Diaphragmatic Function in Cardiovascular Disease: JACC Review Topic of the Week
Fatigue To Breathlessness: 5 Signs To Recognise The Early Signs Of Heart Failure
Heart failure is a condition where the heart muscles do not pump enough blood to meet the body's requirements. It happens when the heart muscle weakens, stiffens, or sustains damage that impairs its capacity to efficiently pump blood throughout the body. In India, heart-related issues or cardiovascular diseases are a major concern, with heart failure affecting a significant number of people in the country. The fact that heart failure has a poor prognosis highlights its seriousness and the need to create more awareness regarding the condition.
Understanding the causes of heart failureAccording to Dr Rajneesh Malhotra, Vice Chairman & Head - CTVS, Cardiac Sciences, Cardiac Surgery (CTVS), Robotic Surgery, Max Super Speciality Hospital, Saket, heart failure can be caused by various factors, including coronary artery disease (CAD), high blood pressure, cardiomyopathy, heart valve disorders, previous heart attacks, diabetes, obesity, smoking, unrestricted alcohol consumption, and other medical conditions. CAD occurs when the arteries supplying blood to the heart muscle become narrowed or blocked, reducing blood flow and potentially causing heart failure. High blood pressure forces the heart to work harder, weakening it and increasing the risk of heart failure. Cardiomyopathy weakens the heart muscle, and heart valve disorders disrupt blood flow, leading to heart failure. Other medical conditions, such as thyroid disorders, kidney disease, and certain infections, can also contribute to heart failure development.
Identifying the initial indications of heart failureRecognising early signs of heart failure is crucial for timely diagnosis and subsequent intervention. Key early signs include shortness of breath, fatigue, swelling, persistent coughing or wheezing, and an increased heart rate.
Heart failure can be managed through lifestyle modifications such as a heart-healthy diet low in sodium and saturated fats, regular exercise, therapies, surgical intervention, and medication. When alternative therapies are no longer successful in treating severe heart failure, left ventricular assist devices, or LVADs, become extremely important. These are mechanical pumps that are surgically inserted into the body to assist the heart in pumping blood throughout the body. Effective management of heart failure requires routine monitoring by a medical team. This could entail routine symptom assessments, medication modifications, hydration status monitoring, and other pertinent parameter tracking.
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Mum Who Had Heart Attack An Hour After Giving Birth Told She Has Just A Year To Live
Kelsie Jade McHugh is on the waiting list for a bowel transplant following a series of serious medical episodes including a heart attack an hour after giving birth
Kelsie Jade McHugh and her husband Danny (Image: Manchester Evening News)
A new mum has been told she has just a year to live after suffering a heart attack an hour after giving birth.
Kelsie Jade McHugh had been trying to have a child with her husband Danny for eight years, so when she fell pregnant they were both overjoyed. However, when her baby's heart stopped 31 weeks into the pregnancy, the longed-for situation became a nightmare.
On October 9, 2022 Kelsie had to undergo an emergency C-section, which saw her baby daughter Renae successfully delivered. Just an hour later, she suffered a heart attack and was immediately rushed back into surgery. Since then, Kelsie has been battling a series of extreme health issues including weight loss, fatigue and nausea, Manchester Evening News reported.
Now, in a terrible blow for the mum and her family, doctors have told her she must have an urgent bowel transplant to survive. Not only was her bladder torn during labour, Kelsie has cystic fibrosis, making her medical situation that much more difficult to manage.
The young mum then suffered from bowel poisoning, leading to intestinal failure. Months later, she began experiencing extreme fatigue and nausea. She found it difficult to keep food down and her weight plummeted. By May, her hair started falling out and she weighed a mere seven stone.
When doctors examined her at Wythenshawe Hospital, they found a 'big mass' in the Oldham woman's small intestine, meaning she had to be hooked up to a TPN (total parenteral nutrition) machine for sustenance. She was then transferred to Salford Royal Hospital for surgery, which took place in October.
Kelsie recalled: "I thought 'this is it, I'm going to get my operation and I'm going to feel so much better... It's going to be amazing, I'm going to be able to go home and start my life'."
By this point the mum had shrunk to just five stone and needed a stoma fitted for the first time. Just before she was due to be discharged on December 11, Kelsie experienced 'really bad pains' in her stomach and noticed a lump. The mass in her small intestine had ruptured.
