A CASE HISTORY
by an Anonymous Heart Failure Patient
At the age of 85, I was admitted to Morriston Hospital (Swansea) A & E unit with a wheezing chest and it was there, as an in-patient, that I was diagnosed with a condition known as heart failure.
It is not known how it developed but I was aware that two years earlier I had lymphoma, which resulted in a course of chemotherapy.
Lymphoma is the fifth most common type of cancer in the UK. It can occur at any age, even in children. It is nearly always treatable; most people live for many years after being diagnosed with lymphoma.
Before starting the treatment my heart was checked with a Muga scan to see if I could have chemotherapy, the test was passed as satisfactory, so I assume I had no heart problem at that time,
During the course of chemotherapy, my weight went down from 14 stone to 8 stone, but is now back to 11 stone. All this is mentioned as a thought that it could have affected my heart. I don’t know.
Of course, my age is a factor, and possibly there could be several other contributory factors.
At Morriston Hospital I was given the following medication after being diagnosed with heart failure: I don't know if this is a general practice, or if it varies with different cases:
Ramipril
Ramipril is a medicine widely used to treat high blood pressure and heart failure. It's also prescribed after a heart attack.
Ramipril helps prevent future strokes, heart attacks and kidney problems. It also improves your survival if you're taking it for heart failure or after a heart attack.
Bumetanide
Bumetanide is used to reduce extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen. Bumetanide is a "water pill" (diuretic) that causes you to make more urine. This helps your body get rid of extra water and salt.
Atorvastatin
Atorvastatin belongs to a group of medicines called statins.
It's used to lower cholesterol if you've been diagnosed with high blood cholesterol. It's also taken to prevent heart disease, including heart attacks and strokes. Your doctor may prescribe atorvastatin if you have a family history of heart disease, or a long-term health condition such as type 1 or type 2 diabetes or rheumatoid arthritis.
Warfarin
Warfarin is a type of medicine known as an anticoagulant, or blood thinner. It makes your blood flow through your veins more easily.
This means your blood will be less likely to make a dangerous blood clot.
Warfarin is used to treat people who have had a previous blood clot, such as:
a blood clot in the leg (deep vein thrombosis, or DVT)
a blood clot in the lungs (pulmonary embolism)
It's also used to prevent blood clots if you're at high risk of having them in the future.
This includes people with:
a replacement or mechanical heart valve
an abnormal heartbeat (atrial fibrillation)
a blood clotting disorder, such as thrombophilia
a higher chance of having a blood clot after an operation
Warfarin is only available on prescription. It comes as tablets and as a liquid that you swallow. The tablets are taken at 6pm each day and the dose depends on the previous INR test.
Tamsulosin
Tamsulosin (Flomax) is an alpha-blocker that relaxes the muscles in the prostate and bladder neck, making it easier to urinate.
Tamsulosin is used to improve urination in men with benign prostatic hyperplasia (enlarged prostate).
NOTE. These were prescribed before my AF condition.
Carbocisteine
Mucolytic medicines, such as carbocisteine, can be helpful for people with a long-term respiratory disease such as chronic obstructive pulmonary disease (COPD). Carbocisteine works by making phlegm (mucus) less thick and sticky, and therefore easier to cough up.
The Follow-up
At the follow-up heart clinic at Neath Port Talbot Hospital, the dose of Ramipril was increased to 10mg per day, 5mg in the morning and 5mg in the evening
The dosage was increased in stages: 2.5 -- 5 -- 7.5 then 10mg per day.
After each increase in dose, my blood was checked to ensure my kidney function was ok. I was discharged from the clinic after the dose reached 10mg per day.
Currently, I attend an INR [1] clinic at approximately 4 weekly intervals to have a blood test to ensure a satisfactory control with the Warfarin doses. This is done with a surgical pinprick on a finger and the resultant blob of blood is checked on a portable instrument. The target, in my case, is a reading between 2 and 3
Readings vary and depend on my diet. An excessive amount of vitamin K, as in broccoli, lowers the reading.
How do I feel?
A general feeling of tiredness and at night in bed I get an intermittent feeling on the left-hand side of my chest as if someone is using a spoon to stir near my heart and then pull our the spoon through my nipple.
Resting my hand over my chest, that is the weight of my hand, seem to limit this effect.
[1[ The international normalized ratio (INR) is a standardized number that's figured out in the lab. If you take blood thinners, also called anti-clotting medicines or anticoagulants, it's especially important to check your INR. The INR is figured out using the results of the prothrombin time (PT) test.
