Congestive heart failure life expectancy: Prognosis and stages
Bibasilar Atelectasis: Symptoms, Causes, And Complications
Bibasilar atelectasis is when there is a collapse in the bottom part of both lungs. It can cause symptoms such as shortness of breath, coughing, wheezing, and more.
Atelectasis is a partial or total collapse of one or both lungs. It may occur for a number of reasons.
For example, when something pushes against the tiny air sacs in the lungs, or alveoli, and causes them to collapse. It may also occur when the oxygen and carbon dioxide in the alveoli move into the bloodstream and no new air moves in, due to an obstruction in the small airways, for example.
It may also result from impaired pulmonary surfactant production or function. Pulmonary surfactant is a fluid that helps prevent the alveoli from collapsing.
Bibasilar atelectasis can cause severe complications if left untreated. How doctors treat it will vary based on what has caused the collapse.
This article explores the causes, symptoms, and possible complications of bibasilar atelectasis. It also discusses how doctors diagnose and treat the condition.
A person's lungs comprise several areas that healthcare professionals call lobes. The right lung has three lobes, and the left lung has two lobes.
When someone experiences bibasilar atelectasis, the lowermost lobes of their lungs collapse entirely or partially.
The lobes of the lungs are filled with alveoli, which are arranged in clusters and surrounded by blood vessels. When a person breathes in and out, the alveoli allow their blood to collect oxygen and get rid of carbon dioxide.
During bibasilar atelectasis, the alveoli in the base of the lungs deflate and stop performing this essential task. Oxygen may not be able to reach the vital organs, making the condition life-threatening in some cases.
It can also cause scarring, which could lead to reduced lung function afterward.
According to the American Lung Association (ALA), people may confuse atelectasis with pneumothorax. This is because some people also refer to pneumothorax as a "collapsed lung". While the two conditions are similar, they have different causes.
In some cases, pneumothorax may lead to atelectasis on one side.
If only a small portion of the lung collapses, bibasilar atelectasis may not cause any symptoms. If a person does experience symptoms, these may include:
A person may have other symptoms as well, depending on the underlying cause.
Older research from 2014 suggests that bibasilar atelectasis is more common after major surgery and anesthesia.
There is a range of other possible causes, as well. Doctors class these causes as either obstructive or nonobstructive.
Obstructive causesA person may experience obstructive atelectasis when something blocks their airway and prevents their lung from filling correctly. This can occur for a variety of reasons, including:
Pressure rather than a blockage causes nonobstructive atelectasis.
Factors that can put pressure on the lungs and make it hard for them to fill up include:
According to the ALA, atelectasis and pneumothorax are similar, so a thorough diagnosis is necessary. Doctors may conduct a physical exam and may also want to monitor a person's oxygen levels or lung function periodically to note any changes.
If they suspect atelectasis, healthcare professionals may order a chest X-ray, ultrasound, or CT scan to confirm their diagnosis.
A doctor may also perform a fiberoptic bronchoscopy. This procedure involves a healthcare professional inserting a tube through a person's nose or mouth to get a closer look at their airways.
How doctors treat bibasilar atelectasis depends largely on the underlying cause of the collapse.
To treat blockages, they will first try to remove the obstruction, using methods such as suction, drainage, or chest percussion. Some medications may also help break up and expel fluids.
To treat causes related to pressure, doctors will relieve the pressure in the lung and allow it to expand fully. This should restore function in the lungs.
When surgery causes atelectasis, doctors may recommend therapies to allow the lungs to expand naturally. They may tell a person to do deep breathing exercises, walk around after surgery to increase their breathing, and gently cough up mucus if possible.
Healthcare professionals will treat lung conditions or medical conditions causing atelectasis to help prevent further collapse. For instance, if a person has a tumor, they may require radiation therapy, surgery, or chemotherapy.
Early treatment of bibasilar atelectasis may improve a person's outlook and prevent the risk of complications.
If there is extensive damage to the lungs or the collapse is not treated urgently, possible complications can include:
Older research from 2014 suggests that many people experience bibasilar atelectasis while they are still in the hospital and recovering from surgery.
If a person is already in the hospital, this can make diagnosis and treatment easier, and may help prevent complications.
In cases where a person notices symptoms when they are no longer in the hospital, it is crucial for them to visit a doctor urgently for treatment.
However, a person's outlook may depend on the underlying cause of atelectasis.
