Heart Failure Diagnosis
Heart failure diagnosis starts with the medical and family histories, physical exam, blood test and other diagnostic procedures.
Heart failure Diagnostic tests
The symptoms of heart failure are common in other conditions and needs to diagnose properly.
- Diagnose whether have any disease condition that can cause heart failures, such as coronary heart disease, high cholesterol, hypertension, or diabetes.
- Rule out other causes of the symptoms
- Diagnose any damage to the heart and measure the hearts pumping capacity.
Early diagnosis and proper treatment can help people with heart failure to live longer without major complications.
Medical and Family Histories
- Doctor asks, whether you or your family members have or have had a disease condition that can cause heart failure.
- Doctor likes to hear about the symptoms such as what, when, how long and how severe are the symptoms.
Physical Exam
- Examine heart sound abnormalities.
- Examine the sound for any extra fluid build-up in the lungs.
- Examine the swelling in ankles, feet, legs, abdomen, and veins in the neck.
Heart failure Tests
- EKG (Electrocardiogram) records electrical pulses of heart, which shows; strength and timing, helps to find how fast the heart is beating, and its rhythm is steady or irregular. Shows, whether the hearts pumping chambers walls are thicker than normal, if so it makes the heart harder to pump blood.
- Chest X-ray – provides the picture of heart, lungs, and blood vessels. In can show the heart size abnormalities, fluid build-up in the lungs, or having lung disease.
- BNP blood test - measures the level of hormone BNP, rises during heart failure.
- Echocardiography produces actual moving picture of the heart. It provides information about the size and shape of heart, heart chamber and valve functioning. It is useful to pinpoint the areas of poor blood flow, contraction abnormalities and any injury in heart muscles. Sometimes this test performs both before and after physical stress, helps to show whether there is a lack of blood flow to the heart during stress.
- Doppler imaging helps to measure the speed and direction of blood flow. Useful to find whether have right side heart failure, that is the heart cannot fill enough blood.
- Holter monitor records the heart rhythm for 24 to 48 hours without affecting your normal daily activities. It is a small box that can be easily carried, and it is connected with an electrode is attached on the chest.
- Nuclear heart scans measures the blood passing through the heart and blood reaching the heart muscles. Nuclear heart scan is by injecting a radioactive substance into the bloodstream, which is visible through a special camera. The healthier heart muscle appears as bright light, but it does not with damaged heart muscle.
- Cardiac catheterization has a long, thin, flexible tube called a catheter is put into a blood vessel in the arm, thigh, or neck and thread it to the heart. It is useful to study the insides of the coronary arteries, which carry oxygen-rich blood to the heart.
- Coronary angiography - A catheter (thin, flexible tube) is inserting into a blood vessel in the arm, thigh, or neck. Inject a special dye that can be visible on X-ray into the arteries. By seeing this picture, doctor can diagnose any blockage in the arteries and its severity. This test also shows how well the heart is pumping.
- Stress Testing is performing by making the heart work hard and beat faster by exercising, if not able to do exercise, then medication is useful to speed up heart. When heart work harder it needs more blood and oxygen, if the arteries are narrowing it cannot provide enough blood or oxygen. Any abnormality such as heart rate, heart rhythm, blood pressure, shortness of breath, and chest pain are helpful in the diagnosis.
- Cardiac magnetic resonance imaging (MRI) shows the structures and beating of the heart. Help to locate damaged parts of the heart. It is useful to find early signs of heart failure, even before symptoms start to appear.
- Positron emission tomography (PET) scanning can show blood flow problems that other diagnostic procedures missed indicating.
- Thyroid function tests are to find how well the thyroid is working. Having extreme hypo or hyper-thyroidism in the blood can cause heart failure.
ED Causes
Erection requires a precise sequence of events; ED can occur when any of these events is disrupted may be due to physical, mental or any disease.
Erectile Dysfunction causes
The erection sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa (a spongy tissue in penis, which produces erection).
Many different conditions can lead to ED. Most of the causes of ED are health problems requiring treatment to help prevent more serious complications than ED does:
- High blood pressure and high-cholesterol can injure the arteries that supply blood to the penis.
- Diabetes injures blood vessels and the nerves that control erections.
