Decompensated heart failure

Decompensated heart failure is the term used to define heart incapacity of pumping enough blood in the main arteries, according to the organism needs. What distinguishes decompensated heart failure from a compensated heart failure is the fact that defensive mechanisms are not efficient anymore and the blood amount delivered to the tissues is no longer sufficient, which determines a variety of symptoms as we are going to reveal next.
How do you know you have a decompensated heart failure and if u need to go to the hospital? Decompensated heart failure has different manifestations, as following:

•  when the left heart is inefficient, blood will stagnate into the heart chambers forcing them to enlarge or increase the number of muscle fibers in order to increase cardiac force; this is a defensive mechanism, which will compensate for a while the inefficient function of the heart. Once this mechanism is no longer able to control the situation, blood will stagnate in the lungs, increasing the pressure in the pulmonary vessels and from this point on, pulmonary edema (accumulation of water in the lungs) and pulmonary hypertension may occur. All these manifestations are a sign that the heart can no longer compensate its diminished function, so we are facing a decompensated heart failure.
•  in right heart insufficiency, cardiac muscle won’t be able to pump blood into the pulmonary arteries, so the blood will flow back in the venous system, determining accumulation of water in different tissues (lower limbs, abdomen-ascites, pleural space).

In clinical practice, people with decompensated heart failure will experience important shortness of breath, being unable to breathe while lying (a condition known as orthopnoea), blue color of the lips and limbs extremities, fatigue, palpitations or rapid heart beats, incapacity of performing daily activities. In more advanced cases, hypotension, fainting, ischemia of lower limbs, stroke or renal failure may occur, these manifestations being the consequence of the low blood flow in the arteries that feed the brain, kidney, or limbs.

What is the cause for decompensated heart failure?

There are many causes for decompensated heart failure, the most important ones are the following:

•  hypertension-if patients don’t follow the treatment, high blood pressure will increase the labor of an already weak heart, making it impossible to accomplish body needs,
•  salt intake-will favor water accumulation in the body, increasing blood volume and requesting a higher cardiac labor,
• infections: respiratory infections, heart wall infections like myocarditis,
• heart attacks, arrhythmia,
• weight gain is common cause of decompensated heart failure,
• patients that no longer respect their heart medication,
• patients that continue to smoke, drink alcohol, with high levels of blood lipids etc.

What are the steps to follow in decompensated heart failure ? People in this condition must be admitted to hospital, carefully watched, investigated for different conditions that might have provoked decompensated heart failure and follow a well established therapy (diuretics and cardiotonic medication will be needed in order to eliminate the overload of water and increase cardiac muscle force).
People with heart failure will have a different number of hospital admissions, followed by „free” periods of time, when the symptoms will be stable. However, the compliance to medical recommendations will determine how fast this disease will evolve, together with the other conditions we enumerated above. Despite the correct treatment and compliance of the patient, heart failure will progress until the only option left is cardiac transplant, but the speed of this evolution can be controlled by avoiding the conditions that favor heart failure to decompensate.

Please call your doctor to find out mode about decompensated heart failure.

Heart palpitations anxiety

What is heart palpitations anxiety?

Anxiety and stress are maybe the “third millennium disorders” and it has “no age” as doctors from all medical specialties have to deal patients suffering from these conditions, both young and old. In some point of our life we all suffered or will suffer from stress or anxiety and many of us deal these conditions by themselves for a long time before they finally decide to sick medical help. Those words are so often used today that it may seem they are part of our life and we must accept them as a normal reaction. But this is not how it really is, because anxiety can change our lives dramatically and make us feel sick, unable to perform our daily duties or even things that used to give us pleasure. Many times when we speak of this disorder we think of heart palpitations anxiety, as it is a frequent symptom in people suffering from anxiety. Next we will find out what anxiety and heart palpitations anxiety really mean and how to deal it.
Anxiety is a medical condition defined as a psychological and physiological state characterized by  feelings of fear, worry, dread, psychological tension or stress that can determine emotional, cognitive, somatic and behavioral changes. This disorder can determine multiple symptoms and among them heart palpitations anxiety are more frequently.
How it feels to suffer from heart palpitations anxiety? Living with heart palpitations anxiety is definitely not easy or comfortable. During heart palpitations anxiety u may feel that your heart beats are too fast or irregular, or that your heart stops for a small period. U may feel dizzy or experience shortness of breath (or suffocation sensation) or even faint. In people that already suffer from heart disease, abnormal heart beats can affect the oxygen supply of the heart muscle and determine chest pain or even a heart attack.
Next we will present the case of a 34 years old women suffering from heart palpitations anxiety:
A 34-year-old female presented with a history of anxiety for the past 20 years. When she was 14, her teacher used to embarrass her in front of the class by making her to stand-up until her face turned red and all the class would laugh. In time she becomes very nervous and fearful about social situation and activities that could draw attention to her. In the highschool she had panic attacks everytime she supposed to make presentation and communicate in peers. She describes she experienced profuse sweetening, heart palpitation and rapid heartbeats, burning in the stomach and the need to get away. These symptoms persisted during university and at the age of 25 she finally sought for professional help. The clinical psychologist diagnosed the patient with social phobia, panic disorder, and mild agoraphobia. She underwent  once- or twice-weekly sessions of psychological therapy with great improvement, slowly she could integrate into the social activities and seemed to be “cured”, convincing her therapist to stop the therapy. After 3 years as she attended the medical school, symptoms reappeared, and they were even worse then the first time and she had to seek the help of a psychiatrist and follow a medical treatment.

