The Current Climate of Cardiomyopathy

Cardiomyopathy better known as ‘heart failure’ caused by various factors can be very debilitating and detrimental to a person’s quality of life. Many patients complain of undue breathlessness and unable to carry out their normal daily activities of life because of their symptoms, and sometimes may become fatigued, depressed and may even feel a sense of hopelessness at times. In the course of my career as a cardiac specialist nurse, I have nursed many patients with various cardiac conditions including cardiomyopathy, and these patients are normally referred and treated under the care of the heart failure team who monitor and stabilise the patient’s symptoms, to prevent remodelling of the myocardium which impact on the left ventricular function.

Many factors such as myocardial infarction, pregnancy, sepsis, alcoholism, obesity, viral infections, endocarditis, SARs Cov 2 can directly impact on the left ventricular function because of myocardial damage either immediately or over a period of time, and this in turn can affect the left ventricular ejection fraction (LVEF). A severe depletion in ejection fraction means less volume of oxygenated blood being pumped round the body efficiently by the heart, and this can make the patient symptomatic with breathlessness and fluid retention. As well as treating patients on a regime of medications to relieve excessive burden on the left ventricle, patients who present with left bundle branch block and widened QRS of more than 120 milliseconds may also meet the criteria for cardiac resynchronisation therapy (CRT). This is done by positioning three leads into the heart (one for right atrium, right ventricle and left ventricle) to pace the heart in order to resynchronise the ventricles to improve systolic function and relieve symptoms.

During the pandemic of SARs Cov 2 (Covid 19), many patients who contracted the virus developed heart failure together with long Covid 19 symptoms. This may have resulted from having myocardial infarction and/or developing atrial fibrillation secondary to sepsis together with myocardial damage. Uncontrolled atrial fibrillation will also impact on left ventricular function therefore patients with underlying coronary artery disease are much at risk for further complications and heart failure after contracting the virus. Even in some cases of mild to moderate stenosis of coronary  artery disease went on to have myocardial infarction after contracting the virus. It appears that patients with underlying risk factors such as type 2 diabetes mellitus, hypertension, smoking, COPD and obesity, chronic kidney dysfunction, anaemia are more at risk of developing heart complications after being infected with Covid 19. However, patients with underlying heart failure who contract Covid 19 are at increased risk of even further burden to the left ventricular function which can be overwhelming and a very frightening experience altogether.

There is a great slogan ‘prevention is better than cure,’ but in a world of growing population and the preservation of an older population with the introduction of modern medicines and procedures, it is vital to recognise the signs and symptoms of angina and heart failure early, so that the necessary treatment can be initiated to preserve muscle mass and prevent further myocardial damage.

References:

Heart Failure – Symptoms – NHS (2020). Available at: https://www.nhs.uk/conditions/heart-failure/symptoms , (Accessed on 27th July 2021)

Heart Failure – Symptoms and Causes – Mayo Clinic (2021). Available at: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms, (Accessed on 27^th July 2021)

Five warning signs of heart failure – Harvard Health (2019). Available at: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms, (Accessed on 27^th July 2021)

Squire, I. B. (2005) Initiating Therapy in Heart Failure. UK, Magister Consulting Ltd.

Bader, F., Manla, Y., Attallah, B. and  Starling, R. C. (2021) Heart Failure and Covid 19. Available at: https://pubmed.ncbi.nlm.nih.gov/32720082, (Accessed on 27^th July 2021)