- Alcohol and drug abuse can cause ED by damaging blood vessels and deadening the nerves that control erections.
- Some prescription drugs such as some antidepressants or some high blood pressure medicines can cause ED. Your doctor may be able to change your drug treatment. Never stop taking a prescribed drug without talking to your doctor.
- Unhealthy habits like smoking, overeating, and avoiding exercise can also contribute to ED.
- Anything that is unhealthy for your heart is also unhealthful for your sexual health.
- An injury to the spinal cord can cause ED by interfering with nerve signals.
- Treatments for prostate cancer, including radiation and prostate removal, can damage the nerves that control erections.
- Diseases that affect the nerves, like multiple sclerosis, can also lead to erection problems.
- A small number of ED cases result from a reduced level of the male hormone testosterone.
- Doctors used to believe that most cases of ED resulted from mental or emotional problems. We now know that many cases of ED have a physical cause; this can lead to depression and worry making the ED even worst. However, depression and worry (or anxiety) can still cause ED.
- A person should not assume that ED is part of the normal process of aging. There is quite likely an underlying cause.
Heart Failure Symptoms
Heart failure is the inability of the heart to fill-in or pump-out blood properly. Shortfall of oxygen produces shortness of breath, tiredness, and swelling.
Heart failure symptoms
- Shortness of breath or difficult-breathing
- Fatigue or feel tiredness
- Swelling in the ankles, feet, legs, abdomen, and, occasionally veins in the neck.
- Chronic Cough, the fluid buildup in the lungs called as acute pulmonary edema results in a persistent cough that may produce a thick, mucous-like substance (phlegm). This severe condition needs emergency treatment.
- Rapid irregular heartbeat happens to compensate for its inability to pump adequate blood throughout the body. Patients may feel palpitations or a racing heartbeat.
- Lack of appetite or nausea happens when the liver and digestive system failed to receive a normal blood supply.
- Mental confusion — reduced blood flow to the brain can cause memory loss or confusion.
All the heart failure symptoms are due to the fluid buildup in the body.
As the heart becomes weaker, symptoms can be worsening. Feel tired and shortness of breath even with minimal effort such as after getting dressed. Some people have shortness of breath, when they lying flat.
Kidney Disease Treatments
Sometimes kidney damages to an extent that they no longer work. If kidney fails, then need to replace their function to clean the blood by filter out wastes.
Treatment for Kidney disease
If kidney failure, needs to either replace their function by dialysis or replace it with a new kidney (kidney transplant). Because of better blood-glucose control and good rates of survival following treatment, doctors start recommending dialysis and kidney transplantation to people with diabetes.
Dialysis is an artificial way of cleaning the blood with an artificial kidney. There are two types of dialysis hemodialysis, and peritoneal dialysis.
Hemodialysis - You need a surgery to make a way to bring the blood from the body and sent back after cleaning. This way (path) is usually made at the forearm using patients own blood vessel or a piece of implanted tubing and cannot be seen from outside. After this surgery start dialysis only after two to three months time to help it heal. Hemodialysis must be done two to three times a week, and it will take three to five hours to complete on a dialysis session.
Peritoneal dialysis - Lining inside the abdomen called the peritoneum can be useful as blood purifying filter. A soft plastic tube is places in the abdomen by performing a surgery. Through this tube, pour the cleansing fluid called dialysate into the abdomen after the body heals. Waste products in the blood pass through the peritoneum and are mixed with dialysate. Then drain out the dialysate along with the waste. Do it some four to five times a day and it takes about 30 to 45 minutes?
Kidney Transplantation
Transplantation is most successful when the kidney comes from a living relative. Another option is a cadaver kidney (a kidney from an unrelated person who has just died). The success ratio is high for kidney transplant from a living relative than cadaver kidney. A good match is most important when using a kidney.
Kidney transplants are safe for a person who does not have heart or blood vessel disease. Before get a transplant, doctor will check the circulatory system to see if it is healthy enough to risk the operation.
Heart Failure Causes
Disease conditions that cause the heart muscle damage or make it hard to work can cause heart failure.
Heart muscle damage releases certain proteins into the bloodstream. This protein has a toxic effect on the heart and normal blood flow, and it worsens the heart failure.