Bibasilar atelectasis describes a collapse in the lower lobes of both lungs. It may cause shortness of breath and rapid, shallow breathing, as well as other symptoms.
Older research from 2014 suggests that bibasilar atelectasis is more frequent following major surgery and anesthesia. However, a range of factors may cause it, including a foreign object in the lungs or pleural effusion.
Treatment will depend on the underlying cause of bibasilar atelectasis. A person should contact a healthcare professional as soon as possible if they experience any symptoms of the condition.
EXCLUSIVE: 'Pretty Healthy' Mom, 39, Felt Like She Had The Flu. Then She Went Into Cardiac Arrest
After going on vacation in July 2022, Loree Benigni, then 39, returned home and felt like she had the flu. When her symptoms didn't improve, she visited an urgent care, where doctors ran tests and saw something wrong with the electric signals in her heart. They recommended that she go to the emergency room, and there Benigni learned her condition was dire.
"They told me at that time I was one of the sickest patients in the ER," Benigni, now 41, of Pittsburgh, tells TODAY.Com. "The last thing I remember is giving them my husband's phone number and then I blacked out."
She lost consciousness because she experienced cardiac arrest due to viral myocarditis, inflammation in middle layer of the heart muscle caused by an infection, according to the American Heart Association. It impacts the heart's ability to pump blood properly.
"I must have caught a virus like a cold or flu while I was on vacation," Benigni says. "That's what attacked my heart."
Struggling to breath after vacationFor their 15th wedding anniversary in 2022, Benigni and her husband visited North Carolina and spent time hiking. When she returned home, she felt worried that she experienced shortness of breath when she moved.
"My whole entire life I've been pretty healthy," she says. "I exercise every day. I was hiking a mountain."
While in the hospital grappling with myocarditis and recovering from cardiac arrest, Loree Benigni focused on healing to return home to her two sons.Courtesy Loree Benigni Benigni took several COVID tests, but they were all negative. She wondered if she had the flu or pneumonia, so she visited the local urgent care clinic in the middle of July. Doctors there realized how ill she was and sent her to the emergency room. Once at the hospital, things escalated quickly.
"I was completely out of breath," she says. "(When) the nurse took my temperature, I got physically ill, and they rushed me back to a room."
They took Benigni for a CT scan to get internal images of her body, but she was starting to lose consciousness. She experienced cardiac arrest and woke two days later, confused.
"I was rushed to another hospital," she says. "I didn't know where I was. … I was extremely swollen from all the things that happened to me."
It took her a few days to feel alert and understand what occurred. She felt stunned by the news that she experienced cardiac arrest and had myocarditis, which can lead to heart failure. Doctors told her family she only had only a 5% chance of survival.
"I was numb because again I never had heart problems, and I was hearing the word 'heart failure,'" she says. "It just happened so quickly. I was just on vacation, and now I'm in a hospital bed."
Doctors wanted to implant a left ventricular assist device (LVAD) called the Abbott HeartMate 3 LVAD to allow her heart to rest and recover. A LVAD assists the heart by pumping blood from the left ventricle to the body. While she was hesitant to undergo open-heart surgery to place the pump, Benigni agreed to it because she wanted to return home to her children. She hoped to have it implanted right away, but she had developed pneumonia in the hospital.
"They wanted to give my body time to rest and get my strength up," she says. "I had to learn how to walk again. I remember the first time physical therapy came in, and I tried to get up. I never thought I was going to be able to walk again or get out of that bed. I was so weak."
She worried that she wouldn't be able to take care of her sons.
"It was like, 'Am I ever going to be able to go home? What happened? What did I do wrong?'" Benigni recalls. "You're asking yourself all these questions."
After a few weeks, by early August, she had recovered enough to have the LVAD placed.
"I was going to have to stay in the hospital for a couple more weeks," Benigni says. "But it gave me hope that I would be able to go home."
What is myocarditis?"Myocarditis ... Means there is a problem with the heart muscle, and it makes it hard for the heart to pump blood," Dr. Robert Kormos, divisional vice president, global medical affairs for Abbott's heart failure business, who did not treat Benigni, tells TODAY.Com. "If myocarditis isn't detected, it is going to lead to heart failure."
Loree Benigni spent 33 days in the hospital culminating with the implantation of a LVAD device to help her heart rest and recover.Courtesy Loree Benigni Myocarditis can also contribute to stroke or cardiac arrest, like it did in Benigni's case. Viruses, such as flu or COVID, can cause viral myocarditis, and cardiologists saw an uptick of such cases during the pandemic, Kormos explains.
