Pumping Marvellous

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Why do doctors feel the ankle of their heart patient

This is a topic that is highly searched through search engines so from a heart failure perspective I will explain in the simple language of “patient speak”. I would like to make you aware that their are other diagnosis conclusions but I am just coming from the Heart Failure perspective.

Fluid accumulation can cause an oedema and in Heart Failure patients the most common and noticeable area that swelling manifests itself is on the ankles and legs and sometimes the abdomen. The accumulation occurs because your left ventricle is not pumping as well as it should be and therefore due to the heart being the engine room of the body it struggles to get rid of fluid therefore it accumulates. If you have Heart Failure then you should really be restricting your fluid intake to 1.5-2 litres per day. You will probably be on diuretics if you have Heart Failure and these enable the Kidneys to get more fluid out of your system as urine. Examples of Diuretics can be found in our medicine / drug section.

It is also very important to reduce your salt content to no more than 2grams of salt a day, in other words no more than a teaspoon. We understand this is very difficult but you can go a long way to reducing it by not putting salt in your cooking or on the table and also not eating ready prepared meals. You will get use to it, try spicing your food?

This is an interesting post based around intelligent pills and Heart Failure patients.

A new era of “intelligent medicines” is heralded today with the disclosure that the NHS is about to begin trials of pills that contain a microchip, reminding patients when to take them.

When the pills are swallowed the “edible” microchips react with the acid in the stomach sending a message to a sticking plaster containing a sensor strapped to the shoulder. If the patient has forgotten a dose, the sensor delivers a text message to the patient’s phone reminding them to take their pills.

In addition, the sticking-plaster sensor monitors the patient’s bodily functions such as heart rate and can recommend adjustments to the dose accordingly, which can also be delivered to the patient via text message. The sensor can also send messages via the internet to carers and, if wanted, other family members, updating them on the patient’s condition.

If successful, the system could improve patients’ well-being while reducing costs by avoiding unnecessary hospital admissions.

The technology, developed by the US company Proteus in California, is being tested initially on 40 NHS patients with heart failure at Imperial College Healthcare Trust in London and the Royal Berkshire Trust in Reading. If successful, the four-month trial will be followed by a larger year-long trial starting in 2011 to measure the effect of the system on reducing hospital admissions.

Patients in the NHS trial will be given versions of two standard heart drugs – bisoprolol, a beta blocker that slows the heart beat, and furosemide, a diuretic that reduces fluid in the tissues – with the microchips incorporated in them.

The sticking-plaster sensor will measure heart rate, physical activity and whether the patients remain lying down while sleeping. If they are frequently forced to sit up, that is a sign of increasing fluid on the lungs, a common and potentially serious side effect of heart failure which requires urgent adjustment of the dose.

Research suggests that between a third and a half of patients do not take their medicines as instructed, leading to worse health, more hospital admissions and wasting $290bn (£186bn) a year in the US, according to a report by the New England Healthcare Institute published last year.

Unpleasant side effects, confusion over instructions, forgetfulness, language barriers and feeling “too well” to need medicine are among the reasons cited for non-compliance. People with chronic conditions such as diabetes and high blood pressure are least likely to stick to the regime prescribed by their doctor.

Nicholas Peters, professor of cardiology at Imperial College and a consultant to Proteus, said: “The whole idea of this technology is to inform patients about their own well-being, to encourage them to take the tablets and to take responsibility for their own health. It can help them stay stable and prevent them getting on to the slippery slope that leads to hospitalisation.”

“People may say, ‘Why do you need technology to detect a missed dose? If I feel ill I can adjust the dose.’ But, in heart failure, once symptoms worsen it is often already too late. There is a narrow window. The patient can become fluid over-loaded and hospitalisation is the inevitable next step.”

The microchip could be placed in almost any medicine. The technology has already been trialled in the US for psychiatric disorders where compliance is a particular problem.

Mobile-phone networks have already developed applications to remind patients to take their medicines, but the Proteus system, called Raisin, takes it a stage further. Networks could offer the application at a discount as an inducement to customers to join.

Dr Jerry Gurwitz, a geriatrician at the University of Massachusetts Medical School and expert on drug errors, said persuading patients to take the drugs they need is a challenging problem, especially among older people who live alone. “I think any person who is practising medicine is going to say it’s one of the biggest challenges and frustrations of providing care to patients right now,” he said.

The Proteus system has received the EU’s consumer and health stamp of approval and the company is expected to seek regulatory approval for widespread use in the EU next year.

Flying, Travel and Heart Failure

After just being on a Transatlantic flight just over a month ago I thought this little article was quite reassuring for Heart Failure patients. As always consult with your Doctor / Consultant before flying anywhere. It will probably be a stipulation of your medical insurance to get an “ok” from them anyway.

Although this article is focussed on cardiovascular you can relate it to Heart Failure. Look for the highlighted text.

This article is by sify

Most people with cardiovascular diseases who are not critically ill can safely fly, a news report says.

The study, conducted by the British Cardiovascular Society, says that such people can undertake air travel provided they drink plenty of fluids, wear compression stockings and take a blood thinner.

However, the fluid intake should exclude alcohol, tea and coffee.

Consultant cardiologist David Smith of National Health Service (NHS) Foundation and colleagues explain that the main impact of air travel is the inhalation of air with reduced oxygen content in a pressurized environment.

This results in lower circulating oxygen levels in the blood, known as hypobaric hypoxia, says a society release.