Causes of Heart failure
- Coronary heart disease – fatty substance called plaque start build-up in the arteries, overtime the arteries narrowed. Therefore, blood supply can slow down or stops causing heart diseases, heart attack, or heart failure.
- Hyperlipidemia – high-cholesterol level in blood damages the blood vessels, fastens the plaque build up, and lead to heart damage and heart failure.
- High blood pressure – if blood pressure stays at or above 140/90 mmHg. It makes the heart work harder, without treatment heart may damage and lead to heart failure.
- Diabetes – long term of high blood glucose can affect nerves and blood vessels that lead to heart damage and heart failure.
- Sleep apnea – breath stops during sleep or swallowed causing a shortage of oxygen and makes the heart to work harder leads to heart failure. Treating sleep apnea can reduce the risk of heart failure.
Properly treating these conditions can prevent or at-least limit heart failure.
Other causes of heart failures
Some heart-related diseases can lead to heart failures; they are:
- Heart muscle diseases – any injury or infection to heart muscles, or present at birth.
- Heart valve disorders – present at birth, any infections, heart attacks, or damage from heart disease.
- Arrhythmias or irregular heartbeats - present at birth, due to heart disease or heart defects.
- Congenital heart defects – heart defect present at birth.
Other factors causing heart damage and lead to heart failure
- Cancer treatments - radiation and chemotherapy
- Thyroid disorders - hyper or hypo-thyroidism
- Alcohol, Cocaine and other illegal drug abuse
- HIV/AIDS
- Too much of E vitamin
Prevent Kidney Disease
Kidney disease can be prevented or stop progression by managing blood-glucose level and blood pressure in near normal range and follow a moderate protein diet.
Prevent/stop the progression of kidney disease
Kidney disease can be prevented or at least slow down by maintaining:
- Blood pressure at normal by medication
- Have moderate protein diet
- Intensive blood-glucose management
Pressure Medicines help prevents/slow-down kidney disease
Drugs used to lower blood pressure can slow the progression of kidney disease. Two types of drugs, ACE inhibitors and ARBs (angiotensin receptor blockers), are proven effective in slowing down kidney disease. In addition to an ACE inhibitor or an ARB, you also may need another blood pressure medication for efficient blood pressure control.
ACE inhibitors, doctors commonly prescribe for treating kidney disease of diabetes. The benefits extend beyond its ability to lower blood pressure: it may directly protect the kidneys’ glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.
It also shows that ARB can protect kidney function and lower the risk of cardiovascular events.
Moderate protein diets are good for kidney
It is harmful to consume excessive protein, if diabetics. For people with largely reduced kidney function, a diet containing reduced amounts of protein may be helpful in delaying the onset of kidney failure.
Intensive blood-glucose management for kidney health
Intensive management of diabetes is a treatment regimen that aims to keep glucose levels close to normal. This treatment regimen starts with frequent measurement and treating accordingly. Furthermore, follow healthy diabetes foods and be more active in your daily routines (or do regular exercise). Some people use an insulin pump to supply insulin throughout the day.
A number of studies shown that, there is a remarkable reduction to the risk for early kidney disease in people with improved blood-glucose control.
Important Kidney care tips
People with diabetes should be consistent in treating other conditions to maintain their kidney healthy.
- Measure A1C level at least twice a year, test provides an average of blood-glucose level for the previous three months. Maintain A1C below 7 % for better effect.
- Check blood pressure several times a year, aim to keep blood pressure at or less than 130/80 by taking an ACE inhibitor, ARB or other medications.
- Measure eGFR at least once a year to know how well kidneys are working.
- Measure protein in the urine, at least annually to check for any kidney disease
- Consult registered dietitian, whether to reduce the amount of protein in diet and to help with meal planning.
Heart Attack Treatments
Early treatment within five minutes of the first symptom is necessary to prevent or limit damage to the heart muscle. Medical personnel can begin diagnosis and treatment even before getting to the hospital.
Heart Attack Treatment
Certain medicinal heart attack treatments can start immediately if you suspect or confirm a heart attack. These include:
- Oxygen to balance the short supply
- Aspirin - prevents blood clot
- Nitrates are commonly used to treat during heart attach, they relax and widen blood vessels and allow more blood to flow to the heart thus reducing its workload.