For some patients, there are early warning signs of myocarditis, but they may go unnoticed, such as palpitations or an irregular heartbeat.
According to the American Heart Association, other signs of myocarditis can include:
Doctors have several treatment options that range from medications to implanting a LVAD, all aimed that helping the heart work better while recovering from myocarditis and heart failure.
"If you give the heart muscle time to recover … you give the heart a chance to repair itself," Kormos says. "In a period of six to eight months, (a patient) can rehabilitate themselves and their heart with proper medication and a heart pump."
While treatment is available, Kormos notes that often women with heart problems are "poorly diagnosed."
"A lot of physicians will say, 'You have the flu. You are short of breath for some other reason,'" he explains. "(It's) poorly recognized. It is a real challenge."
In Benigni's case, doctors quickly diagnosed her correctly.
"This young lady was very fortunate. She had immediate care, and the physician team and the heart surgery specialist made the quick decision to give her the care (she needed)," he says. "Roughly half the women in this country aren't aware that heart disease is the No. 1 killer of women."
He recommends that patients regularly see a doctor to understand their risks of heart disease. If they have high blood pressure or diabetes, they need to make sure it's being properly treated to try to reduce their chance of developing complications. Kormos also believes doctors need to more attune to signs of heart disease in women and make timely diagnosis.
'My children needed their mother'After having her LVAD placed, Benigni spent more time in the hospital before returning home for her sons' first day of school in the fall of 2022.
"That was like a little gift to me that I was there for their first day of school because I never missed that," she says.
After having her LVAD removed, Loree Benigni can resume all normal activities and act as if she never experienced myocarditis.Courtesy Loree Benigni Her family, husband and neighbors helped out while she was in the hospital and after she returned home. To build up her strengt,h she began taking short walk, and returning home.To start, she got past three houses in her neighborhood but went a little bit farther every day.
"Seeing that I was able to walk again, I wasn't out of breath ... That gave me the motivation to want to do more," she says.
Benigni kept walking, took her medications and included lots of healthy food into her diet.
At her first follow-up appointment, he ejection fraction, a measure of how well the heart pumps blood, was almost back to normal. By January 2023, Benigni was doing so well that doctors believed they could remove her pump and her heart would work well on its own.
"I cried. I was extremely happy," she says. "I did everything I possibly could do to help myself, and I was just ecstatic."
Recovery felt easier after her second surgery, even though it was another open heart surgery. Within days, she could walk the halls of the hospital and soon went home. Benigni has returned to work and taking care of her children, and feels incredibly grateful.
"I feel thankful every day that I can go to my son's baseball games, and I can take my other son fishing," she says. "I knew my children needed their mother, and I fought every day to get well again."
Benigni wants people to seek help if something feels off in their bodies. "Go to the doctor," she says. "Don't wait."
What's Behind Major Rise In Heart Failure Deaths?
May 3, 2024 -- Americans are dying of heart failure today at a higher rate than they did in 1999, reversing years of progress in reducing the death rate.
That is the stark message of a new JAMA Cardiology study, which finds that the current mortality rate from heart failure is 3% higher than it was 25 years ago. Based on data from death certificates, the study says, the mortality rate fell significantly from 1999 to 2009, then plateaued for a few years before sharply increasing from 2012 to 2019. During the pandemic years of 2020 and 2021, the latest year for which data is available, heart failure deaths accelerated.
"These data are striking," said Veronique Roger, MD, MPH, chief of the epidemiology and community health branch of the National Heart, Lung, and Blood Institute. "They really constitute an urgent call for action to reverse this trend."
Roger, who was not involved in the study, noted that during the 2000s, the mortality rate from cardiovascular disease declined and that now it has leveled off, largely because of the burst in deaths attributed to heart failure. "This paper shows that not only are we are not making progress, but our gains are being eroded. So it's a major deal."
According to the National Institutes of Health, about 6.7 million Americans have heart failure today. That's just a snapshot in time, of course: About 1 in 4 Americans will develop heart failure during their lifetimes, the NIH said. About half of those with the condition die within 5 years after diagnosis.
People who are 65 or older have a far greater chance of dying of heart failure than younger people do. However, the relative increase in the death rate was most marked among younger Americans, according to the study. Among people younger than 45, there was a ninefold rise in heart failure deaths from 2012 to 2021, and there was almost a fourfold increase among people aged 45-64.
