copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
My Russian-born mother had suffered from congestive heart failure for years, but managed quite comfortably with medications that reduced fluid build-up in her legs. Even at 88, she was active, living by herself in Upper Manhattan, traveling, and taking the bus to Carnegie Hall.
Late one night in June, she called and said, "I am not doing well." She was not the kind of woman to complain, these were words that needed immediate action. My doctor husband could tell by her voice that the fluid in her lungs was high. We called the ambulance and when we arrived at her home, the paramedics were already there. My mother went to the hospital.
She grew weaker and frail. Then she became depressed about being in the hospital. Her spirits were low. I promised that she would not see the inside of a hospital again and I brought her to my home.
My mother thought she would be a bother to me. But I transferred my belt making business to my kitchen table and worked there with my business partner. My mother was a craft person and loved to see the designs and beadwork we used to create belts. I would bring them to her and ask "Which one do you like?" She did not have the strength to talk, but pointed to the desirable one.
All of this was taking place during preparations for my son's wedding in December. My mother came to the wedding and looked glamorous. Then she let go. She told me, "That is it. I've had enough. I wish to die now." My mother was perfectly comfortable during those last few weeks. Her breathing was shallow, but not labored and she did not struggle for air. She was in bed most of the time.
She became comatose from weakness and lack of food (she could not eat much). From time to time she opened her eyes and picked up my hand and kissed it. I kept her favorite music playing all the time. On March 19, I came into the room. She was quiet as before, but I checked her pulse and there was none. I remembered her words to me, "What would I have ever done without your love and care!"
Meditate Word By Word On These Verses:
Luke 14:1-6.
Heredity predisposes some men and women to cardiovascular disease, but to a large extent, it is preventable. Smoking, high blood pressure, and high blood cholesterol doubles a person's risk, while physical inactivity and obesity play supporting roles.
Types of Cardiovascular Disease
A myocardial infarction or heart attack refers to irreversible cell death in the heart muscle. This occurs when the muscle is denied oxygen by obstructed coronary arteries or by constricted coronary arteries. Infarctions occur most often in the left ventricle or side of the heart because that part of the heart does the most work. According to statistics in the "Bolshoi Gorod" newspaper, approximately 300 citizens of Moscow have heart attacks every week.
Question 1: Why is a healthy lifestyle important in many disease processes?
Survival depends on the extent of the dead tissue (necrosis), which causes scar tissue to form on the now useless heart muscle. If the blood deficiency to the heart muscle is corrected quickly enough, the heart grows healthy tissue and can regain some lost function. A "massive heart attack" damages approximately 40% of the heart's tissue.
Symptoms of Heart Attack
There are several classic warning signs that announce a heart attack. The most common is an intermittent or persistent sensation of pressure, tightness, or pain that begins in the chest but may radiate to the shoulders, neck, and arms.
Question 2: What information about heart attack and cardiac symptoms is available to the average person?
Women often exhibit different symptoms. They may feel recurrent pressure or tingling anywhere above the waist when exerting themselves or experiencing intense emotions. There are numbers of people who perceive the discomfort of heart pain as "shortness of breath." This feeling can be a sign of a heart attack, but usually it is accompanied by nausea, vomiting, sweating, and feeling light-headed or faint.
All of us need to be acquainted with these symptoms whether caring for a cardiovascular patient or not. This is because a heart attack can happen to anyone with the high-risk profile we described earlier. Approximately half of the people with diabetes and hypertension die of heart attacks.
Question 3: What are the symptoms for heart attack in (a) men and (b) women?
(Only one of the following answers is correct.)
In men: tightness, or pain that begins in the chest, recurrent pressure or tingling anywhere above the waist. In women: pain in the shoulders, neck, and arms, toothaches and blurred vision.
In men: pain in the shoulders, neck, and arms, toothaches and blurred vision. In women: experiencing intense emotions, depression and/or outbursts of anger.
In men: intermittent or persistent sensation of pressure, tightness, or pain that begins in the chest but may radiate to the shoulders, neck, and arms. In women: recurrent pressure or tingling anywhere above the waist when exerting themselves or experiencing intense emotions.
What if you think a person is having a Heart Attack?
Recognizing and responding to warning signs is critical. Fatal heart attacks usually occur within two hours of the onset of symptoms. Yet, about half of the victims of heart attack wait two hours before getting medical attention. Your client or loved one may protest going to the doctor, but do insist on seeing a doctor.
Not all myocardial infarctions produce the indicators mentioned above. It is possible to have a heart attack with out realizing it. Grady McCool was a 49-year-old realtor and builder. One day he showed a new house to a prospective buyer and suddenly he was so short of breath he could not walk to his car. Because he had been a smoker, he thought it was emphysema. But laboratory tests and a coronary arteriogram (this is a test where dye is put into all the coronary arteries to show if there is a blockage) showed that he had a heart attack, although the doctor could not pinpoint the exact time it occurred.
