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

 

 

 

Understanding Hypertension Infographic

What people with heart conditions need to know about Atrial Fibrillation

This progressive and debilitating disease can lead to stroke, heart failure, and Alzheimer’s disease, and can double your risk of death. Afib takes a physical toll, an emotional toll, and a financial toll on those who are living with it—not just the patient, but the family, too.

Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment.

It can lead to complications.

Symptoms of A Fib

• Skipping, fluttering,or quivering of heartbeat
• Heart beating too hard or fast
• Dizziness or lightheadedness
• Confusion
• Shortness of breath
• Chest pain or pressure
• Tired when resting or when active
• Swelling of feet, ankles,and legs
• Feeling anxious

Here is a short video Do you know what Atrial Fibrillation feels like?

What Causes Atrial Fibrillation?

Atrial fibrillation (AF) occurs if the heart’s electrical signals don’t travel through the heart in a normal way. Instead, they become very rapid and disorganized. With atrial fibrillation (AFib),the electrical signals of the heart are abnormal.

• The top and bottom parts of the heart don’t work together as they should
• The heart beats very fast and irregularly
• As a result,blood is not properly pumped to the bottom part of the heart and the rest of the body

Damage to the heart’s electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease.

 

Understanding the Electrical Problem in Atrial Fibrillation

In AF, the heart’s electrical signals don’t begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don’t travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate.

The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can’t send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren’t beating as fast as the atria.

Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.

If this happens, blood isn’t pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats.

The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.

Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized.

AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can’t restore a normal heart rhythm.

Major Risk Factors

A good question to ask your healthcare provider is what is the cause of my AFib?

Atrial Fibrillation  is more common in people who have:

• High Blood Pressure
• Coronary Heart Disease (CHD)
• Heart Failure
• Rheumatic heart disease
• Structural heart defects, such as mitral valve prolaps
• Pericarditis;  a condition in which the membrane, or sac, around your heart is inflamed
• Congenital Heart Defects
• Sick sinus syndrome (a condition in which the heart’s electrical signals don’t fire properly and the heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate)

AF also is more common in people who are having heart attack or who have just had surgery. The risk of AF increases as you age. Inflammation also is thought to play a role in causing AF.  Drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger AF in some people.  Sometimes, the cause of AF is unknown.

Treatment Goals

• Slow heart rate
• Regain normal heartbeat
• Treat causes
• Lower risk of stroke and heart failure

Warning Signs of Stroke

• Numbness or weakness of the face, arm, or leg ,especially on ONE side
• Confusion
• Difficulty speaking or understanding
• Trouble seeing in one or both eyes
• Trouble walking or with balance
• Dizziness
• Severe headache

Warning Signs of Heart Failure

• Shortness of breath
• Trouble doing usual activities
• Difficulty breathing when lying flat
• Weight gain
• Swelling in legs, ankles, or feet

Treatment options

 Heart Procedures

• Cardioversion

Cardioversion is done two ways: An electrical procedure,  in which your heart is given low-energy shocks to trigger a normal rhythm. You’re temporarily put to sleep before the shocks are given. This type of cardioversion is done in a hospital as an outpatient procedure. “Outpatient” means you can go home after the procedure is done.

Cardioversion through use of medicines. Using medicines to correct arrhythmias also is a form of cardioversion. This type of cardioversion usually is done in a hospital, but it also can be done at home or in a doctor’s office. It is known as a rhythm controller

• Catheter ablation

During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in your arm, groin (upper thigh), or neck. The wires are guided into your heart through the blood vessel.
A special machine sends energy to your heart through one of the catheters. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe.

