Cardiac Disease 1
Len Sperry in Behavioral Health, 2013
Some of the more common heart diseases and conditions are briefly described. Coronary artery disease occurs when coronary arteries, the vessels that supply blood to heart muscle, become hardened and narrowed due to the buildup of cholesterol and other material, called plaque, on their inner walls. As the plaque increases in size, the inner surfaces of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Reduced or cutoff blood flow and oxygen supply to the heart muscle can result in angina; that is, chest pain or discomfort that occurs when the heart receives an insufficient supply of blood. It is a symptom of coronary artery disease rather than a separate disease entity. Heart failure, commonly referred to as congestive heart failure, is a condition of ineffective heart pumping such that vital organs get insufficient blood, resulting in such signs and symptoms as shortness of breath, fluid retention, and fatigue. It results when heart failure has led to fluid buildup in the body. Finally, myocardial infarction, commonly called heart attack, happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Cells in the heart muscle begin to die if they do not receive enough oxygen-rich blood. The result can be permanent damage to the heart muscle or death.
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Characteristic symptoms of heart failure include shortness of breath, fatigue, and ankle swelling, but others include depression, poor quality sleep, confusion, short-term memory loss, dizziness, and nausea [15]. As would be expected, the most commonly reported symptom is breathlessness, present in up to 90% of patients [16]. Breathlessness presents either on exertion or at rest, as orthopnea or nocturnal dyspnea. Fatigue is also prevalent (69%) and exaggerated by ankle edema, weight gain/loss, and depression. Depression is very common and yet underdiagnosed and undertreated in those with cardiac failure. Approximately 50% of heart failure patients in a recent study were classed as depressed during a 5.4-year period, with approximately two-thirds of these receiving treatment with antidepressants [17]. Depression has also been linked to increased mortality, increased rates of rehospitalization, and worsening quality of life in those with heart failure [17-19]. It is important to note that cognitive functioning and depression have been noted to worsen during episodes of heart failure decompensation, with some improvement postrecovery, albeit lower than previous levels [20].
Clinical management
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean in Geriatric Medicine for Old-Age Psychiatrists, 2005
Heart failure is mainly a disease of old age. It has a high mortality and mor- bidity. The patient's condition can fluctuate and deterioration can lead to hospital admission. The most common causes of heart failure are ischaemic heart disease, hypertension and valvular heart disease. Heart failure has a complex pathogenesis but occurs when the heart pump function is unable to meet the physiological demands upon it. Good evidence exists for improvement in mortality and morbidity with medical therapy. Symptomatic heart failure has a worse 1-year mortality than many cancers. Most heart failure is due to left ventricular dysfunction. In older patients, heart failure is frequently seen with normal left ventricular function but with abnormal diastolic filling and ventricular relaxation. This is known as dias- tolic heart failure.
Avoidable and Unavoidable ER Utilization by Cancer Patients on Systemic Therapy
Published in Oncology Issues, 2021
Leonard R. Henry, Deardorff Sherise, Li Jun, Griffin Rhonda, Davis Kacy, Coil David, Kelty Sheila, Kio Ebenezer, Urs W. von Holzen
A history of congestive heart failure was the only pre-defined comorbid condition that predicted avoidable ER utilization. Surprisingly, other comorbid conditions were not individually identified as predictive, nor was the total of comorbidities present in each patient predictive of ER utilization. Congestive heart failure is a known comorbid condition associated with frequent hospital admission and readmission.23 Our study corroborates these findings. Although the number of patients with this diagnosis who also received cancer treatment was very small, half of these patients had avoidable ER visits during the study period. This is a difficult patient population in general and likely even more so when on systemic therapy. For this specific patient population, aggressive monitoring and short cycled visits may help avoid unwanted medical events.
Heart failure in congenital heart disease: management options and clinical challenges
Published in Expert Review of Cardiovascular Therapy, 2020
Elsbeth M. Leusveld, Robert M. Kauling, Laurie W. Geenen, Jolien W. Roos-Hesselink
Symptoms and signs are often nonspecific and can be different from heart failure symptoms in the general population due to the relatively younger age and more complex (cardiac) history of the ACHD population, including a higher percentage of right heart failure [31]. Symptoms of heart failure include, but are not limited to, shortness of breath, fatigue, loss of energy, orthopnea, palpitations, postural nocturnal dyspnea, diminished exercise capacity, loss of appetite, weight gain, swollen ankles or abdomen, and chest discomfort. A thorough history should be taken to elucidate the nature of the symptoms, time frame, provoking factors, such as anemia, arrhythmias, or substance abuse, and alternative explanations. The aim of the physical examination should be focused on signs of congestion and should be repeated at regular intervals during follow-up and treatment.
Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers
Published in Expert Review of Medical Devices, 2018
Timothy A. Joseph, Colleen E. Lane, Erin A. Fender, Chad J. Zack, Charanjit S. Rihal
Significant PVL complicates between 1% and 5% of valve replacements and the incidence is highest among patients with mechanical mitral valve replacement. Symptoms include congestive heart failure and hemolysis. Multimodality imaging including both transesophageal echocardiography and cardiac CT are critical in establishing the diagnosis and defining the size, location, and mechanism of PVL. Surgery is appropriate for patients with PVL due to endocarditis or valve dehiscence. Increasingly, percutaneous treatment is the first-line treatment for many cases of PVL. Percutaneous interventions are associated with less morbidity and mortality when compared to reoperation. However, persistent leak, hemolysis, device embolization, and disc impingement continue to present significant challenges, in large part because currently used devices are not designed for PVL closure. The creation of dedicated devices for leak closure is needed to improve procedural success rates.
Related Knowledge Centers
- Angina
- Chest Pain
- Exercise Intolerance
- Fatigue
- Paroxysmal Nocturnal Dyspnoea
- Peripheral Edema
- Shortness of Breath
- Syndrome
- Orthopnea
- Signs & Symptoms
- Shortness of Breath