Question 4: What is a high-risk lifestyle?
Angina and Heart Attack
The acute chest pain called angina pectoris feels similar to a heart attack. There is a feeling of a dull ache, like the feeling you have in thigh muscles when riding a bicycle up a hill. However, with angina, the lack of blood to the heart muscle is transient. It does not cause the muscle to die.
Both physical and emotional stress cause angina. Grady McCool, who had been a football coach and a Type A personality, learned it was best for him to take a tranquilizer before attending a sport event or to simply avoid such events.
Angina usually lasts for 15 minutes or less. This can seem like eternity to the sufferer. Help him to sit up since this eases breathing. Some patients may need oxygen and medications after an attack. In most cases the first line of defense is nitroglycerine tablets. Nitroglycerine is a coronary vasodilator meaning that it increases the flow of blood to the arteries of the heart. It also lowers blood pressure by enlarging the lumen of the arteries and veins that return blood to the heart. Give one of these pills under the tongue and wait 5 minutes for relief. If the pain persists, try another tablet and wait 5 minutes. If the third pill does not relieve the pain, the person needs to see a doctor. Do not give more than 3 pills because the dilation of the arteries and veins can cause a sharp drop in blood pressure. There are other slow-release drugs that can reduce an impending heart attack. These drugs are Inderal and Cardizem.
Information about storing Nitroglycerine:
- Keep the drug nearby at all times, but not in a pocket, these pills are sensitive to body heat.
- Replace the cap tightly and open a new bottle every three months - this drug is most effective when fresh.
- Avoid taking hot showers or standing suddenly after taking this medication - the lowered blood pressure may cause dizziness and fainting.
Question 5: Nitroglycerin does which of the following?
(Only one of the following answers is correct.)
Makes the person taking it fall down because he has low blood pressure.
Increases blood flow to the heart by increasing the lumen of the arteries of the heart and body.
Makes a person breathe better.
Diagnosis of Heart Attack
A heart attack is diagnosed by electrocardiogram, blood tests that look for evidence of cell death, and clinical symptoms. When all signs point to a heart attack, time is important. Often, thrombolysis therapy is used to dissolve the clot. In this procedure, a catheter is put into the artery that is affected and a drug breaks up the blood clot in the artery. This procedure must be done within 2 hours of the onset of symptoms. Angioplasty is another procedure where a catheter is put into the coronary artery and a tiny balloon blown up inside the artery to make the lumen of the artery larger. The most complex treatment is coronary artery bypass surgery where a blood vessel from another part of the body is grafted around the blocked coronary artery. By the way, Grady McCool finally had coronary bypass surgery and has lived to enjoy his grandchildren.
Cardiac Rehabilitation
Usually, 2 of 3 persons survive a first heart attack. Most stay in the hospital for 5-10 days and begin cardiac rehabilitation in 4-5 weeks after the attack. An essential component of rehabilitation is to start patients on aerobic conditioning to speed recovery. Aerobic conditioning uses oxygen to keep large muscles moving at a certain intensity for 20 minutes. This type of exercise uses several large muscle groups and demands that the heart and lungs get oxygen to the working muscles. It is used to increase cardiac and physical endurance. The types of exercises done are:
- walking on a treadmill with various stages of difficulty,
- stationary bicycling,
- walking laps around the gym and swimming.
Assessment of physical fitness of the cardiac patient is first completed. A measurement of his oxygen capacity in the lungs is measured. Oxygen capacity of a fit person and an unfit person will be the same at rest or walking a treadmill. However, the fit person will have increased oxygen consumption because he does regular exercise. The heart, lungs, and muscles all become more efficient with regular exercise. The heart pumps more blood, the lungs are able to take in more oxygen, and the muscle fibers extract more oxygen from the blood. We know from research that regular exercise decreases coronary artery disease. The reason why cardiac rehabilitation is important is that it keeps the body fit and maximizes the use of oxygen in the body, thereby decreasing problems with circulation and clotting of blood.
The goal for the cardiac patient is to exercise 30 minutes per day. The pulse of a person who is exercising must increase and there is a formula for the pulse beat one wants to attain with exercise. It is this: the number 220, minus your age and then compute 70% of that number. For example, if a cardiac patient is 60 years old, 220 minus 60 = 160. 70% of 160 = 112. The 60-year-old person needs to have a pulse rate of 112 for 30 minutes in order to get the maximum benefit from his exercise regimen.
The regimen is a written prescription by a cardiac rehabilitation physician. An EKG monitors the patient's cardiovascular capacity during minimal exertion and oxygen lung capacity as he begins his exercise prescription. As the patient increases his exercise level, he is monitored for heart problems periodically via EKG. Those persons with abnormal EKGs and blocks in the nerves of the heart are not candidates for cardiac rehabilitation. The prescription that the doctor writes for exercise is based on several factors such as age, weight, type of cardiac problem, other health problems, and analysis of the blood. The factors are all systematized and computerized so that the factors can be entered into the computer, which calculates the amount of exercise needed and the individualized program. I am not certain if Russia has such a systemized process for cardiac rehabilitation.