"The next minute my husband and mum were at the hospital saying their goodbyes to me and I was scared as hell. I was told my bowel had ruptured and that I needed to be taken down to theatre immediately," Kelsie said.
After a gruelling seven-hour surgery, the mum had another stoma fitted and was informed she would need to rely on a TPN machine for the rest of her life. The next January Kelsie contracted sepsis and, just weeks later, began suffering from extreme fatigue. She learned her potassium levels were plummeting to such an extent that she was at risk of a heart attack. After the many traumatic medical episodes, Kelsie has been left with just 20cm of her three-metre small bowel remaining.
Then hospitalised with a failed pancreas, she became insulin-dependent as her kidney, liver, and heart began to fail. Within just seven days, doctors delivered the grim prognosis of multiple organ failure, leaving her with only a year to live. Now desperately needing a bowel transplant to save her life and potentially rescue her other organs, Kelsie is enduring the agonising wait to be added to the transplant list. She shared her fears: "It's just a waiting game, that's the hardest bit it's out of our hands. It all comes down to unfortunately who passes away and who's a match. I could be on the list for months and then may never get the call."
Reflecting on the devastating diagnosis and how it has impacted the family, Kelsie said: "I was just in shock, I didn't want to believe it. I thought this was going to fix me, I was told everything was going to be alright. I've got a little girl I absolutely adore and knowing she might not have her mum growing up absolutely breaks my heart. The thought of death doesn't scare me, it's the thought of leaving her and Danny. All I wanted to be growing up was a mum. They're talking about end of life plans and I don't feel ready, I've only just turned 30."
In response to her situation, a GoFundMe page has been set up, featuring a bucket list of experiences Kelsie hopes to enjoy.
Ask The Doctors: Flu Shot May Help Prevent Heart Attacks
In one study of adults age 50 and older, even mild flu translated to a doubled risk of heart attack in the two weeks following diagnosis. In patients with heart disease, the risk of heart attack, stroke or heart failure quadrupled. Getty Images
Q: I can't stop thinking about what my doctor said when I got my flu shot last fall. I'm a 55-year-old man, and I have a history of high blood pressure. He said the flu shot will give me extra protection against having a heart attack. What is the connection?
A: When we think about the possible complications of the flu, they typically include a sinus infection, ear infection or an escalation to bronchitis or pneumonia. But an emerging body of research now points to a link between infection with the influenza virus and an increased risk of having a heart attack or stroke. This connection has proven to be particularly strong in people living with hypertension and heart disease, and in those who have previously had a heart attack.
In 2018, a Canadian study published in the New England Journal of Medicine found that the inflammation that occurs during a case of the flu can trigger a heart attack. In that study, the researchers analyzed seven years of medical data collected from adults of all ages with confirmed cases of influenza who had been hospitalized. They found that in the week following their diagnosis, patients were six times more likely to have a heart attack than in the year before their hospitalization or the year after.
A separate study, conducted two years later by the Centers for Disease Control and Prevention, looked at health data from 80,000 adults over the course of eight flu seasons. Each of them had confirmed flu cases that were severe enough to require hospitalization. The data showed that 12% of the adults in the study had a heart attack or died of heart failure in the week after their flu diagnosis.
This year, researchers in Spain looked at the same question in adults 50 and older. In that population, even mild flu translated to a doubled risk of heart attack, and also stroke, in the two weeks following diagnosis. In patients with heart disease, the risk of heart attack, stroke or heart failure quadrupled.
As anyone who has experienced the prolonged misery of the flu knows, it's a serious infection. Inflammation causes a wide range of symptoms, including fever, cough, headache, sore throat, congestion, muscle aches and pains, and fatigue and exhaustion. Now researchers suspect that influenza infection may also have an adverse effect on arterial plaque. That's the buildup of cholesterol within the walls of the vessels that return blood back to the heart. It is thought that the widespread inflammation in an influenza infection can cause ruptures in existing plaques. This causes the formation of a blood clot, which then impedes or completely blocks blood flow and leads to a heart attack.
These studies bolster the existing guidance regarding the benefits of getting an annual flu shot. And while it's already spring and time to think about sunblock, in many parts of the country, significant flu activity continues as late as May. Particularly for those at higher risk, it's still not too late to get a flu shot.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.Ucla.Edu.
© 2024 UCLA Health. Distributed by Andrews McMeel Syndication
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