- Treatment to relief chest pain
Once confirm or suspect heart, start treatment to restore blood flow at the earliest. Treatments are medicines and medical procedures.
Heart Attack medications
- Thrombolytic Medicines – is a clot buster, because they dissolve blood clots that are blocking the coronary arteries. For the best result, this medication must give within one hour of heart-attack symptoms.
- Beta-blockers - reduce heart rate and blood pressure by dilating blood vessels. Thus, decrease the workload on the heart and so relieve chest pain or discomfort and help prevent additional heart attacks. Beta-blockers also can be useful to correct irregular heartbeat or arrhythmias.
- Anticoagulants - blood-thinning medication prevents blood clot from forming in the arteries.
- Aspirin and Clopidogrel – is an Antiplatelet medication, stops platelets in blood cells to join and forming undesirable clots.
Medical Procedures for heart-attack
If medicines do not produce expected results by stopping a heart attack, medical procedures such as a surgical or non-surgical method may utilize.
Coronary Angioplasty - A non-surgical procedure used to open blocked coronary arteries. A thin flexible tube called a catheter with a balloon at the end is slowly threading via the blood vessel to the blocked coronary artery. Then, inflate the balloon to clear the plaque by pressing against the wall of the artery; it widens and restores blood flow. A small mesh tube called a stent may put in the artery to help keep it open forever. Sometime, the stents are coat with medications to help prevent the artery from blocked again.
Coronary Artery Bypass Grafting - Take an artery or vein from other parts of the body and place it around blocked coronary to bypass these coronary arteries in a surgical procedure. This makes a new route for proper blood flow to the heart muscle.
Treatment is necessary after an attack and discharged from Hospital. Ever after left the hospital, treatment should continue. The treatment may include daily medication and cardiac rehabilitation.
Therapeutic lifestyle changes are needed that may include; quit smoking, lose weight, diet modification, and increased physical activity, to prevent or reduce the chances of having another heart attack.
Cardiac Rehabilitation after a heart-attack
Cardiac rehabilitation team includes many specialists; include family doctor, cardiologist (doctor specialized in treating heart), nurses, exercise specialist, physical or occupational therapist, dietitian, and psychologist.
- Exercising – heart is a muscle and with a proper exercise, it can be nourished and strengthened to prevent another heart attack.
- Education – rehabilitation team provides tips and helps to learn the best practices to take care of the health, particularly heart’s health.
- Counseling – is to overcome the fear of future and about the next heart attack. The anxiety or stress itself can trigger another one.
- Learning – learn from heart-attack experience, which are the instances, which are unsuitable and need to reduce or avoid. In many cases of it is trigger by stress, so it is necessary to learn to overcome and prevent stress-full situations.
Cardiac rehabilitation will help to take care of the heart health to prevent having another heart attack.
Heart Attack Diagnosis
Heart attack diagnosis is starts on the symptoms experienced, the personal and family medical history, and the diagnostic procedures.
Heart Attack Diagnosis Tests
- Heart attack caused due to the lack of oxygen-rich blood to some areas of heart muscle cell. Therefore, it dies and burst open and put certain proteins in the bloodstream. The amount of this protein in blood is measures by blood tests such as troponin tests, CK or CK–MB tests, and serum myoglobin tests. These blood tests are repeats often.
- EKG (Electrocardiogram) records electrical pulses of heart its strength and timing, helps to find the previous or current heart attack. In addition, it shows if having arrhythmias or abnormal heartbeats, mostly caused by heart attack.
- Coronary angiography - A catheter (thin, flexible tube) is inserting into a blood vessel in the arm, thigh, or neck. Inject a special dye into the arteries that can be visible on X-ray. By seeing this picture, doctor can diagnose any blockage in the arteries and its severity.
Kidney Disease Test
Common diagnosis test for CKD is urine/blood protein levels, Serum creatinine, Glomerular Filtration Rate; Kidney CT scans and Kidney biopsy.
