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Living Well with Heart Failure, the Misnamed, Misunderstood Condition

Living Well with Heart Failure, the Misnamed, Misunderstood Condition - Edward K. Kasper, Mary Knudson Cowritten by a journalist who was diagnosed with heart failure and her (fourth, after not being satisfied with the first three) cardiologist. Clear, thorough, easy to understand. Notes that I wanted to capture:Sleep apnea. .. causes daytime sleepiness, falling asleep at inappropriate times, irregular heartbeats, and worsening heart failure. p.10Ejection fraction. This formula, expressed as a percentage, is the amount of blood pumped out of the left ventricle with each heartbeat divided by the amount of blood in the left ventricle just before it begins to squeeze. .. measured by watching the heart's pumping action in "real time" in an echocardiogram. Normal readings are 55-65%. A reading much below 50% is considered abnormal and indicates a diagnosis of dilated cardiomyopathy. People with dilated cardiomyopathy are the people with heart failure who most often have noticeable symptoms... On the other hand, as many as half of of the people with dilated cardiomyopathy have no symptoms at all. They have yet to develop heart failure. If their cardiomyopathy is not treated, however, they will develop heart failure. These peopled find out only when a routine electrocardiogram done for some other reason reveals abnormalities, after which they will have an echocardiogram, which pinpoints the heart's trouble. p.39Beta blockers are started at low doses and slowly moved up to higher doses because going up too quickly can worsen the symptoms of heart failure. Like ACE inhibitors, beta blockers are used to treat high blood pressure, and common adverse effects are low blood pressure and a slowed heart rate. Either low blood pressure or a slow heart rate may cause dizziness and fainting. Beta blockers may also cause fatigue. With time, this effect usually wears off. Some people on beta blockers experience depression. ... People who have heart disease should avoid tricyclic antidepressants because they increase the risk of rhythm problems with the heart. Arrhythmias and pacemakersA heart beating too slowly produces bradycardia, making you feel sluggish and tired. A heart beating too fast causes tachycardia, and you feel the unsettling erratic nature of your heartbeat. The most urgent malfunction of the heart's rhythm is ventricular fibrillation, when the heart screams to be noticed because it has begun shaking uncontrollably and is unable to right itself and begin pumping blood again. Immediate attention required or death will result. p.83-84Bradycardia is also common in heart failure. The symptoms associated include lightheadedness, fainting, near fainting, and fatigue. Most bradycardias do not need to be treated with a pacemaker. Well-conditioned runners often have a slow resting heart rate. A medication such as a beta blocker may cause bradycardia as a side effect. The treatment then is to either stop the beta blocker or decrease the dose. In anyone with heart failure, stopping the beta blocker may not be a good option, because beta blockers improve survival in people with a weak heart muscle. For such people, the dose of the beta blocker is usually decreased, and a pacemaker is considered. p.91Pacemakers. Implanting a pacemaker normally takes a couple of hours and is done by an electrophysiologist in a cardiac cathererization lab. You will usually be unaware of your pacemaker, which works without creating any sensation. It is noticeable when you lie on your left side in bed and may cause a little soreness in your upper chest where it is placed, but most of the day you will be unaware of it. A pacemaker may have 1, 2, or 3 leads. Each lead has the capability of sensing and pacing. The particular configuration of the leads depends on what the patient needs. The battery will need to be replaced every 5 to 10 years when it runs out of energy. Pacemakers can be programmed to work in various ways and are individualized for each person depending on need. ...Be sure to discuss with your doctor the type of pacemaker you will get, see what one looks like, and ask about benefits and risks. Word of caution about a right ventricular lead pacemaker. ... Almost everyone with heart failure and a weak heart muscle should avoid pacing from only a right ventricular lead. Be sure you know what kind of pacemaker a doctor wants to put into you before you allow the procedure. ...While many people in the general population in need of a pacemakers do not need biventricular pacing, those with heart failure and a weak left ventricle should strongly consider a biventricular pacemaker rather than one with only a right ventricular lead. p.95Potential pacemaker problemsIt may be impossible to get the left ventricular lead where it is needed most, way out on the left side of the left ventricle. ... In such rare cases, a lead may be sew directly on the outside of the left wall of the left ventricle during a brief operation using an incision made between the ribs. This procedure produces 2 scars, one over the pacemaker itself and other between the ribs near the left breast. The pacemaker may get infected. The pacemaker or leads may be defective and need to be replaced or adjusted. The battery needs to be replaced every 5 to 10 years. The pacemaker or the leads might erode through the skin, though this occurs rarely, on the order of 1 in 1000 cases. Breaking through the skin is more of a problem in skinny people. p. 95-96What to beware of in the hospitalInfection. Get rid of all tubes as soon as they are no longer needed. Keep an eye on your skin where IV lines are inserted, and if the area looks looks infected and hurts, point this out to the nurse. Do not be shy about asking your nurses and doctors to keep your IV lines clean. Hand washing is also of the utmost importance. Your doctors and nurses should be washing their hands between each patient. If you do not see a doctor or nurse wash her hands before approaching your bedside to examine you or perform a procedure on you, speak up and ask if she will please wash first. Limiting the duration of antibiotics to just the amount you need and no more will limit your chance of having this bacteria overgrow and cause harm. The surest way to avoid infections is keep your stay brief. Medication. Ask your nurse what medication you are taking and why. If you are not getting the medications you normally take at home, get an explanation. The more involved you and your family, the less likely mistakes are to occur. Blood transfusions.Avoid if not necessary. Check the blood type. Summary-- Know your meds and ask the nurse if you see you are being given something new or not getting something that you normally take at home or at the hospital.-- Discuss your treatment plan with your attending physician.-- Understand why you are getting every procedure, surgery, and test. -- Keep an eye out for infection. Report any redness, swelling, or fever. -- Don't be shy. Make sure your doctors and nurses wash their hands.Never go to a hospital unless you have to, and when you enter a hospital, know to be on guard. Appoint a family member or friend to be your patient representative. Be aware of potential sources of mistakes and help your health care team to avoid them. Keep your stay short and safe. p.212-213Heart failure in elderly peoplePeople who are 80+ are treated with the same medications as younger or healthier patients and respond to the medications as well. Doses need to be adjusted, though, because of the decreased muscle mass and mild kidney dysfunction common in elderly people. p.215Organizing your medicationsDevelop a system.To avoid taking the caps off the pill bottles (for arthritic hands), do it once a month, filling 30 or 31 sandwich bags with a day's worth of medications. Then each morning, sort the bag into morning, midday and evening meds. p.212