Your Heart and Heart Failure: Dr. Peter Rice



 

Heart Failure and The Cries of the Suffering Organs

 

We often struggle to understand disease symptoms. Something goes awry in the body and patients find themselves suffering.  I teach History of Pharmacy in our PharmD program, and often include historical figures who are not pharmacists.  One of my favorites is the Italian pathologist Giovanni Battista Morgagni, an enlightenment physician and scientist who observed closely and explained disease symptoms as “the cries of the suffering organs.” This is a wonderful word picture for understanding disease.

Recently, my mom developed heart failure. Patients have heart failure when their heart is unable to meet the blood and oxygen demands of the body.

This can occur for several reasons:

  • prolonged high blood pressure can change the muscle of the heart so that it becomes less efficient;
  • a heart attack (myocardial infarction) can damage a portion of the heart so that it cannot function well enough to meet the demands of the body;
  • sometimes viral or bacterial infections damage the heart.
  • In my mom’s case, the aortic valve opening narrowed from a normal area about the size of a quarter coin to an area just slightly larger than a pencil eraser.  So in heart failure as a result of aortic valve stenosis (narrowing), the heart is limited by the small opening it must pump through.

Morgagni suggests that disease symptoms represent “the cries of the suffering organs”.  Those with children will recognize that those crying are not necessarily the cause of the problem, and so it is in heart failure. As the heart falters in its duty to supply sufficient blood an oxygen to the body, various organs of the body “cry out”.

  • The gastrointestinal tract may cry out after a heavy meal as the blood and energy needed to digest food in inadequate.
  • As the kidneys are shortchanged in their blood flow, they fail to remove salts and water from the body leading to fluid retention and ankle swelling.
  • The lungs experience pulmonary edema, making it hard to breathe from that extra fluid accumulating in the lungs; this can be particularly troublesome when lying flat as fluid repositions from the ankles to the lungs.
  • Patients may feel dizzy and out of breath as the brain cries out for lack of blood and oxygen. 
  • The heart itself may cry out with angina – chest pain – representing a shortage of oxygen as well as with heart muscle changes in response to working too hard. 
  • Other muscles not receiving enough oxygen cry out with fatigue. Patients with heart failure just want to sit so their hearts do not have to work any harder or fall any further behind in meeting the demands of the body.
    Heart Failure

    Heart Failure


Therapy and medications can sometimes seem misdirected when directed to “the suffering organs”, but understanding disease in this context allows us to appreciate how the organs of the body work together.

Patients with heart attacks will often receive “stents” to keep coronary blood vessels open to provide the heart with blood and minimize damage which follows a heart attack. Blood pressure medications help lower blood pressure and ease the workload of the heart; it’s harder for the heart to pump against a higher blood pressure pushing back on it. Beta-blockers and ACE inhibitors or ARBs (angiotensin receptor blockers) help keep the heart muscle from changing in response to its hard work; think of this as the heart muscle maintaining a good attitude.

Heart failure patients respond well to diuretics, which remove excess salts and water. Even though diuretics influence the kidneys, they help patients feel better by keeping fluid from increasing blood pressure and accumulating in the lungs. Diuretics help heart failure patients feel better.

Sometimes patients with heart failure feel better with oxygen, which can provide a little boost in blood oxygenation or make up for some lost lung function in the presence of pulmonary edema.

It is good for patients to understand their disease states and medications. Take some time to speak with your prescriber and pharmacist. This can help you take your medicines appropriately and recognize when your medicines are working – or not working.    Your pharmacist can help you understand how your medicines are helping you and can help optimize your medicines if they are not working well.  Take good care of yourself.

Resources

National Heart, Lung and Blood Institute Health Topics

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0063056/

American Heart Association: What is Heart Failure?

http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp#.WfaM2ltSzIU

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.

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