When the Heart Can’t Keep Up

By Andrew Ellsworth, M.D.

A woman had been feeling short of breath for several weeks. Physical activities which had previously been easy for her were becoming a chore. In fact, simply laying down resulted in difficulty breathing. She had gained some weight and her legs were swollen.

This woman was a patient of mine, and she was in heart failure. This doesn’t necessarily mean her heart was going to completely stop, but it was having trouble keeping up. For whatever reason, her heart struggled to pump, and fluid was building up in her body adding more strain. It was a vicious circle, and it was getting worse. 
After listening to her story, I completed a physical examination, and ordered a few tests. Then, I talked to my patient about heart failure. We agreed she would take medication to help her heart pump better and fluid pills to help decrease the swelling. 

Heart failure is often triggered by some type of damage affecting the heart’s ability to pump. Heart damage might result from a sudden heart attack blocking blood flow in an artery of the heart. Sometimes damage occurs slowly, blocking blood flow due to the gradual buildup of cholesterol known as coronary artery disease. Other causes of heart failure may include faulty heart valves, an irregular heart rhythm, high blood pressure, smoking, diabetes, or obesity. 

Myocarditis, or inflammation of the heart, can also lead to heart failure. Often temporary, myocarditis can be the result of a virus or other infections, drugs, chemicals, and other diseases.  

Sometimes the reason for heart failure may be a lung problem. The heart pumps blood through the lungs and back to the heart, then out through the body. So, if the blood is not flowing through the lungs efficiently, the heart can have trouble. Thus, a blood clot in the lungs, smoking, vaping, cancer, infection, or other lung problems can also lead to heart failure. 

I recently saw my patient again, and she feels great. She rarely experiences shortness of breath anymore. She faithfully takes the medications and keeps an eye on her weight and her diet, but other than that, she does not think much about it.
​
If you are experiencing increased shortness of breath with activity, swelling of the legs, an unusual increase in weight, increased fatigue, chest pain, or if you feel like your heart is beating too quickly or not in a regular manner, please see your doctor. Your heart works hard so you can keep up your activities. Please make sure you return the favor. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

Prairie Doc® Perspectives for week of October 24, 2021
By Jill Kruse, D.O.
 
When we think of Henry VIII most of us envision an oversized man with multiple wives, a bitter personality, and a propensity for beheading his enemies. A lesser-known fact is that he suffered with chronic leg sores the last twenty years of his life. Living in a time before antibiotics, anesthesia, and proper wound care, this king endured excruciating ulcers with no cure available. Would history have been different if his sores could have been treated with today’s advanced wound care?  

As a young man, Henry was athletic and active. Unfortunately, he had multiple sports injuries, and one which occurred in January 1536 seemed to initiate chronic wounds. He was thrown off his horse at a jousting tournament and his fully armored horse landed on top of him. Reports from the time state he was unconscious for two hours and had several leg bone fractures. Initially he appeared to heal, but he later developed ulcers in his legs, and historians note at that point his personality changed.

His doctors lanced and drained his ulcers, but they never fully healed. There is much modern speculation as to what caused his sores. Likely the injury was the source, but his love of wearing garters around his calves also likely increased his risk for developing varicose veins and blood clots in his legs. His activity level dropped due to his pain and his weight increased. He was at increased risk for type 2 diabetes, high blood pressure, and high cholesterol. All these things together made him susceptible to leg ulcers from blood vessels that did not work well making it difficult for his initial wounds to heal.

If I were transported back to Henry’s court with the limited medical knowledge of that time, there would be little I could do to help him. However, if we were to transport Henry to modern day, we would observe his veins and arteries with ultrasounds. We’d use CT scans to see if infection had gone into the bone. We could determine his ankle-brachial index indicating how well his blood is flowing. And Henry would be given anesthesia while we probed and debrided the wounds. We could treat the root of the infection with antibiotics. And devices such as vacuum assisted closure (wound VAC) and hyperbaric oxygen chambers could help close sores that were left untreated in his time. 

History may have looked very different if King Henry had not fallen from his horse launching a cascade of medical problems. Today, we can learn from his misfortune and take advantage of current wound care treatments which avoid unnecessary suffering, and possibly…change the course of our history.

Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                   

​Prairie Doc® Perspectives for week of October 17, 2021
By Debra Johnston, M.D.
 
In medicine, we routinely ask people about their family health history. Knowing that your mother had diabetes, or that your grandfather battled alcoholism, helps us be alert for health conditions to which you may be predisposed. Sometimes, though, what is revealed by those histories isn’t a medical problem, but a family tragedy.
 