Lifestyle changes

• Do I need to change my eating habits?
•  Should I change my activity level?
• What else can I do to lower my risk?
•  Stopping smoking
•  Limiting/avoiding alcohol
•  Limiting/avoiding caffeine

Resources:

Living with Atrial Fibrillation patient educational materials

Learn about Atrial Fibrillation here

A heart away from stroke documentary  Discovery Channel explores the connection between atrial fibrillation and stroke – in order for patients to learn about the importance of stroke prevention

Sources:

http://www.nhlbi.nih.gov/index.htm

http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

http://www.stopafib.org/

 

Vitamin K and Coumadin

A common concern many heart patients first share is their diet concern following a cardiac event. Blood thinners are very commonly prescribed for heart conditions such as atrial fibrillation, or post valve replacements. Many are told to be careful about leafy green vegetables. What the heck does be careful mean? Many take it to mean they can’t eat green vegetables, but then question how they are to eat a healthy diet. This is a very common misconception. It is important to get vitamin K in the diet, and the goal if taking coumadin/warfarin is to get the approximate same intake each day. This is very difficult to do, thus INR levels are fluctuate greatly and this creates health issues if not closely monitored. Most doctors aim to keep INR around 2.5-3.5.

Click to access coumadin1.pdf

Important Drug and Food Information

From the National Institutes of Health Clinical Center
Drug-Nutrient Interaction Task Force

Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K

The food you eat can affect how your medicine works. It is important to learn about
possible drug-nutrient interactions for any medicines you take.

Why was warfarin (Coumadin) prescribed for you?
Warfarin (Coumadin) is a medicine prescribed for people at increased risk of forming
blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.

How does warfarin work?
Blood clots are formed through a series of chemical reactions in your body. Vitamin K is
essential for those reactions. Warfarin (Coumadin) works by decreasing the activity of
vitamin K; lengthening the time it takes for a clot to form.
International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test
values obtained from measurements of the time it takes blood to clot. Individuals at
risk for developing blood clots take warfarin (Coumadin) to lengthen the usual time it
takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the
INR/PT every month in patients taking warfarin (Coumadin) to make sure it stays in the
desired range.

What can help keep INR/PT in the desired range?
To help warfarin (Coumadin) work effectively, it is important to keep your vitamin K
intake as consistent as possible. Sudden increases in vitamin K intake may decrease
the effect of warfarin (Coumadin). On the other hand, greatly lowering your vitamin K
intake could increase the effect of warfarin (Coumadin).
To keep INR/PT stable and within the recommended range, it is important to:
• Take your medicine exactly as your doctor directed.
• Have your INR/PT checked regularly.
• Keep your vitamin K intake consistent from day to day.

How do I keep my vitamin K intake consistent?
• Keep your intake of foods rich in vitamin K about the same each day. For
example, you may plan to eat only ½ cup of these foods per day. If you like
these foods and eat them often, you can eat more, but be consistent. 

• Eat no more than 1 serving of food that contains 200%-600% DV of vitamin K
• Eat no more than 3 servings of foods that contain 60-200% DV of vitamin K
• Eliminate alcohol if you can, or limit yourself to no more than 3 drinks a day
• Take no more than 800IU of vitamin E supplements
• Avoid cranberries and cranberry juice as they can raise INR and risk of bleeding
• Limit or avoid grapefruit and grapefruit juice
• Work with your doctor when taking CoQ10 as it can hamper the effectiveness of Warfarin
• Many natural supplements affect PT/INR levels, so it is best to avoid them unless your doctor advises otherwise. The following supplements definitely affect PT/INR levels: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, gingko, horse chestnut, insositol hexaphosphate, licorice, melilot(sweet clover), pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.
• To find foods low in vitamin K, see the article on low vitamin K foods, check the nutrition facts for a particular food, or use the nutrient ranking tool to find low vitamin K foods in a particular food group.

Source: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf

Protect your kidneys

It isn’t easy to be a heart patient, there are so many medication and lifestyle consideration to prevent further injury or illness.

