Mitral Valve Regurgitation and Heart Failure " Denise a 78-year-old retired nurse "

Case study ( 8665 views as of November 23, 2024 )

Denise is a 78-year-old retired nurse, who was diagnosed with mitral valve prolapse of her heart. A heart murmur was detected during routine examination prior to her hysterectomy 12 years ago. A cardiac echocardiogram at that time demonstrated severe mitral regurgitation (leak) but she was without heart symptoms and treated conservatively by annual check-ups and repeat ultrasounds.

12 months ago, Denise developed ‘palpitations’ with breathlessness, but nothing new was found on examination and repeat testing. She was next seen in the emergency department with a 3-month history of gradually increasing breathlessness on exercise, 2 weeks of severe breathlessness (worse at night) with a cough, and ankle swelling but in the absence of symptoms of infection.

Denise was found to be in uncontrolled (rapid) atrial fibrillation and heart failure. She has a past history of high blood pressure, high cholesterol and is an ex-smoker. Her current medications include blood pressure, statin and analgesia. She was treated with intravenous diuretics, and increased blood pressure medication. When she was able to lay flat, repeat echocardiography demonstrated severe mitral regurgitation due to mitral valve prolapse and reduced left ventricular ejection function of 25% (normal >55%). Cardiac catheterization was performed demonstrating diseased coronary arteries. Denise was referred for in-patient mitral valve and coronary artery by-pass surgery, and a MAZE procedure to correct her atrial fibrillation.

Denise needs to continue seeing her cardiologist for treatment of her atrial fibrillation and heart failure. She will be seeing a heart surgeon about having her mitral valve replaced in combination with coronary artery bypass grafting (CABG). To help with recovery, Denise should see an athletic therapist at the hospital, a nurse to help her manage her heart failure and a dietitian to help her with diet. It might be wise for her to see a clinical pharmacist since she is on a number of different medications.

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Conversation based on: Mitral Valve Regurgitation and Heart Failure " Denise a 78-year-old retired nurse "

Mitral Valve Regurgitation and Heart Failure " Denise a 78-year-old retired nurse "