In conclusion, heart palpitations anxiety together with other manifestations of anxiety are not easy to deal and live with, but medical help will allow patients suffering from this condition to have a better life.

Heart murmurs in adults

What are heart murmurs in adults?

We all read or heard talking about heart murmurs in adults, and many of us are curious to find out if  they have this dysfunction. A few know the true meaning of this condition, that’s why when our physician tells us we have  heart murmurs either we think we suffer from a devastating disease, either we ignore it, but none of this reaction is normal.  Next we will clarify the meaning and the cause for heart murmurs, in order to prepare people that might be diagnosed with this disorder to understand and deal their condition properly.
Heart murmurs in adults refer to the abnormal sounds heard by doctors when they listen to the heartbeats with a stethoscope. In medical practice, hearing  heart murmurs in adults raises the suspicion of heart valve pathology, but sometimes these abnormal heart sounds can occur in other conditions like a defect in the heart wall, anemia, fever etc. When there is no heart modification that can explain the murmurs, they are called functional. Because this condition can occur in other pathologies beside hear disorder, everytime we suspect a heart murmurs in adults we should check its presence with an echocardiography examination.
Heart murmurs affect both children and adults and are recognized as the “noise” heard between the two normal heart sounds. If the murmur occurs after the first heart sound is called systolic, which means it occurs during heart contraction, and if it occurs after the second heart sound is called diastolic and this means it occurs while heart is in its relaxation period. The classification into systolic and diastolic is important because it indicates whether we are facing a valve stenosis (narrowing of the heart valve) or insufficiency (the valves fail to close properly, letting blood to flow back into the heart chambers). There are other classifications for heart murmurs in adults, but those medical terms are more important for the specialists.

 Why do heart murmurs in adults occur and how we deal with them?

 As we explained above, in most of the cases heart murmurs in adults occur when there is a heart pathology:

• heart valve narrowing or closure impairment, in this case the blood flow becomes turbulent and makes a noise that we call it murmur,
• a defect in heart wall-a congenital defect that occurs in children, allowing blood to flow from one side of the heart to the other, determining blood with oxygen and blood with carbone dioxide to mix. Sometimes this condition can remain undiagnosed until late adulthood, because it is a small defect and doesn’t cause symptoms, but in many cases is diagnosed soon after birth, being recognized as a prolonged murmur (noise) heard during heart auscultation and needs surgical correction. Another type of heart murmur heard in children is the one determined by the ductus arteriosus persistence (a connection between aorta and pulmonary artery in the uterine life).
• other condition like anemia or fever can determine heart murmurs in adults, because they determine turbulent blood flow, but this murmur disappears once the condition is treated.

How do we  with deal heart murmurs in adults ? In patients suffering from valve pathology periodically monitoring is important because in time they can lead to heart failure, in order to prevent this, surgical replacement of the valves can be performed. Heart wall defect can also be repaired providing a normal life for these patients, while the causes for functional heart murmurs in adults once treated determine these abnormal heart sounds to disappear.

Heart murmurs in adults are a serious medical condition,  if you think you have it call your doctor.

Ejection fraction heart failure

What is ejection fraction heart failure?
Ejection fraction heart failure it is a term used to describe the amount of blood that heart can deliver to the main arteries. In medical practice, doctors measure the ejection fraction heart failure because this examination offers details about heart function and helps to determine if  there is a heart failure or not. Once the heart function is impaired, the ejection fraction begins to diminish and the systemic consequences of heart failure begin to occur. In early stages, the body will try to compensate the changes appeared due to heart function decrease, but in time these will become obviously.
What are the signs of ejection fraction heart failure?

