Heart Failure: Learning the Signs and Symptoms

[gerald]

Interesting read and definitely relevant

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Heart Failure: Learning the Signs and Symptoms
By John Bottrell, RRT—March 28, 2017


It has been established that anywhere from 20-70% of people diagnosed with COPD will eventually develop heart failure.1 It doesn’t always happen, but when it does you most certainly want to be prepared so you know what to do and when to seek help. Here are the signs and symptoms of heart failure to look out for.

To understand how COPD causes heart failure, please refer to my post “Links Between COPD and Heart Failure.(https://copd.net/living/links-heart-failure/)”

What are signs and symptoms of right heart failure?

Your right heart receives unoxygenated blood from your body and pumps it through your lungs. After years of pumping blood through diseased lungs, your right heart can become enlarged (hypertrophied) and turn into a weak pump. When this happens because of chronic lung disease it’s referred to as cor pulmonale. It is responsible for 10-30% of hospital admissions for heart failure.

Right heart failure causes blood to become congested in blood vessels. It may cause weight gain. The most common sign is ankle and foot edema, and this is often the only sign. This may be worse after standing all day, and improved at night after lying down all night. Another sign is a bulging of the jugular veins on the sides of your neck. It can also cause stomach discomfort, nausea, weakness, fatigue, palpitations, and shortness of breath.

What is the treatment for right heart failure?

The most common treatment is to lose weight, limit your intake of fluid, and eat a healthy diet that is low in salt. Diuretics may be indicated to pull some of the fluid from your body. They basically make you pee it out. Other medicines can increase the strength of your heart to make it a stronger pump. Other medicines may reduce blood pressure to reduce the work your heart has to do. Of course it’s always a good idea to adhere to your COPD treatment program as well.

When should you seek help?

It’s time to seek help when you experience weight gain, or worsening edema in your legs, feet, or ankles. If you experience increased shortness of breath not responsive to your regular COPD medicines, and as per your COPD plan of action you worked out with your doctor, you should seek medical attention immediately. Keep in mind that shortness of breath may mimic shortness of breath due to a COPD exacerbation. It also will not respond to COPD medicines.

What are signs and symptoms of chronic (it’s always there) left heart failure?

Your left heart receives freshly oxygenated blood from your lungs and pumps it to the rest of your body. For a long time there may be no symptoms. However, as it becomes a weaker pump, it has trouble keeping up with your body’s metabolic needs. For instance, when you exert yourself, your heart may have a tough time keeping up with your body’s increased metabolic needs, making you feel winded, or like you can’t catch your breath (dyspnea). The treatment for this is rest and maybe supplemental oxygen. Medicine may also prove helpful (see below).

What happens during an acute (it’s happening now) episode of left heart failure?

You may experience weight gain. Blood may get backed up into your lungs, causing fluid in your lungs (pulmonary edema). This may cause you to feel like you have to sit up to breathe (orthopnea). You may have a cough, which may be productive of pink, frothy secretions (a very severe sign — call 911 now!). Your oxygen levels may be low. Your breathing and heart rate may increase. Blood will be shunted to your vital organs, so you may feel cold and clammy to the touch, and the skin around your lips and fingertips may appear blue (cyanosis). You may feel fatigue, weakness, and anxiety. These are all severe signs and symptoms, meaning that you need to seek immediate medical attention. Call 911.

Can it be treated?

As noted above, symptoms of right and left heart failure can “mimic or accompany” COPD symptoms,1 but do not respond to COPD medicines. So, it’s important to keep in touch with your doctor, and seek help when you need to. That said, right and left heart failure are usually treated the same. Your doctor can prescribe medicine to remove fluid from your body and to lower your blood pressure so your heart doesn’t have to work so hard. Other medicines can make your heart a stronger pump. A diet low in sodium may also help reduce fluid retention. Supplemental oxygen can help make sure your oxygen levels stay at acceptable levels. Oxygen may be especially beneficial at night when you’re sleeping and when you are exerting yourself.5 CPAP and BiPAP have also been shown to help “improve outcomes.”

When should I seek help?