  • Due to its indigestible nature, fiber passes through the digestive system relatively intact. It adds bulk to the stool and helps promote regular bowel movements, preventing or alleviating constipation. There are two main types of fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and forms a gel-like substance in the digestive tract. It helps to slow down the absorption of sugars and regulate blood sugar levels. By doing so, it can contribute to managing hunger and preventing rapid spikes in blood sugar levels. Good sources of soluble fiber include oats, legumes, fruits, and vegetables. Insoluble fiber does not dissolve in water and adds bulk to the stool. It helps to promote regularity and prevent constipation. Insoluble fiber can be found in foods like whole grains, nuts, seeds, and the skin of fruits and vegetables. Both types of fiber have their own health benefits and are important for maintaining a healthy digestive system. It is generally recommended to consume an adequate amount of dietary fiber for optimal health, which can vary depending on age, sex, and individual needs.
  • Atrial fibrillation is a condition that significantly increases the risk of stroke compared to the general population. The risk is approximately five times higher for individuals with atrial fibrillation. Strokes can have severe consequences and lead to other health complications. For patients with atrial fibrillation, it is crucial to understand the importance of taking prescribed anticoagulant medications regularly. Anticoagulants, often referred to as blood thinners, help prevent the formation of blood clots that can travel to different parts of the body, including the brain, and cause a stroke. Therefore, it is essential for patients not to forget or miss their daily doses of blood thinners. Compliance with medication is of utmost importance in stroke prevention for individuals with atrial fibrillation. Even missing a single dose can increase the risk of a stroke. Patients should have open discussions with their prescribing doctors to determine the most suitable anticoagulant medication for their specific needs and strive for long-term compliance. Improved compliance leads to better outcomes in stroke prevention. Currently, there are several stroke prevention medications available on the market. Warfarin is a well-known option that has been used for over 40 years. However, it can be complex for patients to manage due to frequent blood tests and dosage adjustments based on factors like concurrent medications and dietary choices. Fortunately, newer anticoagulant drugs are now available, which offer similar safety profiles to Warfarin and, in some cases, provide even better stroke prevention. These newer drugs eliminate the need for regular blood tests and offer once-a-day or twice-a-day dosing options, enhancing patient compliance over time. When choosing the right anticoagulant, patients should consider factors such as safety, potential side effects, and ease of use. It is recommended that patients with atrial fibrillation consult with their family doctor or cardiologist to gather more information about stroke prevention and the benefits of these novel anticoagulants.
  • A myocardial infarction, commonly known as a heart attack, is an acute event that occurs as a result of a chronic condition called atherosclerotic heart disease. During a heart attack, there is a blockage in a coronary artery, leading to a cessation of blood flow and subsequent death of heart muscle. The mainstay of therapy for a heart attack involves the use of blood-thinning drugs. Aspirin is the most commonly used blood thinner. Depending on individual circumstances, additional blood-thinning medications may be prescribed alongside aspirin. Examples of such medications include clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). Newer drugs like prasugrel and ticagrelor show promise in certain cases. It's important to note that all medications can have side effects, although the frequency and severity may vary. When it comes to blood-thinning drugs, the most common side effect is bleeding. This can manifest as easy bruising or prolonged bleeding from minor cuts or injuries. Severe or life-threatening bleeding, such as gastrointestinal ulcers or bleeding in the head or eye, is extremely rare with these medications. While the bleeding associated with blood thinners can be bothersome, it's typically not life-threatening. However, individuals taking these medications should exercise caution to avoid accidents or injuries. ACE inhibitors, another class of medications commonly used in heart disease management, may have different side effects. The most common side effect of ACE inhibitors is a dry, hacking, and irritating cough. Although this side effect can be bothersome, it is not typically dangerous. If a patient finds the cough intolerable, alternative medications can be considered. A rare but alarming side effect of ACE inhibitors is angioedema, which presents as pronounced swelling, particularly around the airway, leading to difficulty breathing. While this side effect is uncommon, individuals experiencing breathing difficulties while taking an ACE inhibitor should seek immediate medical attention as it can be a medical emergency. It's important to remember that while these are the more common side effects associated with these medications, there can also be rare or idiosyncratic reactions. If you suspect you are experiencing a side effect from a specific medication, it is advisable to consult your physician or pharmacist promptly. Each individual's medical condition and biological makeup are unique, so medication choices may vary. It's important to consult with your own healthcare provider regarding any medication-related concerns or issues.