Comorbidities Lead to Heart Failure
In the view of study co-author Marat Fudim, MD, an associate professor of cardiology at Duke University in Durham, NC, the increase in heart failure deaths among younger people is probably related to the fact that obesity and diabetes have become more prevalent among young adults. It's not surprising, he said, that an increasing number of people with these disorders develop heart failure in middle age.
Otherwise, he said, "the reversal of [heart failure mortality] trends seems to have hit men and women and the different races in a very similar fashion. It didn't discriminate in that or in rural versus urban residents. While there were stark differences between racial groups and between rural and urban in heart failure mortality rates, the reversal trend is very similar among all these groups."
"What we see in practices is that comorbidities drive heart failure," said Fudim, whose own cardiology practice specializes in this condition. "Heart failure is rarely a single disease problem. Usually, heart failure patients have obesity, diabetes, cardiac artery disease, hyperlipidemia — all these diseases are driving heart failure, which leads to mortality."
The increase in heart failure mortality predated the COVID-19 pandemic, but COVID accelerated the increase in deaths from this condition. From 2012 to 2019, the average annual percentage change in mortality was 1.82%; during 2020 and 2021, it was 7.06%.
Fudim said there were two reasons for this. First, patients who were hospitalized for a COVID-related pneumonia had a roughly 20% higher chance of developing heart failure than did other people, after adjusting for their health status. In addition, COVID worsened health disparities related to race and income level, and it made the health system focus on COVID-related care rather than on heart failure prevention or management.
Factors in Mortality Rate Increase
A co-author of an earlier paper that showed an increase in the rate of heart failure deaths agreed that COVID was "like throwing fuel on the fire" of heart failure mortality.
Sadiya S. Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at the Feinberg School of Medicine at Northwestern University in Chicago, also agreed that the increase in the number of middle-aged people dying of this condition is probably related to comorbidities they developed earlier in life. Khan added kidney disease to the list of potential disorders related to death from heart failure. And, she said, she is also seeing earlier onset of heart failure.
Khan's research group published a paper showing that the mortality rate for heart disease from hardening of the arteries -- known as ischemic heart disease, which often leads to heart attacks -- declined even as the heart failure death rate rose. She attributes this mainly to there being better treatments for the underlying heart disease.
"For ischemic heart disease, there has been a lot of progress in effective therapies, particularly related to stenting and effective lipid-lowering therapies with statins and some new therapies. We haven't seen the same progress for heart failure."
Another factor that might have contributed to the increased mortality rate is the prevalence of heart failure. If more people develop heart failure, more of them will die of it. On the other hand, said Roger and Fudim, a higher death rate might result from patients with heart failure being sicker than they used to be, even without increased prevalence. Fudim said the data show the heart failure rate is fairly flat but gradually ticking up.
Where Did We Go Wrong?
Khan's 2019 study suggested that the earlier decline in cardiovascular disease deaths reflected the success of policies aimed at increasing control of blood pressure and cholesterol, along with higher rates of people quitting smoking and effective medication use.
"However, the prevalence of obesity and diabetes has increased dramatically, the decline in overall CVD death rates has stalled, and heart failure-related CVD mortality rates are rising," the paper said.
If so many of the right things were being done, why did the heart failure mortality trend reverse?
Roger doesn't blame doctors, who continue to do the right things, in her view.
"What we haven't done right is our failure to control obesity and diabetes. Diabetes travels with obesity, so if we focus solely on obesity, the choices that you and I and everyone make when we eat are not in the doctor's office," Roger said.
"I think we've done the best we could with the things that are within our control," she said. "But that's offset by the trends in obesity, which are related to the consumption of ultra-processed foods, sugar-sweetened beverages, and so on."
Fudim, in contrast, believes the health system is at least partly to blame for the reversal of the heart failure mortality trend. Partly because of the shortages in primary care, he said, access to care is limited in many areas, prevention and chronic care are being under-emphasized, and some heart failure patients are not getting the care they need.
Roger agreed. She cited the substantially higher heart failure death rate among Black people as evidence that "difficulties in accessing the health care system and the quality of health care both play a role."
On the other hand, she said, health systems have placed a priority on improving the care of heart failure patients, partly because of Medicare incentives. The increase in the rate of heart failure deaths, despite all of these efforts, she said, should be "an urgent wake-up call. There are new avenues of research, prevention, and clinical practice that should be synergized to address or mitigate this trend because we can't let it go on like this."
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