Ideally, you’ll want to seek help long before symptoms get severe. Your body will show early signs of acute heart failure, such as worsening edema of your lower legs, ankles or feet and weight gain. Seek help if you experience worsening fatigue, irregular heart beat, rapid heart beat, chest pain, dizziness, or confusion. You should also seek help when you experience worsening shortness of breath, or any of the signs and symptoms noted above for acute left heart failure.

What is the bottom line?

Not everyone with COPD will develop heart failure. There is no cure, but it can be treated. It’s important to know that people are living longer than ever before thanks to modern wisdom and medicine. So, if you experience any of the above symptoms, tell your doctor, and call 911 if you need to. The sooner you seek help the easier it is to fix you and get you back to your home.

copd.net/living/heart-failure-signs-symptoms/

[jarca]

good topic. I have an echo done of my heart when i have my other annual tests for COPD done & so far so good.
I have wondered, if one starts to show heart failure with COPD, is this a Pulmonary Specialist feild or a Cardiologist feild now?
In my brain, because it is a COPD side effect one would need to see a Pulm. who can treat accordingly; but then it is now a heart problem?
(i always feel that getting too many dr's starts getting confusion who is treating what)

[gerald]

Jarca, I am fighting with that now. Unfortunately you end up with a cardiac specialist.
An additional unfortunate aspect is they cardiac specialists do not know
anything about COPD and are not interested in learning.

Most of the medication the Cardiac specialist tries to prescribe makes the COPD worse.

[sharon]

I have had a echo last month, after complaining of increase in shortness of breath. Was told I have moderate pulmonary hypertension, which said my right side of heart is having problems. Dont understand a whole lot about it. I was going to ask if I should see a heart doc but after Geralds statement ,I dont know. I have a appointment with pulmonary and have questions about this. Few years ago had superficial phlebitis which I was told was due to copd. So I have questions about blood thickness and heart. The heart failure thing is scary.

[gerald]

Sharon, I would reommend that you try and see a cardiac specialist.   There is another test they can run called a Myocardial profusion test (spelling ?), it tests the flow through the heart and determines if it is pumping properly.

Problem is going to be that Cardiologists don't understand much about COPD and the pulmonary specialists are not too up on the heart.  Result is that getting straight answers can be a challenge.

[ozboy]

I had a CTPA done in August 2016.......CT Angiography.

Without writing up the Page Long Report.....The End Comment stated...

(1)  No pulmonary embolus demonstrated.nopathy

(2)  Intraluminal bronchial foci are seen. These may all reflect mucous plugging. The differential for one of the left intraluminal bronchial foci also includes carcinoid. Thes appearances could be reviewed on follow-up CT chest study in 4-5 months.

(3)  Marked diffuse emphysema. No pneumothorax.


The other findings were...The trachea moderately distended. No mediastinal, axiillary or base of neck lymphadenopathy is demonstrated. Marked diffuse central lobular and an acinar emphysema present. Minor acetectasis/scarring in the right lower lobe.


Plural spaces clear. The included upper abdomen shows no masss legion. Simple cyst of the pressure right kidney. No bony destructive process.

Am I on the Right Topic?

My previous Echochardiogram (transthoracic with dye contrast) done  in June 2016 -Poor views due to hyperinflated lungs. Impression of low normal  R.V function, no obvious pulmonary hypertension.

[jarca]

gerald; thanks on your input about having 2 different specialists as i kind of thought they wouldn't know "who's on first" of the others specialty. makes me happy that my heart seems to be doing good so far (knock on wood) as i don't want to deal with specialists when i don't have to.
after my experience going to see a pulm that specialized in PF (rather than my original pulm that focuses mainly on my copd) and the 2 lung specialist giving me 2 different sets of instructions ----did you know pulms specialize in different diseases? go figure. thank goodness i had lived with COPD long enough that when the PF pulm told me to just turn my 02 up as high as i want i knew that's not what i could do due to the copd CO retaining!


sharon, from my understanding "pulmonary hypertension" is "high blood pressure in your lungs" which can make your heart work harder --- it is totally different that "high blood pressure" that affects your heart.....I personally think that would still be a pulmonologist area of expertise.
have you gone back to your Pulm to talk about the results of your test? i'd ask him if it is time to see a cardiologist yet.