Question 6: Why is cardiac rehabilitation important?
(Only one of the following answers is correct.)
It improves the function of the heart, lungs and muscles.
It improves physical endurance.
It increases the lifespan of a person.
Depression is a common side effect for heart patients since they are usually busy people with Type A personalities. For more than a few months, they must slow down their usual fast-paced activities. The final but important component of rehabilitation is weight control and decreased intake of high cholesterol foods. They cannot eat MacDonald's hamburgers anymore! That is why you have "Bush legs" here for sale and the cardiac patients in the States eat chicken breasts! The legs of a chicken have more fat and Russians exercise more than Americans!
Congestive Heart Failure
This is a condition of older people in that the heart's pumping ability gradually decreases over a period of years. The disease typically affects the left ventricle first and then the right. In left sided failure the damaged heart keeps pumping but not efficiently. It cannot eject the amount of blood that the body needs. This causes fluid to build up in the lungs.
The opposite problem is that the right side of the heart fails to adequately fill with blood since its muscles have lost their elasticity. The blood builds up in the veins - especially those in the legs, feet, and ankles. It eventually seeps out of the blood vessels and collects in the tissue spaces causing swelling.
Decreased cardiac function is a natural consequence of aging. But of the 400,000 cases of heart failure diagnosed each year, the problem is other cardiovascular disease. The most common cardiovascular disease is uncontrolled blood pressure. Heart failure is also a complication of a heart attack. If the muscle of the heart does not beat efficiently due to death of a certain amount of tissue in the heart muscle then it does not adequately pump blood. Congenital heart defects, rheumatic fever, arrhythmias, and lung diseases also cause heart failure.
For a while, the heart muscle compensates for the condition by getting larger, the muscle gets thicker to expel blood more effectively, and the heart rate increases to improve circulation. Eventually, these compensations cannot stop the deteriorating condition. Simple activities may cause such fatigue that a person cannot care for himself any longer. Two in three heart failure patients die within 5 years of diagnosis.
Question 7: To compensate for heart failure, the heart:
(Only one of the following answers is correct.)
gets larger, the muscles get thinner in the heart, and the rate of the heart beat decreases.
gets larger, the muscles get thinner, and the rate of the heart beat increases.
gets larger, and the rate of the heart beat increases, to pump blood better.
Symptoms of heart failure include shortness of breath, fatigue, peristent croupy cough, raspy and shallow breathing, wheezing, rapid pulse, inability to sleep, and profuse perspiration. The symptoms associated with fluid retention are swollen feet, ankles, legs, and hands and abrupt weight gain of about 2 kilograms in 4 days.
Labored breathing is the most common indication of heart failure. In the early stage of the disease, this happens only during physical activity. As the heart weakens and the lungs grow more congested, patients feel short of breath even when resting. Sometimes it is difficult for persons with pulmonary edema to breath while lying down and this makes sleeping difficult. They may sit up suddenly in the middle of the night gasping for breath.
It is best for such persons to sleep in a semi-vertical position in an easy chair or hospital bed. If oxygen is available, this helps to give the needed supply of oxygen to the blood and the rest of the body.
Question 8: What is the difference between left- and right-sided heart failure?
Diagnosis of Heart Failure
The symptoms are often so unmistakable that treatment is started on the basis of the patient's history and physical examination. An EKG is done as well as an x-ray or echocardiogram to ascertain the size of the heart, the amount of blood pumped by contractions, and detect presence of fluid in the lungs.
Treatment of Heart Failure
Heart failure is curable either by remedying the primary illness or surgically correcting the anatomical problem - such as a defective heart valve. But the problem behind most cases of heart failure can only be partially rehabilitated. Therefore, extending survival time and minimizing symptoms are the goals of therapy.
Success is the responsibility of the patient. He must follow heart healthy habits. That means no smoking, no alcohol, losing excess weight, eating a low fat and low salt diet, and following an exercise plan written by the rehabilitation doctor. For most people this means a radical change in lifestyle. If persons with heart failure choose not to change, the caregiver's focus is to make the person comfortable.
Question 9: Heart failure is cured by:
(Only one of the following answers is correct.)
being a responsible person.
solving the primary health problem or surgical correction.
stopping the eating of chips.
The treatment of congestive heart failure is to:
- strengthen the heart's contractions,
- ease the workload of the heart, and
- decrease the fluid in the lungs and elsewhere in the body.
Digitalis is the medication that strengthens the heartbeat, Capoten eases the heart by enzyme inhibitors, and Hyrodiuril releases excess fluid in the body.
When all else fails, a heart transplant is the last option for selected patients. But often hearts are not available and death is certain.
Question 10: In the summer time, do you ever watch peoples' feet on public transportation? Which ones have left sided heart failure?