Common heart medication interact with our foods and other medications.  NSAIDS increase heart problems, Coumadin requires watching vitamin K, Grapefruit interacts with many heart medications, some diabetes medications increase heart risks, some heart medications increase risk for diabetes. Now we have a another  to be concerned about. Here is a new advisory the combination of NSAIDS and hypertensive drugs. This is challenging as we encourage patients to exercise and often there are side effects of sore muscles and joints. Based on this the recommendation for sore muscles and joints should be to use  ice and stretch…avoid the Motrin, Advil, Ibuprofin, Moabic, etc. The other challenge is to get the orthopedic physician and the cardiologist to work together to prescribe the safest medication regiment for you. Most importantly do not stop your anti-hypertensive medications without first consulting your physician, sudden withdrawal can be very problematic.

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypert ensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published inBMJ.

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypertensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published in BMJ.

Analyzing data from nearly half a million people taking antihypertensive drugs, researchers found 2,215 cases of acute kidney injury after a mean followup of 5.9 years. People on dual therapy were not at increased risk for acute kidney injury. However, when NSAID use was added to dual therapy, there was a modest but significant increase in risk (rate ratio 1.31, CI 1.12- 1.53). The increase in risk was highest in the first month of treatment.

The authors concluded that “increased vigilance may be warranted when” NSAIDs are used with dual antihypertensive therapy, especially in the early treatment period.

In an accompanying editorial, Dorothea Nitsch and Laurie A Tomlinson write that the safety of dual therapy still remains to be demonstrated and that the study likely “underestimates the true burden of drug associated acute kidney injury” in patients taking antihypertensive therapy and NSAIDs. Physicians should inform patients taking antihypertensive therapy about the possible risks of NSAID use and should ”be vigilant for signs of drug associated acute kidney injury in all patients.”

Here is the BMJ press release:

Triple mix of blood pressure drugs and painkillers linked to kidney problems

Absolute risk still low, but doctors and patients should be vigilant

Research: Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study

Editorial: Safety of co-prescribing NSAIDs with multiple antihypertensive agents

Patients who take a triple combination of blood pressure drugs and common painkillers are at an increased risk of serious kidney problems, especially at the start of treatment, finds a study published on bmj.com today.

Although the absolute risk for individuals is low, it is still something doctors and patients should be aware of, say the researchers.

Acute kidney injury (also known as kidney failure) is a major public health concern. It occurs in more than 20% of hospital inpatients and is associated with around half of all potentially preventable deaths in hospital. It is often triggered by adverse reactions to drugs, but little is known about the safety of different drug combinations.

So a team of researchers from the Jewish General Hospital and McGill University in Montreal, Canada, set out to assess whether certain combinations of drugs to lower blood pressure (antihypertensive drugs) and non-steroidal anti-inflammatory drugs (NSAIDs) are linked to an increased risk of kidney injury.

These drugs are commonly prescribed together, particularly in elderly people with several long term conditions.

Using the world’s largest computerised database of primary care records (CPRD), they identified 487,372 people who received antihypertensive drugs between 1997 and 2008. Drugs included angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and diuretics, with NSAIDs.

Patients were tracked for nearly six years, during which time 2,215 were diagnosed with acute kidney injury that prompted admission to hospital or dialysis (7 in 10,000 person years).

The results show that patients taking a double therapy combination of either a diuretic or an ACE inhibitors or ARB with an NSAID were at no increased risk of kidney injury. However, a triple therapy combination of a diuretic with an ACE inhibitor or ARB and an NSAID was associated with a 31% higher rate of kidney injury, particularly elevated in the first 30 days of treatment during which it was 82% higher.

These results remained consistent after adjusting for confounding factors and controlling for other potential sources of bias.

The authors conclude that, “although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs.” They add: “In particular, major attention should be paid early in the course of treatment, and a more appropriate choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice.”

In an accompanying editorial, researchers at the London School of Hygiene and Tropical Medicine say this study “is an important step in the right direction” but “probably underestimates the true burden of drug associated acute kidney injury.”

They suggest that clinicians advise patients of the risks and be vigilant for drug associated acute kidney injury, and say “the jury is still out on whether double drug combinations are indeed safe.”

Acute Kidney Injury Associated With Dual Antihypertensive Therapy And NSAIDs

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.

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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?