Dani Aylsworth was 19 when she joined the Army in 2008. She served in Afghanistan as part of an elite female Special Forces team. But when she returned home as a combat veteran, posttraumatic stress disorder (PTSD) hit hard. For 6 years, heavy drinking helped buffer the painful memories.
In 2017, Aylsworth went to the doctor feeling unwell. "They told me I was young and healthy, so it was probably just an upper respiratory infection," she says. Unbeknownst to Aylsworth and her doctor, she had pneumonia. After 2 weeks without treatment, it turned into sepsis.
This was when Aylsworth's heart failure crisis began. The sepsis attacked her heart, and she spent 12 days in a coma. When she woke up on Christmas Eve, 2017, just 8% of her heart was working.
Normally your heart pumps oxygen-rich blood from your lungs out to the rest of your body. Heart failure can mean that your heart is too weak, or it can't fill up with enough blood to meet your body's oxygen needs. When this happens, the blood backs up. This causes fluid to build up in your body.
Aylsworth's doctors sent her home with an external defibrillator vest. If her heart went into a life-threatening rhythm while healing, the vest would shock it back into its normal rhythm.
Her heart didn't heal.
"I kept drinking," she says. "My heart output wasn't increasing." Her ejection fraction, the amount of blood her left ventricle pumped out with each contraction, was just 17%. A normal ejection fraction is 55% to 75%.
Though heart failure isn't curable, treatments can slow damage to your heart and improve your symptoms. You'll probably need to stay on treatment long-term.
Managing heart failure often involves a combination of medication, surgery, and devices.
Medications. A few different medicines treat the causes and symptoms of heart failure:
Surgery. Doctors can use a few procedures to treat the cause of heart failure or implant a device to keep your heart in a healthy rhythm.
We already use wearable sensors with our smartphones and watches to track our daily steps and sleep. Now, researchers are studying whether these devices might also improve heart failure care and outcomes.
Wearable sensors that track measurements like your heart rate and blood pressure could help your doctor see whether your treatment is working, and if you need to make some changes.
Some heart monitoring features have already been incorporated into smartwatches. One technology uses a light sensor to measure changes in blood flow and heart rate through the skin.
The studies on wearable devices have so far been small but promising. In one study, a wearable vest that monitors fluid in your lungs helped reduce hospital readmissions by 87%.
A few challenges stand in the way of making wearable devices available for everyday use. One worry is that the connectivity these tools require might expose people's sensitive health data to hackers.
Follow a Heart-Healthy Diet
Try to increase your daily servings of fruits and vegetables. Add whole grains, fish, skinless poultry, and low-fat dairy. Go light on sodium, saturated fat, trans fat, and sugar. Avoid or limit caffeine and alcohol.
Get into an exercise routine that combines aerobic activities like walking or bike riding with strength training. Your doctor might recommend a cardiac rehabilitation program to help you exercise more.
It raises your heart rate and blood pressure, forcing your heart to work harder.
Keep Track of Your Weight
Quick weight gain is a sign that your heart failure is getting worse. Tell your doctor if you gain 5 or more pounds in a week.
Manage Stress with Relaxation Techniques
Take 15 or 20 minutes each day to meditate or practice yoga. When you're under stress, it's harder to follow the treatment plan your doctor prescribed.
A couple of weeks after Aylsworth awoke from her coma, her heart failure started to progress. "The first thing I noticed was my memory," she says. "The lack of oxygen to my brain due to low cardiac output made me forgetful. I forgot who my daughter was one time."
Her body began to hold onto fluid. It would seep out from between her fingers. She couldn't catch her breath, and everything she did made her tired. As the heart failure got worse, her organs started to fail. "My gallbladder kept backing up from my liver and poisoning me," she says. Then came the two cardiac arrests that nearly ended her life in 2018.
Heart failure is a chronic and progressive condition. It's with you for life and it gets worse over time. The course of heart failure can be unpredictable. It's also different for each person. But by following your treatment plan, you can manage your disease and keep it stable.
While you're in treatment for heart failure, it's important to maintain a good quality of life. This term describes how much of an effect heart failure symptoms have on your daily activities. A common way to measure quality of life is with the Kansas City Questionnaire. It includes 23 questions about your symptoms and how they've affected you in the last 2 weeks. Your doctor can use the results to adjust your treatment.
Aylsworth's heart failure has improved, but her future is still uncertain. Her ejection fraction hovers only 4% above the range for heart failure.
"I don't know if I'll need a heart transplant later on," she says. "There's so much unknown. All I know is that I have the control to, at least right now, manage this. I know that if I do what I'm supposed to do -- take my meds, eat how I'm supposed to, get up and get out -- I'm going to feel good."
Given her uncertain future, she's making multiple plans for her medical care. She has a primary care doctor and cardiologist in Destin, FL, where she lives. And she's setting up connections with a major medical institution that has an advanced heart failure clinic, "in case things get bad again."
Aylsworth enrolled in a cardiac rehabilitation program, coupled with outpatient treatment to address her alcohol use and PTSD. Cardiac rehab taught her interventions like diet and exercise to strengthen her heart.
Today, she takes 12 medications. Some manage her blood pressure. Others remove extra fluid from her body. She also takes supplements to replace the magnesium and potassium that her medicines deplete. Aylsworth credits medication and lifestyle changes like exercise, diet, and quitting alcohol with helping her recover.
"Everything that they told me to expect hasn't happened, and I'm doing the opposite. I'm getting better," she says.
"I'm able to walk without getting winded. I'm able to finish a sentence without gasping for air. I'm able to wake up in the morning without my face being full of fluid and puffy. I'm able to exercise with my daughter."
About 9 months ago, Aylsworth started working part-time at a performance and recovery center that specializes in cold therapy. She's close to earning her bachelor's degree in social work. And she recently celebrated her second anniversary of sobriety.
"Life now is so much different than it was before," she says. "I'm just so thankful to be here and to have survived, to be sober, to be healthy...It's hard not to be positive."