2023-05-06 01:08:04
Heart weakness with normal systolic force… a paradox looking for treatment pathways
In a new medical statement, the American College of Cardiology (ACC) issued an Expert Consensus Decision (ECD) on the course of treatment for heart failure in which the heart’s contraction force and blood pumping are normal. It is a clinical condition that is medically called “heart failure with preserved ejection fraction (HFpEF)”.
The statement, published in the April 19 issue of the Journal of the American College of Cardiology (JACC), states: “Heart failure with preserved ejection fraction is one of the most pressing diagnostic and therapeutic challenges in clinical medicine today. This is due to its increasing prevalence, low prognosis, poor prognosis, limited treatment options, and the great burden on the health care system around the world.
The editorial board of Cardiology Magazine, issued by the American College of Cardiology, had published in its first issue in 2022 an article entitled “Cover Story – Heart Weakness with Ejection Fracture Preservation: New Year, New Hope.” In it, they said: “Heart weakness with preserved ejection fraction has been called the greatest unmet need in cardiovascular medicine.”
Blood ejaculation meter
The ejection fraction is a measure of the percentage of blood leaving the heart each time it contracts. It is normal for the left ventricle to absorb the blood coming to it from the lungs after purifying it from carbon dioxide and providing it with oxygen, then its muscle contracts with natural force in order to pump and expel this pure blood throughout the body. Normally, 55% of the blood that was absorbed by the left ventricle will be ejected from the two processes of systole and pumping. And when the heart weakens from contraction and ejaculation of this rate, the weakness of the heart is called “HFrEF – Heart failure with preserved ejection fraction”, which is the predominant case among the cases of weak heart.
However, in the past years, cardiologists have known different cases of heart weakness, in which the patient shows symptoms and signs of heart weakness (shortness of breath, swelling of the legs, and fluid accumulation in the lungs), but with the presence of systolic strength and blood ejaculation rate in a normal amount. These are cases of “weakness of the heart with preserved ejection fraction”, which do indeed represent a clinical paradox, which has made it problematic in cardiology circles, and among patients, about the perception of this happening with this paradox. Consequently, these cases posed complex medical problems, in the necessity of providing accurate diagnostic elements for these cases, in order not to over-diagnose them to include groups of patients who do not meet those elements necessary for accurate diagnosis. Also, in the methods and paths of successful treatment.
Diagnostic and treatment pathways
Therefore, the cardiology community strives to establish clear foundations for diagnosis and treatment pathways. Among the most important of these is this recent 44-page edition of the American College of Cardiology, which highlighted the “urgent need” to diagnose “heart weakness with preserved ejection fraction” with “accuracy”, in order to allow the implementation of treatments “based on scientific evidence and guidelines.” In the “just in time” to improve patient outcomes.
According to medical statistics, cases of “heart failure with preserved ejection fraction” are “on the rise” in the United States and the rest of the world. This is due in part to increasing age, the burden of obesity, and the repercussions of living a sedentary lifestyle over physical activity. Cases of “heart weakness with preserved ejection fraction” constitute more than 50% of the total cases of heart failure. But it is still “not recognized” in everyday clinical practice, as the medical document writing team led by Professor Michael Kittleson, a physician at Cedars-Sinai Medical Center in Los Angeles, California, put it bluntly. The document added that cases of “heart failure with preserved ejection fraction” are complex cases, often accompanied by multiple and overlapping comorbidities, including high blood pressure, diabetes, obesity, and sleep apnea, which requires a multidisciplinary approach. The team writing the medical document confirmed that the aim of their new issuance to the American College of Cardiology is to establish a structure for the steps of diagnosis and mechanisms for making clinical decisions regarding them, manage the treatment of comorbidities, and implement the latest medical treatment methods (drugs and non-drugs) guided by medical guidelines based on evidence and scientific evidence. Comprehensive medical care.
Doctors from the Yale University School of Medicine in Connecticut, in the October 20, 2020 issue of JAMA Medical Journal, published their study entitled “Heart Failure with Preserved Ejection Fracture: It’s Time to Reset”. They said: “Of the 5 million patients in the United States diagnosed with heart failure, approximately 50 percent have a weak heart with preserved ejection fraction. Its prevalence is increasing annually compared to the type of heart failure with low ejection fraction. By 2030, annual healthcare spending for heart failure is expected to reach nearly $70 billion annually. Heart failure with preserved ejection fraction is an important public health problem that will increase with population age, and with an increased and simultaneous prevalence of associated risk factors, including hypertension, obesity and diabetes.
