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

 

 

 

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/

 

Cardiac Surgery Patients: Think Posture!

If you just had your chest recently surgically opened, the last thing you want to think about is stretching, but after time it becomes very important. You may not physically remember the pain of surgery but your body does. It gradually rounds the shoulders forward, the head is carried slightly more forward, and these changes make the subtle curve in the low back gradually flatten. Many patients when they first attend cardiac rehabilitation complain of pain and spasm to their upper back and shoulders. When I worked in physical therapy I would have many patients present several years after open heart surgery with low back pain. Many had the characteristic posture I described above.

Here are a few suggestion to help you in the healing process.

Be very aware of your posture – if you are sore, think about what posture you are in. Are you seated with your shoulders slumped and head forward? If so adding a lumbar support to your chair will help to straighten your back posture. Another suggestion is to get up and move more frequently.

Pain in the shoulder blade region?

If so begin with gentle chest stretching and shoulder stretching. It is very important you avoid pain. I usually wait until my patients are approximately 6 weeks in recovery before initiating this. Do not take any stretch to pain. Do not bounce stretches.

There are three different postures to get the different muscle groups of the chest. One leg is forward simply to maintain the curve of the low back. Hold the stretch 10 to 15 seconds, repeat 1-2 times. It is ok to do this stretch a few times per day.

   These are other good stretches for the chest

Upper back stretching

The muscles act very similar to pulleys. If one side shortens the other side lengthens. If the muscles of the chest are short the muscles of the upper back are stretched. Prolonged stretch leads to muscle spasm, and this makes many people feel like they have knots in their upper back. There is a great stretch for this.

Reach down grasp opposite knee with hand (left hand grasp right knee). Relax your head pull up gently, hold 10-15 seconds. Repeat with opposite hand/knee. repeat one to two times.

Use a lumbar support in your favorite chair, while driving, or sitting for a prolonged time. You can either purchase one at your local medical supply/pharmacy, or you can simply roll up a small towel and put it in the small of your low back.

 

 

Coronary Heart Disease

Health Devices

Today’s technology allows heart patients to monitor their own health changes and be proactive in caring for themselves. I believe we are on a medical breakthrough using the internet and new technologies. In the past one would have to go to their doctor and report transient changes in blood pressure, heart arrhythmia – (palpitations) out of range blood sugars, etc.  The modern healthcare approach is to then order several very expensive tests in hopes of capturing the data and then making changes to the patients care plan once there is evidence of the changes. Today’s rapidly emerging technologies now allow patients to capture this information with home devices which cost much less than the tests ordered by our modern healthcare system.

Let’s look at heart rhythm monitors as an example. Atrial fibrillation is a very common heart rhythm problem, and for many patients they will go in and out of this rhythm. They may feel the heart racing, skipping beats, or feel shortness of breath and fatigue when the rhythm is abnormal. If A fib is dangerous immediate care can be initiated and then  managed with blood thinners to decreased risk of stroke. Therefore it is worth monitoring and catching it earlier vs. later.   There are now  monitors one can purchase for about $200 that would capture the rhythm put it to memory, then you can send to your physician electronically. Other heart arrhythmia that can be detected and managed this way  include heart blocks, abnormally slow heart rhythms, tachycardia –  fast heart rhythms.  The modern course is to order a holter monitor or an event monitor. The holter monitor is worn for 24 hours or more, then it takes up to two weeks for it to be interpreted  dictated and the reports received and acted on by the ordering physicians. Event monitors are placed below the skin and worn for 30 days or more. Consider given the progressive nature of heart problems, that these tests are not  usually run only one time on an individual over the course of their life.

HOLTER MONITOR SCANNING					$312.00
HOLTER MONITOR RECORDING					$345.00

Handheld home devices purchased for about $200 can be used by the patient with  little education,and a plan of care is devised  between the patient and the physician..  This could potentially allow you to  manage their issues more in a much more convenient and timely manner. The device is owned by you and thus can be used over many years. Below is the typical physician algorithm for managing arrhythmia’s.

 

 

With today’s hand held monitors available at a cost of approximately two hundred dollars, patients can capture the irregular rhythm when it occurs, save the data, report it to physicians and have their care evaluated much quicker – provided they can get an appointment with their healthcare practitioner. Wouldn’t it be even better to be able to transmit the information to the physicians email, and then be triaged based on the data?

The problem is $$$$$$$, and the medical system in the US is slow to adopt change. If it cuts in to the profit of healthcare it isn’t likely to be adopted.  This a role where I believe mid level practitioners like PA’s, CNA’s can play a role in triaging care, as the current work demand doesn’t allow most physician the time to undertake electronic care of patients. It may take patients to make the change, those who are under insured, uninsured, or have significant financial obstacles which impede access to traditional care.

On a side note I really enjoyed Eric Topol’s book The Creative Destruction of Medicine. It makes one think about how medicine can change practice models.

With personal technology, doctors can see a full, continuously updated picture of each patient and treat each individually. Powerful new tools can sequence one’s genome to predict the effects of any drugs, and improved imaging and printing technology are beginning to enable us to print organs on demand. Topol offers a glimpse of the medicine of the future—one he is deeply involved in shaping.

Below are a couple of examples of how patients can control and manage their health data:

http://www.misfitwearables.com/health_device_at_a_glance

http://online.wsj.com/article/SB10001424052702303404704577311421888663472.html

http://www.favoriteplus.com/easy-ecg-handheld-monitor-fp180.php

 

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.