Resource for Heart Failure

http://www.heartfailurematters.org/EN/Warning-signs/Warning-signs

 

Below is some of the content from the above listed web site. It is a great resource for helping heart patients to understand the warning signs of heart failure and the actions to take. If you are a heart patient, or the significant other/caregiver take the time to review this site. It is important sometimes the symptoms sneak up on you.

 

 

Heart failure can be managed well with the right treatment and lifestyle adjustments, as recommended by your doctor or nurse. However, it is important to monitor all your symptoms on a regular basis as heart failure can progress slowly.

 

You can use the list on the left or any of the links below to learn more about the symptoms you should be monitoring and what to do if they get worse.

 

You should call for help immediately if you experience:

 

Persistent Chest pain that is not relieved by glyceryl trinitrate (GTN / nitroglycerin)

Severe and persistent shortness of breath

Fainting

 

You should inform your doctor as soon as possible if you experience:

 

Increasing shortness of breath

 

Frequent awakenings due to shortness of breath

 

Needing more pillows to sleep comfortably

 

Rapid heart rate or worsening palpitations

 

And you should discuss any of the symptoms below with your doctor or nurse.

 

Rapid weight gain

 

Progressive swelling or pain in the abdomen

 

Increased swelling of the legs or ankles

 

Loss of appetite/nausea

 

Increasing fatigue

 

Worsening cough

 

To help you monitor your symptoms, please click on the links below to find useful resources that you can download, print and fill in. You can then take these with you when you see your doctor or nurse and discuss your symptoms.

 

Symptom and event diary

 

Monitoring your heart failure chart

 

Warning signs leaflet

 

 

 

Grief triggered from news

Most of us in the US tonight are feeling an overwhelming sensation of grief following the news of the school shooting in Connecticut.

I could not help but to feel grief upon hearing the horrible news today coming out of Connecticut. My heart aches for these families. The raw pain they must be feeling, the heaviness in their hearts, the overwhelming anger towards those who did the crimes, the loss,  and the timing of the holidays makes it even worse. I feel compelled to reminded my readers how grief and heart disease are connected. The hospitals need to be prepared. With grief comes increased heart pain. Emotional distress is a trigger for angina as well as heart attacks.

How will you grieve?

Is it possible to grieve and not have heart ache?  Should I use nitro if my heart aches?

Some suggestions if you are overwhelmed by grief I tell myself include:

  • Count your Blessings
  • Hug those you can
  • Express your love others
  • Light a candle
  • Meditate
  • Pray
  • Write about your emotion
  • Don’t allow your emotions over the situation compromise your health
  • Tune out…turn the news off…take a walk…..breathe the fresh air, enjoy the lights, listen to music

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Emotional distress is a common trigger of angina.

With loss many experience increased heart symptoms of chest pressure, chest discomfort, pain, heaviness, fatigue and energy loss.

 Heartache the emotional pain recognition site in the brain is located near the region that senses and interprets sensations. When we suffer emotionally, the brain responds by releasing neurochemicals we experience in our body as an intense aching in our upper abdomen and lower chest. Grief-related stress can increase blood pressure and heart rate, raise levels of the stress hormone cortisol, constrict blood vessels, and disrupt cholesterol-filled plaques that line arteries. Any one of these changes raises the risk of heart attack.

Grief also makes blood “stickier” and therefore more likely to clot. Acute stress tends to increase levels of the hormones known as catecholamines which causes platelets to stick together. If a plaque bursts, the resulting clot is more likely to cut off blood to the heart.

American Heart Association’s Circulation reports scientists have found evidence that grief might actually break your heart. Studies show that people grieving the death of a close loved one could have a heart attack risk that is higher than normal.

The calculated the risk of a heart attack as 21 times higher in the first day after the loss of a loved one.  Risk declines steadily with each day after a loved one’s passing, but it remains eight times higher one week after the death and four times higher one month afterward, according to the American Heart Association journal Circulation

The link between grief and bereavement was strongest among people who had preexisting risk factors for heart disease and heart attacks, such as high blood pressure or unhealthy cholesterol levels. People mourning the loss of a loved one might further increase their heart-attack risk by sleeping poorly, eating less,  and skipping their medications. Other factors may include binge eating of comfort foods, increased alcohol or tobacco in an effort to comfort oneself from the intense loss.

.Grief

Broken Heart Syndrome; 

Takotsubo Cardiomyopathy is a type of heart failure caused by grief or stress where the left ventricle balloons out taking on an unusual shape like a Japanese fishing pot. The symptoms are the same as a heart attack but an electrocardiogram does not always show the problem. You experience chest pain, shortness of breath, arm pain, and sweating as in a classic heart attack but its different. Postmenopausal women who are grieving are the main patients who experience this type of heart failure. It is caused when experiencing grief, stress, emotional trauma, or physical stress. The best test to confirm this heart problem is a contrast echocardiogram or an angiograph which takes pictures of your heart. The recovery for this type of heart failure usually takes less time than a classic heart attack.

