Pumping Marvellous

Look to your legs Heart Failure Patients

Doctors tend to treat  heart muscles when the organ reels under an attack, overlooking the condition of the legs, which could provide vital clues in treating the condition, new research says.

A University of Leeds research team has, for the first time, shown that  leg muscle dysfunction is related to the severity of symptoms in heart failure patients, the Journal of Applied Physiology reports.

“Many chronic heart failure patients complain of leg fatigue during  exercise and this can prevent them from being active,” says Harry Rossiter, of the Faculty of Biological Sciences at the university.

“Our study shows that by warming up properly, patients can improve the oxygenation and performance of their leg muscles, which is beneficial in promoting exercise tolerance,” he adds.

In a series of experiments with chronic heart failure patients, the research team measured responses of the heart, lungs and leg muscles following a moderate exercise warm-up, according to a statement from the university.

Using a near-infrared laser to measure the oxygenation of the leg muscles, they found that warm-up exercise increased the activity of skeletal muscle enzymes that control energy production.

However, this adaptation was less in patients with the most severe symptoms, showing that the heart failure condition had a negative impact on the normal function of the leg muscles.

“When your muscles don’t use oxygen well, it causes an uncomfortable burning sensation during activity,” says Klaus Witte, cardiologist in the team.

“The effect of a warm up is to direct oxygen to the places that are going to need it, and make the muscles ready to use it when you start exercising,” Witte adds.

“Our main message is that exercise is safe and beneficial in patients with heart failure. By warming up the leg muscles properly, the exercise can be more comfortable and sustained for longer – affording great benefits for these patients,” Rossiter says.

What are are Implantable cardioverter defibrillators

People who have a particular sort of abnormal heart rhythm, called pulseless VT (ventricular tachycardia) or VF (ventricular fibrillation), may need to have a device fitted called an ICD. Ventricular tachycardia is when the heart beats too fast, and this means that there is not enough time for the heart to fill with blood properly between beats (contractions), so not enough blood is pumped round the body.

In ventricular fibrillation, the heart rhythm is so abnormal that the heart no longer contracts, but quivers instead. This results in death, unless an electrical shock is given to the heart to restart it.

An ICD works by constantly monitoring the heart rhythm. If ventricular tachycardia is detected, the ICD will try to correct it. If this does not work, the ICD will try to bring the heart back to normal by giving it a small, controlled electrical shock. If this fails, the ICD will deliver a larger shock, which is known as defibrillation.

If the ICD detects ventricular fibrillation, it will defibrillate the heart immediately.

As with pacemakers, ICDs are implanted in hospital, usually under local anaesthetic and complications are rare. Like pacemakers, you will need to avoid things that can interfere with the way in which the ICD works, such as airport security systems.

So what is a Pacemaker?

If you have a problem with the way the normal electrical impulses in your heart work, you may need to have a pacemaker fitted. A pacemaker artificially takes over the role of the heart’s natural pacemaker (the sino atrial node), either all of the time, or just when your heart is not beating properly. There are several different types of pacemaker. The best one for you will depend on what type of heart rhythm or beat problem you have.

The pacemaker will be implanted in your chest by a surgeon, normally under local anaesthetic, but you will usually need to stay in hospital overnight to check that it is working properly. Serious complications from pacemakers are unusual.

Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic. You will also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.

Cardiac Stress Test

A cardiac stress test is the analysis of the heart’s electrical activity and rhythms before, during and after exercising on a treadmill or bicycle in a controlled environment.

Many people with coronary artery blockage have minimal symptoms and an unchanged EKG while at rest. By exposing the heart to the stress of exercise during the test, signs and symptoms of heart disease may be revealed and can lead to a definitive diagnosis and treatment.

The test screens for the presence of heart disease and evaluates the physical status of previous surgical procedures, such as coronary artery bypass and angioplasty, as well as an individual’s fitness level. It is performed in the presence of a physician, and is also known as a graded exercise test (GXT), exercise-tolerance test (ETT), exercise-stress test, exercise electrocardiography or treadmill test.

What is Cardiac Catheterization

This sounds a little scary but it is a standard procedure.

Cardiac Catheterization is a specialized X-ray examination of the heart that uses contrast dye inserted through a catheter to allow the doctor to view the condition of the heart chambers, valves and coronary arteries. It is also known as a “dye study of the heart” or coronary angiogram.

This procedure is used to look for any problems in the heart valves or main blood vessels, or to see if there is fatty buildup in the coronary arteries. It takes place in the Cardiac Catheterization Laboratory.

If abnormalities are found, treatment may include medication, changes in daily habits, surgery, further cardiac tests or angioplasty.

So what is an Echocardiogram – usually referred to as Echo

We have tried to keep this simple and easy reading so you can digest it at you own pace. It sounds invasive even frightening but it isn’t. I have had to already, its a bit like ultrasound on your chest and the jelly is a little cold.

The echocardiogram test decides for sure whether or not you have heart failure. An echocardiogram is painless. A pulse of harmless, high-frequency sound waves is passed through the chest wall, and these bounce back from the structures in the heart.
For the test, you will be asked to lie on your left side with your left arm behind your head. Lubricating jelly is put on your chest, and the ultrasound probe (recorder) is placed at various points on the chest between the ribs. The probe picks up echoes from the heart and shows them on the screen as a detailed picture (echocardiogram) of the structures of the heart.
The test allows the operator to find out a lot of information about the heart, including:
• How well the valves are working, and whether any of them are damaged.
• How well the heart is working as a pump (i.e. systolic function when the beat or contraction of your heart forces blood to circulate around the body).
• How well the heart relaxes after pumping (i.e. diastolic function when the heart relaxes after each beat or contraction, allowing it to fill with blood).
• Whether there are holes in the walls between the chambers of the heart, disrupting the one-way system of blood flow and allowing blood to flow from one side to the other (intracardiac shunts).