When you are suffering from heart failure it is important to recognize the problem and look for a doctor as soon as possible, only in this way you can receive the correct treatment which will help the heart to function better and delay farther deterioration. At the beginning, people with diminished ejection fraction heart failure will feel more and more tired, but usually this symptom is wrongly associated with getting old, gaining weight, anemia or simply overlooked. Many people will find it is normal to feel tired during effort, without noticing that a few months ago they were able to perform the same effort without getting tired. Only when tiredness is getting worse and they have to deal it in common daily activities like walking, they begin to feel is something wrong and look for medical help, but in that moment their ejection fraction heart failure is already diminished. There are a lot of people living with diminished ejection fraction heart failure without knowing about this until they have routine medical examination or until symptoms get worse. In time, tiredness is accompanied by shortness of breath, blue coloring of lips, hands, feet, legs begin to swallow due to edema. It is important to report these symptoms to your doctor, because this will help him suspect your heart is not working normally. Diagnosing heart failure is not the last step before patients can start taking medication, it is also very important to find the cause for ejection fraction heart failure deterioration: is it a heart attack, a heart valves pathology, infections of heart walls, ischemia (heart cells don’t receive enough oxygen) ? etc.

Is there any treatment for diminished ejection fraction heart failure?

There are many drugs available that can help heart function better, but there is no cure for this, once the heart failure occurs, heart function and ejection fraction will deteriorate in time. What we can achieve by medication is to delay the progress of heart function impairment, ameliorate symptoms and increase the quality of life. One mistake made by many patients is to think that once they take the prescribed medication, their heart will continue to function normally from that point on, forgetting to fallow a correct diet, without salt and fats, continuing to drink alcohol, smoke, gain weight,  etc.

In patients diagnosed with heart failure, periodically heart function evaluation is very important and one examination that can offer information about the evolution of heart function is ejection fraction heart failure.

Decreased cardiac output

What is a decreased cardiac output?

Decreased cardiac output is a synonymous term used for heart failure or heart insufficiency. In patients suffering from decreased cardiac output or heart failure, the amount of blood that vessels „offer” to the tissues is not enough for the metabolic demands. Decreased cardiac output means that heart can’t function at its proper parameters, even if the heart muscle labor increases and all types of compensating mechanisms are used.
How can doctors tell us if we have a decreased cardiac output?
Decreased cardiac output determines a diminished ejection fraction (a smaller amount of blood is delivered to the aorta and its branches) and can be discovered when your doctor performs an echocardiography. Measuring the ejection fraction periodically will offer information about the heart failure evolution, but is not always correlated with the severity of symptoms. For example, there are patients with severe decreased cardiac output (about 24%) that still can perform common activities without having shortness of breath, chest pain, palpitations or getting tired, while other patients with a higher ejection fraction (and therefore a higher cardiac output) have all the symptoms listed above.

Decreased cardiac output- clinical case report:

After the theoretical part of this article listed above is time to pass to a more practical part, in order to understand what the decreased cardiac output manifestations are and how it can affect people life and daily activities.
Next we will present a case of a 63 years old patient suffering from heart failure, with a decreased cardiac output, so we can have a better image of how life is for a person diagnosed with this disorder.
Case report:
A 63-year-old Caucasian man had a 40 years medical history of diabetes, treated with glyburide 10 mg twice/day. He was also known with coronary heart disease and heart failure (left ventricular ejection fraction 25% determined by echocardiogram, NYHA class II-III), hypercholesterolemia, and chronic renal insufficiency (serum creatinine 1.4-1.8 mg/dl). His drug therapy included aspirin 325 mg/day, digoxin 0.125 mg/day, simvastatin 20 mg at bedtime, metoprolol 50 mg twice/day, and nitroglycerin 0.4 mg sublingually as needed. At that clinic visit, the patient had no other complaints and his heart failure appeared stable. Nine days later he came to the clinic with an increase in weight of 3.6 kg (baseline weight 78.6 kg) complaining of shortness of breath. Physical examination revealed bibasilar rales (pulmonary sounds heard during breathing which may indicate infection, pulmonary edema, allergy or bleeding etc.), +S₃ gallop (abnormal sound heart during heart auscultation, which indicates heart failure), and increased jugular venous distention (JVD-because right heart has a decreased function, blood will flow back into the veins that bring it into the heart chambers), but no lower extremity edema. Again, he reported adherence to drug therapy and no dietary indiscretions.  After treatment adjustment he was released from the hospital, but returned 2 weeks later reporting that his weight increased, and legs edema occurred, while his wife confirmed he had a high sodium intake. Chest radiograph was consistent with pulmonary edema. Fluids were immediately restricted, and the patient was given bumetanide 5 mg intravenously twice/day. By hospital day 2 the patient had lost 4.1 kg by diuresis and  on hospital day 5 his heart failure was stable.
In conclusion, decreased cardiac output is the main manifestation of heart failure and has a great impact in patients’ life (as we saw in the case above).

If you think you have any of the following symptoms of decreased cardiac output contact your hospital.