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So that nitro bit….yep if you are feeling chest pain, sitting and  relaxing  controlling your emotional health by avoiding anger response or  intensive grief, …… and your doctor has  prescribed nitro  for you this would be an indication to  use it. Of course if it doesn’t get better and  your symptoms are worsening call 911.  Hospitals are you prepared?

Cold Weather Posture Causing Angina Like Symptoms?

Cold weather changes our posture causing aches and pains, but how can you tell if it is angina?

Having poor posture when it is cold can contribute to aches and pains in the same areas that people complain of angina discomfort. When the cold weather hits many cardiac rehabilitation patients begin having complaints of discomfort that is felt between the shoulder blades, neck pains and chest discomfort. It is tough to tell the difference for many between angina and muscular skeletal pain.

Let talk about posture

What is your posture when you are cold? Do you pull your shoulders up to your ears, roll your shoulders and neck forward to hide in the warmth of our clothes or chair? Do you cross your arms shortening the chest muscles and hold them in these positions for prolonged periods of time? All of these can cause the muscles to spasm and give sensations of pain. Remember most of the time angina pains follow the same pattern, but as with anything human it can change. So your angina should usually present the same way, if it is in the chest or arms, then expect angina to primarily present this way.

               

This posture held for any prolonged pain will cause upper back discomfort, neck pain, possibly chest and arm discomfort.

So is it angina?

Well lets review  first what angina is.

Angina may feel like pressure, squeezing, or heaviness in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Stable Angina

Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.) Stable angina usually presents itself with exercise, after eating large meals, emotional stress, and a cold environment such as exertion in the cold air.

If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn’t a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina

Unstable angina doesn’t follow a pattern. It is a change from your usual angina pattern, it  is when angina occurs more often and may be more severe than stable angina. Angina occurring while resting is considered unstable angina, or when it occurs with lighter amounts of workload or effort than usual.  If it takes more nitroglycerin than usual to relieve the discomfort, or nitro doesn’t relieve it at all than that too is considered unstable angina. Rest may not relieve the pain.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Skeletal Muscular Symptoms

Can be reproduced by touching the area with symptoms and creating pain. You can’t touch your heart, but you can touch your chest, arms, back and jaw. If you touch it and it hurts that is a sign of muscular skeletal symptoms. Can you move a certain way and cause the discomfort to either show up or go away? This too is less likely to be related to the heart.

Does stretching or improving your posture help the symptoms? Consider adding a small pillow to the low back area of your favorite chair, desk and car  this forces your upper body to maintain better posture. Widening and opening up the chest. If you note you have had very poor posture try the chest stretches below.

Be fluid in your upper body movement

Allow your arms to swing when walking, wiggle those shoulders and neck. Dress warm enough that you can maintain good posture. Wiggle your hips, consciously think about your body. Is it stiff and tight? If so loosen up, relax, stretch, workout.

Be Safe

If you cannot tell the difference and suspect you are having angina, follow your care plan established by your health care practitioner, and if necessary seek medical attention. If the symptoms include shortness of breath, nausea, profuse sweating, lightheaded, dizzy contact your healthcare provider ASAP or call 911. 

Reducing the risk for a second heart attack

Many patients come through their heart procedures and feel they are cured. Unfortunately for most, heart disease is a chronic progressive disorder of the arteries in which deposits of cholesterol, calcium, and abnormal cells (that is, plaques) build up on the inner lining of the arteries.  Heart disease usually progressively deteriorates over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits. This is a hard concept to grasp, and it doesn’t mean it is a death sentence either.

You can do everything right and still have further heart issues.

When patients struggle with this, I point out doing everything right may be why they survived, as approximately 50% of people do not survive their first heart attack.   It is so important for each person to know their body’s signs and symptoms and not ignore them. We don’t really know what makes coronary artery disease aggressive, there seems to be several factors. These factors include inflammation, c- reactive proteins, genetics, lifestyle to name a few.

Some patients will have multiple issues for years requiring frequent interventions and then be fine for many years before having another issue. On average coronary artery bypass  grafts  10 years out will be 50% blocked. Some patients will go 20-30 years before needing another intervention, yet others may not even go a week or month before having symptoms. Thirty percent of open heart surgery patients will continue to have angina symptoms after surgery. The drug eluding stents have  much lower rates of re-stenosis than the bare metal stents which average 25-30% re-stenosis rates, but in both cases the vessels often continue to develop blockages in other locations in the artery. If the bare metal stents are going to re-stenos the usually do so in the first 3-6 months.  It is vital to stay on the platelet inhibitors – Plavix (clopidogrel) as prescribed to prevent complications. Frequently second heart attack occur when patients stop taking their platelet inhibitor medication.

