” in the form of pain, abnormal shortness of breath, or other symptoms, stop or slow down what you are doing. Exercise within those limits is usually okay.

Heart Valves, Leg Pain, and Exercise The Saturday Evening Post