What strategies can help manage congestive heart failure?

Question

Hi doctor,

I am 70 years old and have been experiencing intermittent chest pain. For the past three months, I have been unable to walk fast or climb stairs, which I was previously able to do without any issues. I suffer from shortness of breath accompanied by palpitations, and when the chest pain persists, the breathing difficulty becomes severe. Last month, I underwent an ECG and an echocardiogram, both of which showed normal results. However, my CBC test revealed an elevated WBC count (21,800). I was also asked to get a chest X-ray (PA view), and the result was normal.

I have low blood pressure (80/60 mmHg), which has caused numbness in my hands and legs. Last month, during a severe episode of chest pain and dizziness, I was unable to respond properly due to a dry mouth and tongue. I was also advised to undergo a brain MRI and an EEG, and both tests came back normal, except the MRI indicated I have sinusitis. My general physician prescribed Propranolol 10 mg for palpitations, Rabeprazole 20 mg, a probiotic supplement, Montelukast, and Cefixime 200 mg.

Recently, the chest pain has returned and has lasted for three days. The pain feels stabbing as if a heavy rock is pressing on my chest. Could you please advise me on what further steps I should take? Should I undergo additional heart checkups? I was advised to do Holter monitoring, but it has not been done yet. I look forward to your response.

Many thanks in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I have noted all your details. Your symptoms are most likely due to congestive heart failure (CHF). Cardiac failure does not necessarily indicate a defect in the heart itself but rather refers to a situation where the heart pumps less efficiently than normal. As a result, blood flows more slowly to the heart and throughout the body, increasing pressure inside the heart. In an attempt to hold more blood, the heart stretches its chambers. Although this effort helps to keep the blood moving, it gradually weakens the heart.

In response to this strain, the kidneys retain more salt and fluid in the body. These fluids may accumulate in different areas, particularly in the legs, feet, and ankles, leading to congestion in the body. This condition is medically referred to as congestive heart failure.

The most common cause of CHF at the age of 70 is coronary artery disease. I would recommend some baseline cardiology tests to rule out any underlying coronary artery disease, in addition to the 2D echocardiogram. A stress test should also be conducted, as any ischemia (reduced blood flow) to the cardiac muscles will be reflected in this test. Together, the 2D echo and stress test have a sensitivity rate of more than 85 percent in detecting coronary artery disease.

Other recommended tests include:

Liver function test – to rule out liver issues as a cause of your symptoms, since liver failure can also lead to fluid overload.
Renal function test – to check for any underlying kidney problems.
Fasting lipid profile and thyroid profile – hypothyroidism can lead to pedal edema (swelling in the legs and ankles).
Fasting and postprandial blood sugar tests.

As for your current medications, based on the information provided, they do not appear to be contributing to your symptoms.

I hope this helps.

Thank you.