 

Try to adhere to lifestyle changes that will reduce your long-term risk after another heart attack. These  are known  risk factor reduction measures and they include achieving and maintaining an optimal weight, beginning a heart-friendly diet, ending tobacco use, achieving excellent control of diabetes and high blood pressure, and adhering to regular exercise. Lifestyle changes are much more challenging to start and adhere to.  If it were only as easy taking a pill. Keep your risk factors in the best control possible. Try to get blood pressure, blood sugar, cholesterol numbers to national guidelines. Exercise regularly. Eat a rainbow of color in fresh fruits and vegetables each day. Don’t let stress effect your health, manage your stress as best as possible, consider counseling.  

Listen to your body are symptoms creeping up on you?

Be on the lookout for new symptoms, for changes in energy patterns, note if you are becoming less active due to fatigue. I believe many can stave off a second heart attack if they are very tuned in to their bodies signals. Keep a diary or log of your symptoms, look or patterns especially increasing fatigue, increasing shortness of breath, increased use of nitroglycerin,  episodes of sudden weakness or profuse sweating. If you note a pattern don’t wait, contact your healthcare practitioner to discuss. They key is to prevent any further loss of heart tissue by preventing another heart attack. If you think you may be having another heart attack follow the emergency steps listed below:

  • Call 911 and describe what symptoms you’re feeling and where you are located.

  • Chew an aspirin (325 mg) at the first sign of an attack. Aspirin makes blood platelets less likely to stick to each other, assisting blood flow and reducing clots. Chewing the aspirin gets it into your blood stream much faster than if you drink it down with water.

Heart Patients must Prepare for Emergencies

Researchers have noticed that number of heart attacks increases during earthquakes and other natural disasters.

One reason may be that during a stressful episode, your heart’s need for oxygen increases but the body is unable to increase the blood flow through the diseased heart (ischemia). Stress hormones also make arteries narrow, which may cause a break in the fatty material built up in the blood vessel.

Do you have enough Heart Medications  in the event of an emergency?

Do you have accessibility to all your medications? What medications are critical to not run out of? Having a supply of prescription medications on hand in the event of a disaster or weather emergency could mean the difference between survival or being another number added to the death toll. Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals understand there are many barriers including restrictive insurance benefits, patients’ resistance to mail order, and higher co payments. Physicians, pharmacists, and insurers also vary widely in their preparedness planning. It can be difficult to get a physician or a pharmacist in the event of disasters.

Getting more than a 30 day supply, in the U.S., can be difficult if not impossible.Even if you have a sympathetic doctor that you can talk into writing an extended prescription, getting around the insurance company’s “three month limit” policy can be an insurmountable roadblock. So how do you stock up on prescription medical supplies? How do you get enough on hand to see you through an extended emergency, one that could last for days or weeks?

Be prepared to pay for the extra medications entirely out of your own pocket. This could get expensive rather quickly, so consider what medications you absolutely cannot be without such as pressure medications, diuretics, insulin, blood thinners. You can ask your physician for samples to prepare for emergencies.

Diabetes Medications Emergency Preparedness

Everyone needs to be prepared for emergencies–but a person with diabetes has additional issues to consider. When establishing your disaster preparation kit, include a seven-day supply of some diabetic foods and a seven-day supply of medications and testing equipment. Blood sugar levels should be carefully monitored during an emergency because the added stress may cause blood sugar levels to fluctuate more than normal.

People with diabetes should tell rescue workers and/or shelter staff that they have diabetes. They should also drink plenty of clean water, watch what they eat, and stick with the regular testing and medication schedule.

For more information, visit http://www.ready.gov/seniors

Living with an LVAD emergency preparedness 

Battery life becomes an issue without electricity. Does your local EMS know that you have a LVAD and will need electricity to stay alive? If you do not have a generator to keep your batteries charged in the event of a power outage, call your local Emergency Medicine Station and let them know you may be in need of help.

You can safely plug your battery charger into a generator to charge batteries, and you can safely plug in your power base unit to maintain the internal battery to a generator. DO NOT hook up to the power base unit that is being powered by a generator. Generators experience power surges, and you cannot be hooked up to the pbu. STAY ON BATTERY POWER throughout the power outage. If you do not have a means to charge batteries, contact your local EMS, explain your medical need for power, and take your battery charger to the EMS to charge batteries. If you cannot drive, ask them to send transportation for you or to supply you with a generator. If you have any questions or problems, please call your LVAD Coordinator on call at your hospital center.

  Another thing to do in the event of power outage…If you cannot keep your power base unit plugged into a generator, please remove the battery from the bottom of the PBU. There are instructions for doing this in your HeartMate II manual. If you do not remove the internal battery, the low battery alarm will continue to squeal at you! Also, this may damage the battery. Again, if you have questions, call your LVAD Coordinator on call.