Chronic kidney disease (CKD) diagnosis test
Protein urine test other wise called as Urine protein, Urine albumin and Albuminuria. Which measures the amount of proteins commonly albumin, found in a urine sample. Perform this test as a screening test for kidney disease. Normally, protein is not appeared in the urine when a routine dipstick test is performed. Normal values for a random urine sample are approximately 0 to 8 mg/dL if higher, then it may be due to diabetic nephropathy.
Microalbuminuria test measures for small quantities of protein commonly albumin in the urine sample. The amount of water in urine can vary and affect the concentration of albumin. Thus, the amount of creatinine is also measured, and the result has a ratio of albumin to creatinine. If an abnormally high level of albumin is noted, health care provider’s advice to repeat the test on a 24-hour urine sample. Perform this test to find kidney damage (diabetic nephropathy) in a person with diabetes for a long duration. Normal albumin to the creatinine ratio is less than 2.5 mg/mmol for men and 3.5 mg/mmol for women.
Abnormal levels of the protein (mostly albumin) in the urine signal the beginning of a condition called microalbuminuria, often noted in diabetic nephropathy. Diagnose microalbuminuria if there are 30 to 300 mgs of albumin in two different 24-hour urine samples. Diagnose albuminuria if there are more than 300 mgs of albumin.
BUN (Blood urea nitrogen), Urea nitrogen is formed when proteins are broken down. Draw blood from a vein, usually from the inside of the elbow or the back of the hand. Some drugs affect BUN levels so consult before going for a test. The normal value will be in the range of 7 - 20 mg/dl if higher, then it may be an indication for kidney disease.
Serum creatinine test is to measure the creatinine level in blood. Creatinine is a breakdown product of creatine, an important part of muscle. Draw blood from a vein, usually from the inside of the elbow or the back of the hand. This test is to examine kidney function. If kidney function is abnormal, blood has increased level of creatinine, due to decreased excretion of creatinine in the urine. Creatinine levels will vary depends on the person's size and muscle mass. A normal value is 0.8 to 1.4 mg/dL. Females usually have a lower creatinine than males.
Glomerular Filtration Rate (GFR) is the best way to find how well the kidney functions, no need to have another test to know the GFR. Calculate GFR from the blood creatinine, age, race, gender, and other factors. GFR value is helpful to determine the stage of kidney disease and helps to plan further treatment.
Ultrasound or CT scan produces a picture of the kidneys and urinary tract. Helpful to find any physical structural abnormalities, that is the kidney is larger or smaller than normal, whether have a problem like kidney stones or tumor.
In some time, perform a kidney biopsy to check for a specific type of kidney disease and see how much kidney damage has occurred.
Kidney Disease Stages
Diabetic nephropathy may take many years to develop. Filtering function of the kidneys is usually higher than normal in the first few years of diabetes.
Kidney disease stages - based on filtration rate
- At stage one, kidney has damaged slightly with normal or increase filtration at this beginning stage of kidney disease. Glomerular filtration rate (GFR) is more than 90 mL/min/1.73m2.
- At stage two kidney’s filtration, function usually remains normal during these periods. Glomerular filtration rate (GFR) is between 60-89 mL/min/1.73m2.
- At stage three, kidney’s function is moderately decreased with glomerular filtration rate (GFR) between 30-59 mL/min/1.73m2.
- At stage four, kidney’s function decreased severely with glomerular filtration rate (GFR) is between 15-29 mL/min/1.73m2.
- At stage five, kidney’s function is almost failed with glomerular filtration rate (GFR) is Less than 15 mL/min/1.73m2 and requiring dialysis or transplantation.
Kidney disease stages based on the urine protein level
Over years of diabetes, people who are developing kidney disease will have small amounts of the blood protein called albumin begins to appear in the urine. This is the first stage of CKD, called as microalbuminuria. The kidney’s filtration function usually remains normal during these periods.
When disease progresses, more albumins appear in the urine, this stage called by macroalbuminuria or proteinuria. The kidneys filtering function starts to drop slowly, and the body starts to retain various wastes as filtration falls. When kidney damage progresses, blood pressure rises as well that in turn affect kidney.
Kidney damage rarely happens within the first 10 years of diabetes, and usually takes 15 to 25 years for kidney failure to develop. For people with diabetes of more than 25 years without any sign of kidney failure has decreased risk of developing kidney disease.