Beware of chronic heart failure

The end of November last year was the first time I met Mike. I remember that when he came to see me in the clinic, his head was sweating even when he was sitting there.

He thought at first that he was overweight, so he had this symptom and was determined to lose weight.

But the more I exercise in recent days, the more I feel shortness of breath, and even at night when I sleep, I feel short of breath.

He told me, "It's just not possible these days, and I can't sleep well at night, and I can only squint a little bit when I sit down to sleep." I explained, "This may be heart failure, and the situation may be serious, so you need to be hospitalized for further examination and also to find out what the disease is."

01 The patient's treatment process

After admission, routine checkups, lab tests, and examinations were performed. The examination revealed a blood pressure of 160/80 mmHg and oxygen saturation of only 90% without oxygen. The laboratory tests revealed a special indicator of heart failure, NT-proBNP, which exceeded 8800, while the normal value of NT-proBNP for people under 50 years old should be 450ng/L. Xiao Zhang's indicator was high.

The electrocardiogram showed a heartbeat of 130 beats per minute, which should fluctuate between 60 and 100 beats per minute in a normal adult, and was too fast. The chest CT showed an enlarged heart and pleural effusion and other signs of heart failure.

An ultrasound of the heart shows an ejection fraction (EF) of only 39% in the left ventricle, while the normal range for EF is 50% to 70%, and if it is below 40%, the condition is called declining ejection fraction heart failure.

In addition to these findings, Mike also had purple lips, bilateral lower limb edema, chest tightness, shortness of breath, excessive sweating, and other manifestations.

From the above symptoms and test results, it was clear that the diagnosis of heart failure was correct. Because Mike was experiencing dyspnea, elevated blood pressure, and rapid heartbeat, he was put on cardiac monitoring as well as blood pressure and oxygen monitoring after hospitalization.

The main means to relieve the symptoms of the acute phase in patients with chronic heart failure are cardiotonic and diuretic measures, which can eliminate the patient's edema and prevent fluid from collecting and staying abnormally in the body, so Mike was given furosemide diuretic and drainage to reduce the load on the heart, while sacubitril valsartan was applied to allow the blood pressure to return to normal as soon as possible, and also to protect the heart.

Considering that the most common cause of heart failure is coronary artery disease when Mike could lie flat, he was scheduled for coronary angiography, which showed no narrowing of the coronary arteries. Special tests such as cardiac CT, cardiac nuclear scan, and biopsy of the heart muscle were also done, all of which suggested no problems, which was good news for Mike.

02 Patient treatment outcome

After admission, Mike's symptoms of chest tightness, shortness of breath, and edema in both lower limbs disappeared after active treatment, and he could walk easily, and even sleep peacefully at night. His blood pressure dropped to 130/80 mmHg by the next day's follow-up, and his oxygen saturation reached 95% without oxygen.

The NT-proBNP dropped to more than 3500 and the EF of the heart ultrasound rose to 42%. Before discharge, the NT-proBNP was rechecked, and it had dropped to more than 430, basically back to normal.

Two months later, Mike came to the hospital for a follow-up check, and the EF of the heart ultrasound had returned to normal, reaching 58%, the original symptoms had disappeared, and he was able to walk with strength.

03 Precautions in daily life

Although Mike is not very old, heart failure tends to worsen after infection, so usually, he should pay attention to rest, ensure sufficient sleep, can take rest in a semi-recumbent or sitting position, gradually increase the amount of activity, and if there is an uncomfortable reaction, should stop the activity.

Patients with heart failure are recommended to have low salt and low-fat diet and must control salt intake to reduce the load on the heart. Secondly, more vegetables, coarse grains, large fish and meat, drinking alcohol, and tobacco category should be contraindicated, especially tobacco must be contraindicated.

Because Mike's 172 cm height but weighs 160 pounds, Mike was instructed to actively control his weight from now on, and also to lose weight appropriately.

Because of his heart failure, he needs to have his NT-proBNP, electrocardiogram, and heart ultrasound reviewed regularly to prevent a recurrence of the disease. If the edema in the lower extremities worsens and you have no strength to walk, you should contact us as soon as possible.

Because Mike also suffers from hypertension, he was advised to take his blood pressure medication regularly, not to stop it at will, and to monitor his blood pressure daily.

04 Doctor's insight

It took almost a month for Mike to come to the hospital, which delayed the treatment and worsened his condition. Therefore, we remind everyone that even for young people, if you have symptoms such as weakness, chest tightness, shortness of breath, etc., which are different from usual, you should go to the hospital in time to see them.

Dyspnea is the most common manifestation of chronic heart failure. Patients often wake up with breathlessness in the middle of sleep, accompanied by a feeling of suffocation, and they are forced to sit up and breathe before their symptoms are relieved.

In addition, there are often symptoms such as purple lips, frequent coughing, fatigue, dizziness, heartburn, chest tightness, and oliguria. Some patients also develop bilateral lower extremity edema, which appears or worsens in the evening and is depressed, and in severe cases, edema may appear all over the body.

In addition, abdominal distention is also one of the common manifestations of heart failure. The distention mostly occurs in the upper abdomen, and its accompanying symptoms include loss of appetite, vomiting, etc. When the above symptoms appear in the body, you must be alert, do not let it go.