Earlier in my career, my older patients commonly told me that their grandmother, or even their mother, died in childbirth. Today, it is all too easy to forget just how perilous it can be to be pregnant. In the early 1900s, nearly one mother died for every 100 live births. Even today, approximately 800 women around the world die from pregnancy related causes EVERY DAY, and a woman’s lifetime risk of dying as a result of pregnancy hovers around one in 200. In some countries, that risk is around one in 20. In others, it is less than one in 10,000. Infants, and their older siblings, face a grim future without those mothers. Many infants don’t survive to their first birthdays. Older siblings have an increased risk of death before age five. 
 
Although most maternal deaths occur in the developing world, where access to trained birth attendants or clean birthing conditions is limited, the United States ranks disturbingly high among developed nations. In fact, our rates were higher in 2017 than in 2000. A woman’s risk of death varies with her age, education, socioeconomic status, and most dramatically, race. Black women face a risk of pregnancy related death more than triple that of white women, and indigenous women face approximately twice the risk. Wealth, health, and education are not enough to close these gaps. Serena Williams and Beyonce have both spoken publicly about their own life-threatening pregnancy complications. More research is needed to understand and address these disparities, and maternal mortality rates in general.
 
Sometimes death is caused directly by a pregnancy: bleeding, eclampsia, embolisms of amniotic fluid into the mother’s lungs, infections. Sometimes death results from the added stress of pregnancy combined with another disease. Weakened hearts, for example, may not meet the additional demands of pregnancy and delivery. Historically, influenza has killed disproportionate numbers of pregnant women. My own great grandmother was one of them. Similarly, a pregnant woman who contracts Covid is 20 times more likely to die than one who doesn’t. Women who struggle with depression or substance abuse may fall victim to overdoses or suicides triggered by the stress of pregnancy and caring for a newborn. Domestic violence may start or escalate during pregnancy, and too many women die at the hands of current or former partners.
 
The good news is that nearly two thirds of maternal deaths are thought to be preventable. We simply need the societal will to make changes and save lives.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

Prairie Doc® Perspectives for week of October 10, 2021
By Kelly Evans-Hullinger
 
In the last couple years, I have developed a renewed awe and appreciation of our scientists around the world who work for entire careers to advance science and medicine in their laboratories and beyond. One such scientist is Dr. Barry Marshall. 

Marshall is an Australian physician scientist, who in the early 1980’s along with his cohort Dr. Robin Warren, initiated a paradigm shift in the world’s understanding of gastrointestinal disease when they discovered the bacterium Helicobacter pylori. Prior to that, peptic ulcer disease was thought to be due entirely to lifestyle factors and stress. Marshall and Warren were ultimately able to show that H. pylori played a major role in maybe 80 percent of ulcers worldwide at that time.
 
H. pylori is an unusual bacterium in that it can grow and thrive in a highly acidic environment like the stomach, and for that reason it was difficult to grow in culture. It was found to be widespread around the world, partly due to poor water sanitation systems. The bacteria can invade the surface of the stomach and duodenum, causing inflammation of the stomach or gastritis, ulcers, and rarely, stomach cancer. We now know that if H. pylori is a causative factor in a patient’s stomach ulcers, eradication of the bacteria is an essential part of curing the patient’s disease. 

Now here is the greatest piece of this science story. At the time Marshall and Warren made their discovery, the worldwide scientific community was skeptical that H. pylori was an important factor in peptic ulcer disease. H. pylori did not grow in mouse or rat stomachs, so there was not a good way to study it in a traditional lab. Famously, in 1984 Marshall underwent biopsy of his own stomach, proving he did not carry the bacteria nor have any stomach disease. Then, he drank a beaker of H. pylori culture broth. What followed was an acute gastric illness, and after 2 weeks he had another biopsy showing proven H. pylori infection and gastritis. He then cured himself with an antibiotic and bismuth.

After Marshall’s case study was published, much further research ensued. Today, we can detect H. pylori in our patients with several noninvasive testing strategies, and if detected treat them with a combination of antibiotics and acid reducing medication. Surgery to remove a portion of ulcerated stomach, commonplace prior to this discovery, is now incredibly rare in the developed world. In 2005 Marshall and Warren were awarded the Nobel Prize in Physiology for their detective work.

I wonder, had Dr. Marshall not risked his own health for his experiment, would our understanding have shifted so quickly? Maybe, maybe not, but the story sure wouldn’t be as captivating.
​
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.