How is congestive heart failure managed in patients?

Question

Hi doctor,

My father is 67 years old. His medical history includes pneumonia several years ago, leg cramps that occur about once every two weeks (which vitamin B helps alleviate), and minor daily coughing of uncertain cause. He has never smoked and does not consume alcohol. Three and a half weeks ago, he went to the emergency room due to severe chest pain. His EKG (electrocardiogram) showed no significant concerns, the chest X-ray was clear, and the CT (computed tomography) scan of the chest was normal, along with all laboratory tests. He was given Morphine and Nitroglycerin, which resolved his chest pain.

He was sent home the same night with a prescription for Nitroglycerin and an appointment to see a cardiologist. He saw the cardiologist one and a half weeks ago. The cardiologist indicated that his EKG revealed atrial fibrillation (AFib) and expressed concern regarding the CT scan of the chest due to the poor timing of filming in relation to the contrast injection. He prescribed Diltiazem, Apixaban, and Nitroglycerin as needed (PRN). Additionally, he placed my father on a cardiac monitor at home and scheduled a follow-up appointment in two weeks.

After the cardiologist appointment, my father developed a severe dry, hacking cough that worsens each day, making it difficult for him to sleep. He can only manage to sleep in a chair intermittently. Strangely, when he lies down, the cough subsides but resumes immediately upon sitting up or walking around.

I finally convinced him to call the cardiologist about his persistent and severe cough since starting the new medications. We met with the cardiologist, who reviewed the heart monitor readings. As the cough persisted, a chest X-ray was ordered, which showed no signs of pneumonia, but fluid was found around his heart. Consequently, the cardiologist added Digoxin, Furosemide, and Potassium to his regimen, alongside Diltiazem, Apixaban, and Nitroglycerin PRN. He was instructed to wear the monitor for a longer period and given a follow-up appointment in three weeks.

Now, on the third day of his new medication, there has been no improvement in his cough or ability to sleep; in fact, his symptoms have worsened. He has never had heart issues before. I need your help with my father's cardiac illness and diagnosis.

Please assist us.

Answer 1

Hi,

Welcome to icliniq.com.

It is encouraging to hear that you are concerned and actively involved in addressing your father's health issues. From your description, it appears that he may have congestive heart failure. This condition can lead to fluid accumulation around the heart, which may be causing both the atrial fibrillation and the cough. It is common for symptoms to worsen when lying down, as the position of the heart changes in that posture.

I recommend consulting your cardiologist to reassess the dosage of Furosemide. Furosemide is the primary medication that helps remove excess fluid from the body, although it can sometimes cause a mild cough. This side effect may have been the reason the cardiologist initially altered his medications.

In my opinion, the current treatment seems appropriate; however, he may require a higher dose of Furosemide or possibly an admission for intravenous administration of Furosemide.

I hope this helps.

Thank you.