Ozboy, you results totally confuse me; i think that they should give us our test results in dr language & actual english we can understand.....the one thing i noticed on your results is that it says "no" to many of the things they were looking at--- i like to see "no" or "none found" on my tests.
the one i cant figure out is #2---"Intraluminal bronchial foci are seen...." as that sounds like a tumor was found, but then it says " These may all reflect mucous plugging." with the mucus plugs you have had problems with, i would hope that is what they are seeing. ---from my "expert analysis" it looks like a rather good report

[sharon]

Well thank you all for your input. The pulmonary said hypertension may be caused by low blood oxygen at sleep  and maybe not breathing well while sleeping so sending me for sleep study and on oxygen at night. She said if I went to cardiac doc they would probably do a catherization. not exactly sure what that is. Not sure if I want to go through that or if its necessary. I know I still have a high heart rate at times, and not when active mostly when I lay down in afternoon, sometimes goes up to 128. I know what you said about heart doc not knowing about pulmonary and vice versa so just as confused as to what to do other than get through the sleep study for right now.

[gerald]

Sharon, that was some of the first symptoms I had.   I did a 24 holter monitor test for blood oxygen and it found that my blood oxygen drop below the acceptable level ove 55% of the time at night.  So it was recommended that I use oxygen at night.   (Unfortunately they forgot to tell me that for a year!) 

I have had a high heart rate for years. It would always be greater than 100, and usually around 120.  It was never considered an issue until they discovered the heart failure. Then they wanted to bring it down.

They had tried to use beta blockers to reduce the heart rate which unfortunately are incompatible with COPD.  The caused the mucous to build up in my lungs. In addition they lowered the heart rate and then pegged it low so even when you got drastically out of breath it would not speed up accordingly.

I ran into some cardiac people at ST Pauls hospital in Vancouver that were familiar with COPD and Cardiac issues. It was a breath of fresh air to get advice from them and to get a better understanding of some issues etc.

You are going in the right direction, get the sleep study done.  If you need to use oxygen while sleeping it will help protect your internal organs.   

The next step for the Cardiologist may be an Echo Cardiogram to so that they can see the heart in action and see how well it is doing. 

[gerald]

I ran across this link in one of my folders.  It is worth spending a few minutes taking a quick read of the website

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What's the Link Between COPD and Heart Failure?


www.webmd.com/lung/copd/copd-and-heart-failure#1

[gnott]

jarca and sharon
[What follows in pure medically unqualified opinion, formed completely by personal experience the hard way. Smile]
YES, you need two specialists a Pulmonologist AND a Cardiologist. And from now on “2 different sets of instructions” will be constantly in your future. Actually you will need three – add a General Practitioner you like and trust. Not considered a “specialist”, but actually better in many ways. Can help you filter through the specialist’s noise by providing a more holistic view (meaning universal) – i.e. what is most likely best for YOU. Also find a pharmacy and pharmacist who has time to discuss medications with you. They can ward off a ton of problems.

As noted by others – these specialty dudes (male/female) WILL SELDOM (hmm, scratch that) – WILL NEVER agree on anything other than exercise and not smoking. That’s why you have to have a GP and pharmacist. Write out a list of medications, supplements, etc. with scheduled times (or marked “as needed”) and dosages and let them look at it. I am really not sure how many times in the last year their review has made a real difference for me, but it has: items taken too close together; items that shouldn’t be taken at all; taken later at night; taken in morning; six hours from this - four hours from that; and so on.

If you have ANY other issues which are impacting your life – Stomach, bladder, … - get a specialist for that too. DO NOT expect either your cardiologist or pulmonologist to care if you have a belly ache. (That’s why a GP is priceless – they can direct you to someone who WILL care.)

Now, totally off subject, but I just got out the hospital with a ‘near’ or ‘mild’ stroke. I was told to immediately go to the ER if my pulse rate while sitting went to 125. I realize I’m four days late and my condition and situation is entirely different than yours, BUT I seriously believe sharon you need to seek medical help immediately. Call or go in.

[wendyco]

gnott I totally agree with the advice you gave...sorry to hear about your TIA, hope no lasting damage anywhere and that this is an isolated insident

[sharon]

Gnott, I hope you are alright.

[jade]

Gnott sending you caring thoughts.