Taking Life's Lessons to Heart

As a Greenwich mail carrier, Douglas Castiello walks miles through numerous neighborhoods with ease every day. So, he was surprised to suddenly develop a bloated abdomen. He was tired and short of breath merely crossing the street. His foot was swollen, too.

After multiple episodes, Castiello headed to Greenwich Hospital’s Emergency Department with stomach complaints. He was surprised yet again to learn the true cause of his problems: The 57-year-old had congestive heart failure (CHF). His heart wasn’t pumping enough blood rich in oxygen and nutrients to the rest of the body, potentially leading to serious consequences.

"I was shocked," said Castiello of Eastchester, NY.

Today Castiello is proof that people with congestive heart failure can lead a full life with fewer symptoms by managing the chronic condition with medication and lifestyle changes. He credits the doctors, registered nurses, exercise physiologists, nurse practitioners and other professionals at Greenwich Hospital and Yale New Haven Health Heart and Vascular Center in Greenwich for turning his health around.

"I could not have been in better hands," said Castiello. "They made it easy for me to get better and make lifestyle changes. I look at this entire experience as a blessing."

A national epidemic

At least six million Americans over the age of 20 have congestive heart failure, according to the American Heart Association. CHF occurs when the heart is too weak to pump enough blood or too stiff to relax and fill with enough blood. It can develop slowly over time, or when the heart is damaged, such as after a heart attack. Symptoms include fatigue, shortness of breath, and swelling and weight gain from fluid accumulating in the ankles, lower legs or abdomen.

"It’s an epidemic. It’s the top reason people over age 65 come to our Emergency Department," said Michael Chen, MD, a Yale Medicine cardiologist who specializes in congestive heart failure. Dr. Chen diagnosed and treated Castiello at Greenwich Hospital and provided follow-up care at the Yale New Haven Health Heart and Vascular Center at 500 West Putnam Ave. in Greenwich.

"Aging is a major risk factor because it can weaken and stiffen the heart muscle. We are going to see more and more of these patients," said Dr. Chen. He noted census findings that Fairfield County has a growing number of older residents, compared to the rest of Connecticut. "In fact, Greenwich Hospital’s cardiac patients are 10 years older than those at other Yale New Haven Health hospitals in Bridgeport, New Haven, New London and Westerly, RI," he said.

No "magic bullet"

Diagnosing heart failure requires a physical examination, blood tests and imaging procedures, such as chest X-rays, electrocardiogram, echocardiogram, cardiac catheterization and magnetic resonance imaging (MRI). While no cure exists, medications and lifestyle changes can help people to live longer with fewer symptoms. Some patients need a pacemaker to control the heartbeat or an implantable cardioverter defibrillator to jump-start the heart if it stops beating.

"There is no magic bullet to diagnosing or treating heart failure. It requires a team approach with multiple specialists and tests to get a full picture," said Dr. Chen.

Castiello spent several days at the hospital to undergo tests, including an angiogram that found his arteries were clear. He met with a nutritionist and began eating a low-salt diet.

"The doctors and nurses did a great job of taking care of me. It was amazing," said Castiello, who wore a device with a built-in defibrillator for several months after he left the hospital.

Strengthening the heart

The next step in Castiello’s journey involved cardiovascular rehabilitation, a medically supervised program designed to improve cardiovascular health. The individualized program includes aerobic exercise, strength training, stretching, nutrition counseling, and education about managing stress and other heart-healthy lifestyle topics. Patients are continuously monitored by an EKG, and exercise physiologists and registered nurses repeatedly check blood pressure and oxygen levels during a session.

"The staff assists patients to modify their risk factors – such as hypertension, diabetes, high cholesterol and obesity – through lifestyle changes. The importance of decreasing sodium intake is a common topic," said Lisa Elpi, CES, coordinator of the Cardiac and Pulmonary Rehabilitation Program at Greenwich Hospital’s Center for Healthy Living located at 500 West Putnam Ave.

CHF patients, in particular, focus on aerobic exercises to improve the pumping action of the heart’s left ventricle, explained Elpi, a certified exercise specialist. "We concentrate on duration more than intensity. Heart failure patients tend to rest more often because they get fatigued and out of breath. That changes as the deconditioned heart gets stronger," she said.

Castiello was pleased to see his exercise capacity improve during the three-month program. He doubled his time on the treadmill to 20 minutes and went from walking 2 miles an hour to walking 3.5 miles per hour with a 2.5 percent incline. He became strong enough to move onto strength training. His ejection fraction – a measurement of how much blood the left ventricle pumps out with each contraction – jumped from 15 percent to 55 percent. His favorite part of the program were the education modules. “Those were packed with great information,” he said.

These days, Castiello is taking all those lessons to heart. He’s back to delivering the mail. He and his wife are once again enjoying after-dinner walks and weekend hiking excursions. The entire family eats a lot more fruits, vegetables and lean meat. They’ve cut back on salt, too.

"It’s been a healthy change for the whole family," Castiello said.