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Vol. LXV, No. 15
July 19, 2013

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Itís All in Your Head
Woo Demonstrates Connection Between Heart Failure, Brain

Dr. Mary Woo of the University of California, LA

Dr. Mary Woo of the University of California, LA

It’s common knowledge that our muscles, from head to toe, are connected. But what about other organs such as the heart and brain? Dr. Mary Woo of the University of California, Los Angeles, recently spoke on her findings, which show that patients with heart failure commonly exhibit issues in the brain as well.

Woo worked as a staff nurse in cardiac critical care for 13 years and received her master’s degree and doctorate in cardiovascular nursing from UCLA. It was there that she noted that she “could tell who was going to die” by listening to the way patients were breathing while they slept.

These subjects were exhibiting central sleep apnea, which means the brain’s respiratory control centers were imbalanced during sleep, causing uneven breathing patterns. She later noticed during her time as a research assistant at the UCLA division of cardiology that heart failure patients often exhibited a set of mental symptoms as well as central sleep apnea, including sleep problems, clinical depression and difficulties with cognition/motor coordination.

Woo makes presentations on her findings worldwide and has published more than 100 articles and multiple book chapters on cardiovascular disease. She has received many awards, including being recognized as a “Pillar of Cardiovascular Research” by the American Heart Association Council on Cardiovascular Nursing. She is currently a professor at UCLA.

One key example Woo offered was part of the Montreal Cognitive Assessment test (MoCA): patients are given 5 words to repeat back to the examiner immediately, and again 5 minutes later. Patients without heart failure usually got 4 or 5 correct both immediately and at the 5-minute mark, whereas patients with heart failure often only scored 1 or 2 at both times. Magnetic resonance imaging brain scans also showed that patients with heart failure had significant mammillary body and hippocampal damage, which are brain regions associated with memory.

“When we actually looked at the hippocampal volumes…both the volume and cognitive performance were dramatically lower in comparison to the healthy control group,” said Woo. Her studies also found that “the amount of sleep apnea was in fact directly correlated with the amount of brain injury.”

Because these mental and behavioral problems are so closely related to cardiovascular function, she said, we need to “clinically evaluate and treat” these problems as well as treat heart failure, since they are linked.

She also stressed that her findings affect current patient education and self-care strategies, especially because many heart failure patients are unlikely to do anything proactive without a serious push from their health care provider due to their lowered cognitive ability.

One clinician from Pennsylvania mentioned during the Q&A session that in her clinic, they often call the doctor for patients, because patients just won’t do it themselves. Woo said this was a good example of how the cognitive changes found in heart failure affect their care and underscores the need to explore alternative decision-making strategies for this patient group. After all, “hearts and brains don’t grow on trees,” she said.

Woo’s presentation was the 2013 NINR Director’s Lecture, an annual event that brings the nation’s top nurse scientists to share their work. The lecture series began in 2011 as part of the observation of the institute’s first 25 years at NIH.

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