Nutrition in emergencies

If you are sensitive to sodium and have to cope with no electricity do you have access to foods that won’t put you in congestive heart failure. Many pre packaged ready to eat meals are very high in sodium. This can add additional stress to your cardiovascular system, which may be already stressed due to the emergency. Will others know if you have special nutritional needs?

Hydration:     Liquids are important to your health do you have access to clean water?

Chest Pain after having Stent

Chest pain following successful balloon angioplasty or stent is a common problem. Although the development of chest pain after coronary interventions may be not a problem, it is disturbing to patients, relatives and hospital staff.

Possible Causes of Pain:

  • acute coronary artery closure,
  • coronary artery spasm
  • heart attack,
  •  local coronary artery trauma

The distinction between these causes of chest pain is crucial in selecting optimal care.  Early intervention can limit the damage. Management of these patients may involve repeat hospitalization for  coronary angiography and/or additional intervention.

Commonly, repeat coronary angiography following Angioplasty (PTCA) in patients with chest pain demonstrates  lesion to be widely patent/open  suggesting that the pain was due to

  1. coronary artery spasm,
  2. coronary arterial wall stretching
  3.  non-cardiac 

 Coronary arterial wall stretching is common and occurs significantly more often after stent implantation than after PTCA or coronary angiography alone. This may be a result of the overdilation and stretching of the artery caused by the stent implantation and the consecutively high degree of stretching and the elastic recoil is minimized. Kind of like a deflated balloon, the artery doesn’t go back to original circumference.

sciencedirect.com

After getting out of the hospital every little ache and pain makes you think  “Is my heart giving me problems?” It is really difficult not to panic.

Here are some tips that should be of help you to know when to seek emergency care:

  •  Is the discomfort you are feeling the same  or similar to the discomfort that brought you to the hospital? If so, this could be a problem. It is more likely to be a problem if it is similar…don’t wait until it is bad to seek treatment. Time is muscle and we don’t want  you to lose any muscle.
  •  Does the discomfort also have other symptoms that pair up with it? These symptoms might include shortness of breath, profuse sweating, nausea, radiating discomfort into neck, jaw, arms or back.  If there are multiple symptoms you should call 911.
  •  Can you reproduce the pain or discomfort with touch or movement of body. It is less likely to be a heart symptom if you can make it hurt through touch. This is usually muscle or skeletal origin or what is referred to as non cardiac chest pain.
  •  The 4 E test…does the discomfort come on with Emotional stress,  Exercise, after Eating, or with a cold Environment? If so these are common triggers of heart symptoms. If you rest and they go away it probably isn’t emergent but you should notify your doctor as soon as possible. Keep a log of the frequency of these symptoms..when they come on, how frequently, what were you doing when they occurred, how intense was it, and what made them go away.
  • Unstable Angina….this is angina or heart pains that are coming on more frequent, occurs at rest or wakes you from sleep, or you need more nitro than usual to relieve discomfort.                                                                                                                                                                                       

If your symptoms are that of unstable angina you contact your doctor  - call 911

If you suspect you are having a heart attack chew up an adult strength aspirin and call 911.

Do not drive yourself to the emergency room. The ambulance crew is your first line of medical treatment, they will provide you with emergency medications, alert the hospital to your condition so they can manage your care quickly and efficiently. Time is muscle don’t waste any time.

Chew the aspirin even if you take an aspirin a day as regular medicine. The extra one helps more than it hurts. Only chew one not a handful that could causes more problems.

Antiplatelet effect of chewed, swallowed, and dissolved aspirinChewing aspirin hastens its antiplatelet effect, as measured by the reduction in blood thromboxane B2 levels. It took only 5 minutes for patients who chewed aspirin to achieve a 50% reduction in baseline levels, versus almost 8 minutes after they took it in a solution and 12 minutes after they swallowed it whole.Source: American Journal of Cardiology Vol. 84, p. 404.

May 2005 Update

It is best not to lie down. Try to stay calm, do some relaxation deep breathing – think belly breathes – make belly go out when you breath in. Avoid short shallow chest breathing. Focus on staying calm. If you think you are going to pass out try coughing or bearing down like you are having a bowel movement.

If you have Nitroglycerin tablets or spray that were prescribed by your doctor use them.  I can’t tell you how many people forget about their nitro when they need it the most. Place one under your tongue, do not chew it. It should make you have a headache, or cause a flushing feeling, or tingle under your tongue. These are indications that your nitro is fresh. If you suspect your nitro is old (over one year if bottle unopened, or greater than 6 months since bottle was opened) find a fresh bottle. Nitro is a very volatile compound and breaks down rapidly if in contact with air, heat, light, or plastic.