  • Heart failure occurs when the heart's pumping function is impaired, leading to symptoms and fluid buildup in the body. It is crucial to discuss heart failure with your healthcare provider, as it poses significant challenges. In Canada, over 500,000 individuals live with heart failure each year, while in the United States, that number reaches five million. Once heart failure develops, it significantly impacts quality of life and increases the risk of mortality. The mortality rate for individuals with heart failure is approximately 10 percent per year. Over a five-year period, four to five out of 10 patients may succumb to heart failure. If you experience sudden symptoms or have recently been discharged from the hospital or have undergone tests to diagnose heart failure, it is important to be aware of potential signs and symptoms and promptly address them. Signs of heart failure include shortness of breath at rest or during exertion, irregular heartbeats, swelling in the hands or legs, bloating, fatigue, or a general feeling that something is not right. Many patients with heart failure struggle to lie flat while sleeping due to breathlessness or may wake up abruptly with a shortness of breath sensation. Patients at higher risk for heart failure are typically older individuals with chronic medical conditions or those who have experienced events such as heart attacks or strokes. It is important to consider a constellation of symptoms and patterns that persist for several days rather than relying on a single symptom. When in doubt, it is crucial to follow up with your physician for further evaluation and guidance. Since treatments for heart failure can vary depending on the individual patient and the healthcare provider's approach, it is essential to schedule an appointment with your physician or local expert to discuss any questions or concerns you may have. They can provide personalized advice, recommend appropriate interventions, and guide you through managing heart failure effectively.
  • About 10% of people will have a cause that’s really driven by an inherited reason or a genetic cause. Those two main causes of cardiac arrest, the first one being the arteries in the heart. We have genes that program our arteries, things like cholesterol and blood pressure.
  • Atrial fibrillation can be described as a condition in which your heart beats irregularly. When your heart beats irregularly, you can have clots form, which lead to stroke. You can have an irregular heartbeat which leads to heart failure, as well as it can lead to other complications involving the heart.
  • The most alarming side effect, which is happily very rare, is an allergic reaction to an ACE inhibitor called angioedema, which manifests itself as pronounced swelling around the body, and most importantly around the airway, which causes difficulty dangerous, and that can be quite dangerous.
  • Typically in AF, the heart starts beating irregularly and often rapidly. This is the most common rhythm disturbance out there. It is age related, so its likelihood increases as we get older, although it can still occur in children and young adults.
  • There are some dietary considerations for someone in Denise's position, particularly if she is put on warfarin or another blood thinning medication. It will be important to monitor the amount of Vitamin K-rich foods she consumes so her intake remains balanced, since Vitamin K is a key player in the process of blood clot formation. Vitamin K is important so blood is able to clot when necessary (ex. stopping a cut from bleeding) but in this case it may interfere with the medications if her intake is sporadic instead of consistent. Additionally, following a heart-healthy diet (low saturated fat, trans fats, sugar, salt, and more fruits, vegetables, and whole grains) will help manage her blood pressure and cholesterol.
  • I was recently at the dentist and learned that some heart diseases - like atrial fibrillation - can affect the kind of dental treatment you can receive
    • I agree @Michelle Kaarto. Not just for those with heart conditions but all medical conditions should be disclosed to your dentist
    • @K.Michael - I would assume that dental care of people with atrial fibrillation may have to be modified if they are on certain medications. A lot of people with atrial fibrillation take anticoagulants, or anti-clotting medications, which could affect major dental surgery. Sharing your health history with your dentist is a smart idea.
  • Would Denise's heart murmur have contributed to her developing hearth failure ? Or is it just likely her overall bad health ?
  • My mother has a mitral valve prolapse and is in fact having many of these symptoms. This is a timely article for me.
    • I'm sorry to hear about your mother, healthymama. What treatment plan has she been given?
    • @Healthymama I hope your mother is ok. Does she know if she'll require surgery to treat her mitral valve prolapse ?
  • I used to work with someone who had heart failure - she could barely speak or breath. I was amazed to learn that it was in fact a treatable condition and she recovered fully
    • That happened to a relative of mine too. When we heard heart failure we really thought it was the end for him but in fact he is living a normal life now after treatment (though is on a lot of medication).
  • What is a MAZE procedure?
    • In atrial fibrillation, electrical signals travel to the atrioventricular node in an abnormal fashion which leads to an irregular and unsynchronized heart rhythm. The MAZE procedure is a surgical procedure where cuts are made in both the right and left atria and then sewn back together, forming maze-like scar tissue. This allows the atrium to still hold blood before ejecting it into the ventricle, but the lack of conductance across scar tissue forces electrical impulses to travel down a single path to the AV node at regular intervals. As a result, a normal heart rhythm is restored.
  • My Dad died of a Heart attack after ignoring symptoms and high cholesterol for years
    • Sorry to hear about that. Some heart failure symptoms can be very tricky or confusing.
  • Would her smoking have exacerbated her mitral regurgitation - the existing condition ?
    • Good thought. I also wonder if there is anything in her life that changed recently to cause her heart health to get so much worse.
  • Could the heart murmur have been there for a long time ? Is is possible that it was undiagnosed prior to the testing she had done ? Is there any exercises that she can do to help strengthen her heart ?
    • That's a good question about the heart murmur. I believe that you can have one and have it go undetected until other symptoms emerge. People live quite healthy lives with heart murmurs
  • The article indicates "When she was able to lay flat, repeat echocardiography demonstrated severe mitral regurgitation". Why would Denise have been unable to lay flat ? The breathlessness and cough mentioned as one of her symptoms ?
  • Denise's situation sounds like a very complex one. The suggestion that she see a clinical pharmacist is a good one. Managing multiple physicians and medication can be difficult.
    • At her age, Denise may have cognitive difficulties in managing her health, and may not be the best advocate for her ongoing care. She should consider allowing a close family member join her for her healthcare appointments, and become educated on her condition and her treatment plan.
    • It is especially hard for seniors to keep track of the many medications they are on, and for loved ones and caregivers to keep track when they need help.
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