Monday, March 17, 2014

A Less Common Heart Condition that Causes Disability

I need a medical problem for an older man. Serious enough that it might be life-threatening if he doesn't take time off work and look after himself, but not immediately fatal. I want it to start with an attack of some type, followed by a week in the hospital and several months of decreased activity. A cardiac issue seems logical, but is there anything less commonly encountered?
Any ideas?

One possibility is an infected heart valve, called endocarditis. The infection can cause a valve to begin leaking, causing an "attack." Sweating, weight loss, hemorrhages under the nails, palpitations (heart skipping beats) can be additional symptoms. Patients may present in sudden onset heart failure (short of breath, swollen legs, can't breathe when lying down).  Older patients may have valvular heart disease on the basis of degeneration (wear and tear). Old unaddressed/unrecognized rheumatic disease (from rheumatic fever) is a possibility as well.
Once the infection was recognized, your patient would need several weeks of outpatient IV antibiotics, and consideration of a heart valve replacement. The infection alone will be cause for seriously decreased activity. If you transition into a valve replacement surgery after the antibiotics, he's looking at several more months of decreased activity.

Myocardial infarction (heart attack with damage to the heart muscle) often presents with a sudden attack of chest pain. In the USA, a blocked artery may be treated with clot buster drugs (like streptokinase) or by opening the artery in the cardiac cath lab (special X-ray suite) by using a wire and a balloon. Other standard treatment includes aspirin (or other platelet inhibitor drug), beta blocker drug (Example: metoprolol), treatment of high cholesterol (ideally with a statin), smoking cessation, weight control, and (if present) diabetes management. The patient would be off work for six weeks, and need a treadmill test to determine residual cardiac disease before clearing to return to work. Outpatient cardiac rehab three days a week for six months is recommended. If the guy had a physical job, he might have to cut back at work to a more sedentary position.

If the heart attack did enough damage to seriously affect the pump function of his heart, he could end up with congestive heart failure. That could also be grounds for decreased activity on a more long term basis.

Hope this helps!

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
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