Detection of problems - Medical Pathway

If all goes well, a patient with heart failure is an outpatient and not in the hospital. In this case the patient only visits the cardiologist once or a few times a year for a re-evaluation. A lot can go wrong in between. Due to certain triggering factors the hemodynamic balance may be disturbed and acute heart failure may occur. In addition, chronic heart failure can progress and evolve into advanced heart failure or terminal heart failure. Moreover, patients with heart failure usually have multiple comorbidities.

These additional problems often lead to a deterioration of the condition with an increase in symptoms, a poorer quality of life, progressive heart failure with sometimes hospital admissions or death of the patient. Timely detection and correct approach to these problems are therefore very important to preserve the patient's quality of life and prognosis as optimal as possible.

What problems can occur in patients with heart failure?

*Infections:

Infections cause fever and increased cardiac output, which puts an additional burden on the heart. In patients with heart failure, this can lead to cardiac decompensation and possibly hospitalization. Sometimes dehydration can also occur due to vomiting or diarrhea. In these cases, patients must be closely monitored to detect alarm symptoms in a timely manner and address them correctly.
In case of persistent subfebrility or fever without focus, endocarditis should be suspected. This is often accompanied by persistent malaise, anorexia, weight loss, etc. Sometimes a new heart murmur can be heard on auscultation. Patients after valve surgery, drug users, congenital heart disease and immunocompromised patients are particularly at risk. To make the diagnosis correctly, multiple hemocultures must be taken before antibiotics are started empirically. It is best to consult with the treating cardiologist.

** Weight changes : increasing excess weight or losing weight.

Weight gain can be the result of fluid retention, but can also be the result of increasing obesity due to dietary mistakes or reduced physical activity. Weight often increases slowly over several weeks, without increase in dyspnea and without clinical signs of fluid retention. Diuretics should therefore not be increased based solely on weight if there is no increase in dyspnea or fluid retention. If in doubt, the patient is best referred for re-evaluation with echocardiography.
In case of unexplained weight loss, a gastrointestinal examination and a screening for malignancy should always be performed. Hyperthyroidism must also be ruled out. If these examinations are reassuring, the patient should be referred to the treating cardiologist, as unexplained weight loss may be a sign of cardiac cachexia, a symptom of progression to advanced heart failure.

How can these problems be detected in time?

Good monitoring of symptoms, clinical signs, parameters (weight, blood pressure, heart rate), medication intake, diet, blood samples , etc.

Daily monitoring must be done by the patient and/or those around him. If necessary, home nurses and care assistants can play an important role. Other healthcare providers can also play an important role in this. Telemonitoring of parameters and/or devices helps to improve this follow-up.

In case of problems or questions, an easy consultation should be possible with the GP, the heart failure nurse and/or the treating cardiologist.

In addition, there must be regular clinical re-evaluations during consultations with the treating physicians.

Alarm symptoms in the home situation

Certain symptoms may indicate a new problem and may be a harbinger of a deterioration in the condition of the heart and the overall clinical condition of the patient. Without timely and correct treatment, this can lead to hospitalization or even death of the patient.

It is important that the patient and his environment, but also every healthcare provider involved, pay attention to the occurrence or not of these symptoms.

In case of alarm symptoms, the GP and/or the heart failure nurse / cardiologist must be contacted quickly!

Alarm symptoms are:

Unexplained weight gain : increase of 2-3 kg or more in a few days despite a normal diet.
Increasing "dyspnea d'effort" and decrease in exercise capacity.
Dyspnea at rest and/or when lying down (orthopnea) . Having to sit upright at night due to shortness of breath when lying down. Urgent inspection is then required.
Increasingly annoying cough , which becomes worse when lying down.
Increasing edema of the lower legs or ascites.
Unexplained weight loss (below the target weight) with possible signs of dehydration (thirst, hypotension, fatigue, dark urine with reduced diuresis, etc.).
Increased or decreased blood pressure.
Brief and abrupt loss of consciousness or dizziness.
Palpitations (palpitations) and/or a sudden change in heart rate.
ICD shock.
Pressing retrosternal pain (angor) .
Vomiting, anorexia, drowsiness.

Recognizing and assessing symptoms or complaints of heart failure is crucial to monitor the condition of a patient with heart failure and to know when additional consultation or follow-up is necessary. This easy-to-understand symptom chart can help. If desired, this can be downloaded and/or printed for the patient to use.

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