The most important finding from an echocardiograph is usually a measurement of how well one of the chambers of your heart the left ventricle is pumping. The left ventricle pumps the blood around the body. The wall of the left ventricle is normally much thicker than the wall of the right ventricle, because the right ventricle only pumps blood to the lungs and back.
This measurement, called the left ventricular ejection fraction (LVEF), is an estimate of how much of the blood that enters the left ventricle is pumped out when the heart muscle beats (contracts). In a healthy heart, about 60% of the blood entering the left ventricle gets pumped out when the heart muscle contracts. So a normal LVEF would be around 60%. A value of less than 40% would indicate that the heart is not pumping well.

Sometimes different types of echocardiogram are performed. These include:

Stress echocardiogram

This is an echocardiogram that is carried out to see how the heart functions when it has to work extra hard. It is performed by increasing the persons heart rate, either by exercise on a treadmill or exercise bike, or by special medication.

Transoesophageal echocardiography

This test is carried out when doctors need to look at your heart valves in more detail. Pictures of your heart are taken from inside your body, by passing a small probe mounted at the end of a thin flexible tube down your oesophagus (the tube that connects your mouth to your stomach). Before the test, you may be given a mild sedative to help you relax, and an anaesthetic will be sprayed on the back of your throat to make you more comfortable. While the probe is in your oesophagus, pictures of your heart are taken. The probe is then gently withdrawn.

What is an ECG test

Don’t worry it sounds a little complicated but it isn’t and you shouldn’t worry about it. If you are a Heart Failure patient then you will know all about it or you should do!

This is what it is all about

Electrocardiogram (ECG)

An electrocardiogram is a test that measures the electrical activity of the heart. It can detect problems with the way the heart beats (rhythm) and check if you have had a heart attack in the past that you were perhaps unaware of.
During the test, self-adhesive electrodes are attached to the skin on the arms, legs and chest. Some areas may need to be shaved. The test is painless, and takes less than a minute to carry out once the electrodes are in place. The electrodes are then removed, and the doctor will review the ECG trace on a computer or paper print-out.

Sometimes you may need a slightly different type of ECG test.

These include:

24-hour ECG recording (sometimes called Holter monitoring or ambulatory ECG)

In this test, the ECG is recorded over 24 hours. The electrodes are attached to your chest, and the wires attached to these electrodes are connected to a small portable tape recorder, which is worn on a belt around your waist. The test is useful because it shows changes in your hearts rhythm (palpitations) that may occur only sporadically.

Exercise ECG (sometimes called an exercise stress test)

This is an ECG that is recorded while you are walking on a treadmill or cycling on an exercise bike. It records how your heart copes when it has to work harder during exercise.
If your ECG and the results of your blood tests or X-ray are abnormal, then you are more likely to have heart failure. However, it does not mean that heart failure is definitely causing the symptoms. Your doctor will probably want you to have an echocardiogram to decide for sure.

You have to realise that Heart Failure is a complexed condition and is very dynamic. What we mean by that is that it doesn’t have one symptom that will cause failure of the Heart.

We also believe that not all Heart Failure Patients should be categorised with Heart Failure as in a lot of cases it is not failure of the heart, it should be categorised as a dysfunction of the heart. Although not curable at the moment symptons can be managed.

Knowing the symptoms of heart failure is very important. These symptons can manifest themselves in any age of person – this is really important as the medical profession are not focussed on people under 40 getting Heart Failure symptoms and that is a fact because it is so rare. If in doubt demand a BNP test from your Doctor.

So how do I know if I have developed heart failure?

What are the symptoms of heart failure?

The main symptoms of heart failure are:
• Breathlessness (dyspnoea) when you’re more active than usual or sometimes when you’re resting.
• Extreme tiredness and weakness.
• Swelling in the abdomen,legs, ankles and feet (oedema).

These symptoms are often caused by other conditions, but they are signs that you might have heart failure. Your doctor may suggest doing some tests to see if you have got heart failure, or to rule it out as a cause for your symptoms.

Other symptoms that might be associated with heart failure include:
• Being woken up in the middle of the night gasping for breath (paroxysmal nocturnal dyspnoea).
• A cough that will not go away.
• Nausea (feeling sick).
• Lack of appetite.
• Confusion or difficulties in concentrating.

If you have already been diagnosed with heart failure and you get any of these symptoms, or the ones you already have do not get better, it could mean that the condition is worsening and you need to have your treatment changed.

Welcome to Pumping Marvellous.

This is a site run by patients for patients.

The site is designed to help inform and educate those who have Heart Failure, their Carers and anybody who would like a non medical viewpoint of what it is like to live with and manage Heart Failure.

As patients of the East Lancashire Primary Care Trust in the UK we are backed up by a world class group of clinicians ranging from Consultant Cardiologists whose specialism is Heart Failure, experienced nurses who work on the cardiac wards at the Royal Blackburn Hospital, dietitians and physiotherapist who specialise in diet and exercise and finally Angela Graves who is the Heart Failure Nurse Manager and her team of experienced Heart Failure nurses.

You will find our approach and discussions both formal and chatty and we would be really happy to answer any questions you may have. We can’t not help get technical sometimes but there is no other way to describe what we need to communicate to you.

Enjoy the site and start to learn about Heart failure from a different perspective.

Thanks

Nick Hartshorne-Evans