Weakness of the heart… pumping and filling problems
Heart failure is a condition in which the heart is unable to pump enough blood that the body needs to function efficiently and comfortably. Any condition in which every part of the body is negatively affected.
In the normal state, the heart expands as it fills with blood (during diastole), then contracts to pump blood out (during systole).
Heart failure occurs when the systolic (pumping) or diastolic (filling) action is not adequate. This is usually due to weak or hardened heart muscle, or both. This injury may be acute, i.e. weakness occurs within a short time, in a few cases. Thus, symptoms of heart failure appear quickly.
But in the majority of cases, it takes a chronic course. Thus, the patient does not show any symptoms at the beginning of the condition, but within months or years, the patient begins to feel tired and short of breath, then fluid pools appear in the legs, lungs, and abdomen.
When a doctor suspects that a patient has a weak heart, based on their symptoms, they start testing. Among the most important are Echocardiography, ECG, chest x-ray, and a number of elements in blood tests. Then the doctor may order other advanced examinations, either to evaluate the cardiac arteries, or to more accurately evaluate the status of the heart valves, or to evaluate the heart’s electricity, or to assess the condition of the heart muscle itself.
The treatment takes two paths compatible in time: an urgent path that treats the symptoms to alleviate them, i.e. fluid buildup, and treats any severe disorders that cannot be delayed with rapid therapeutic treatment, whether in the arteries (heart attack attack) or in the rhythm of the heartbeat (atrial fibrillation) or in Valves (severe aortic valve stenosis). And a path that branches into several paths according to the type and cause of weakness. That is, is it weak systolic capacity or weak diastole capacity. After determining the type of weakness, the search for the causes of weakness begins, whether acute or chronic. Then work begins to address the root of the problem.
– 11 reasons other than my heart for a weak heart
> The weakness of the heart is not necessarily caused by a disease that originates in one of the parts of the heart itself. Rather, there are several non-cardiac causes that affect the heart and cause it to become weak. Either cause systolic or diastolic weakness. and the most important:
1. High blood pressure: When not treated properly, it causes constant stress on the heart muscle, to pump blood more forcefully than usual, in the face of high pressure in the arteries. As a result, the walls of the heart thicken and/or harden, so the hardened heart does not fill with blood as quickly or as often as usual, and pumps less blood with each beat.
2. Diabetes and obesity: both of which, through multiple mechanisms, will lead after a while to changes that increase the hardness of the walls of the heart, and thus weaken the heart.
3. Aging with associated diseases: the walls of the heart tend to harden more with age. And the associated infection with both high blood pressure, obesity and diabetes, which is common in the elderly, increases the risk of cardiac weakness.
4. Myocarditis: Inflammation of the heart muscle caused by a bacterial, viral or other infection can damage the heart muscle, impairing its ability to pump blood.
5. Medicines: such as chemotherapy drugs for cancer that affect the heart muscle, and non-steroidal anti-inflammatory drugs (NSAIDs) (commonly used), cause the body to retain fluids, which increases the burden on the heart and accelerates its weakness.
6. Amyloidosis: It is a disease that occurs when a protein called amyloid (an abnormal protein that is not found in the body normally) accumulates in the organs of the body, which weakens them from performing their functions. One of the organs that may be affected by the heart muscle.
7. Constrictive Pericarditis: In it, the membrane that envelops the heart (pericardium) hardens and prevents the heart from filling with blood or pumping blood, even if the heart muscle is healthy.
8. High blood pressure in the pulmonary arteries: This occurs as a result of several reasons, the most important of which is pulmonary embolism (pulmonary embolism), as a result of the transmission of clots from the deep veins in the legs or thighs. As well as sleep apnea, and chronic obstructive pulmonary disease.
9. Anemia: Anemia reduces the amount of oxygen carried by the blood, which forces the heart to work harder to deliver the same amount of oxygen to the tissues. There are many causes of anemia, including heart failure itself.
10. Disorders of the thyroid gland: Hyperthyroidism causes the heart to overstimulate, pumping blood too quickly, but not enough in each beat. When hypothyroidism is weak, all the muscles of the body, including the heart muscle, become weak, because the muscles depend on thyroid hormones to function normally.
11. Renal weakness: Renal failure leads to damage to the heart, because the kidneys are unable to get rid of excess fluid in the bloodstream, and thus the burden on the heart increases. Eventually, the heart can no longer meet the body’s need for blood, and heart failure develops.
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