Passengers already at high risk of angina, heart failure or abnormal heart rhythms might be adversely affected by hypoxia.

Otherwise, the blood oxygen levels induced by flying appear to have little or no adverse circulatory effects, certainly not for short-and medium-haul flights, for heart patients, the report says.

So what we are saying is that you must take the advice of your Consultant or Doctor. Don’t book until you have had the OK!

Managing Heart Failure in extreme Heat

I am currently going through my first summer after being diagnosed with Heart Failure in January 2010. Writing this I am thinking maybe I should write this next year when I am an expert but the subject is always at the top of my mind so nothing like the present but I thought I would need some help so the following is an excerpt from the British Heart Foundations website.

“Extremely hot weather can cause dehydration and heat exhaustion. Heat and humidity can
interfere with the body’s natural cooling process. If you have a heart problem, extreme
heat may place an extra burden on your heart and circulation.

Excessive sweating in hot weather increases the loss of fluid from your body. This reduces
the total blood volume. This will increase the workload of your heart and the demand for
oxygen, which can lead to angina if you have coronary heart disease. Losing too much
body fluid will also increase your internal body temperature, which could be life-threatening if left untreated.

If you are in hot and humid weather, it is very important to wear light, comfortable clothing. Managing your fluids is a very difficult process as you are trying to balance excess perspiration as well as the diuretic action of your drugs. If you feel as though you need to increase your fluids have a chat with your clinician. However if you need to take more fluid on board then sip the fluid or have a look at some of my tips, sweets, frozen grapes and water spray. Try to avoid caffeine-based drinks because these act as a
diuretic. (That means that they increase the amount of fluid you get rid of through your kidneys.)

Symptoms of heat exhaustion include heavy sweating, cold clammy skin, dizziness,
muscle cramps, shallow or fast breathing, nausea and vomiting. If you have any of these
symptoms, get medical attention immediately.

It’s a good idea to consult your doctor if you have any concerns about extremes of
temperature or have plans to travel to a country with either a hot or cold climate.

Health spas, saunas, jacuzzis and steam rooms

If you have a heart condition or have high blood pressure, it is generally advisable not to
use spa facilities – including baths, saunas, jacuzzis or steam rooms. In particular, don’t
use facilities that involve a sudden change of temperature – for example, having a hot
sauna and then plunging into a cold bath. If you particularly want to use any of these
facilities, ask your doctor about it first. Depending on what heart condition you have, your
doctor can give you advice on which types of facilities you should avoid.

Diuretics

Diuretics used to be known as water pills because they stop fluid collecting in your body and make you urinate more often. These are one of the most common treatments in heart disease. However, there have been only a few large studies into how effective they are in heart failure.

Researchers have combined the findings from smaller studies and concluded that diuretics extend life and improve symptoms of heart failure. Clinicians recommend them for people with heart failure who have signs of fluid retention, such as swollen ankles or breathlessness due to fluid in the lungs. Doctors will vary the dose of diuretic depending on your symptoms.

There are many different types of diuretic, but some of the most widely used for heart failure are bendroflumethiazide, chlorthalidone and furosemide.

Hi Nick

I was reading this with interest, and just thought that maybe carrying a spray type bottle with water in might let you just moisten your mouth and tongue without consuming large volumes?

You could even freeze the water or juice if you plan to carry it around all day, then as it melts during the day it will still be cold and refreshing.

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.

Heart Failure diagnosis not only affects the patient but also the whole family. It is a very difficult time for all and there are many physical and emotional obstacles to overcome. We have found that the best source of self help for carers of Heart Failure is the British Heart Foundations publication “Living with Heart Failure”. This really is a comprehensive and well thought out section in this publication and is especially invaluable for people needing to care for patients with severe Heart Failure.

Your carer is invaluable and as a patient you need to be aware of the stresses and strains on your carer. They not only offer that crucial emotional support but are often your second set of eyes. The eyes that recognise changes in you, Heart Failure patients aren’t necessarily the best at seeing new symptoms or a deterioration of existing symptoms. Below you will find a list of warning signs to look out for. Depending on the severity of your Heart Failure or your drug regime these effect people in different ways.

Palpitation
Memory problems or lack of concentration
Disturbed sleep pattern
Slow weight gain (with no change in diet or exercise regime)
Weight loss (with no change in diet or exercise regime)
Feeling helpless
Lack of sex drive

Below you will find a list of symptoms that if they get worse the I suggest you seek immediate medical attention.

Swelling of the feet,ankles or abdomen
Sudden weight gain
Breathlessness
Wheezing or a dry cough
Light-headedness or dizzy spells
Acute fatigue
Heavy pressure across the chest or chest pain

Heart Failure for the patient and the carer is about management of the condition. Make sure that you mention or your carer mentions to your Heart Failure Nurse any of the above. As indicated some of these symptoms can be due to drugs.

For example if you are on an optimum dosage of a beta blocker and ace inhibitor then the propensity when you stand up quickly to feel dizzy and light headed is quite common, but just check with your Heart Nurse first.

Another example is self management of your fluid intake. You will find that when it is hot and the sun is shining and you are feeling thirsty then keep an eye on your fluid intake and let your carer influence you to stay out of direct sun light. If you do take on more than 2 litres of fluid and you feel that you maybe retaining more fluid than normal, stay in the shade for the next couple of days and reduce your fluid intake to lets say 1.5vlitres a day and you will find this will probably reduce fluid retention without the need to up the dosage of your diuretic.

Self management is key with your carers help.