Shortness of breath at night and health status in congestive heart failure: Effects of environmental conditions and health-related and dietary factors

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH). Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care. Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

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Abstract 204: Trends in Emergency Department Visits for Chest Pain Suggestive of Coronary Artery Disease and Shortness of Breath Suggestive of Congestive Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.204 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Aarti Patel ◽

Zhijie Ding ◽

Christine Eichelberger ◽

Christopher Pericone ◽

Jennifer Lin ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Emergency Department ◽

Congestive Heart Failure ◽

Secondary Diagnosis ◽

Shortness Of Breath ◽

Principal Diagnosis ◽

Ed Visits ◽

Artery Disease ◽

Over Time

Background: Payment reforms and other policy initiatives are accelerating the shift of risk from payers to providers. As a result, population health management is playing an increasing role in decision making by providers, guided by the Medicare Triple Aim. Reducing avoidable hospitalizations is an important tool for achieving this aim, by increasing quality of care and containing hospital costs. Previous studies have examined the trends over time of emergency department (ED) visits for major diseases. However, there is very little data assessing ED visits related to the symptoms of these major diseases. This study examined the trends of ED visits for chest pain (CP), a symptom suggestive of coronary artery disease (CAD), and of shortness of breath (SOB), a symptom suggestive of congestive heart failure (CHF). Methods: We conducted a population-based cross-sectional study to estimate ED visits for CP suggestive of CAD and for SOB suggestive of CHF in the US for the years 2006 through 2013 at encounter level, using the Nationwide Emergency Department Sample (NEDS) database. We defined CP suggestive of CAD as a principal diagnosis of CP for the ED visit (ICD-9-CM code: 786.5), with a CAD code (410-414) as a secondary diagnosis but no diagnosis for other serious conditions that may trigger CP (e.g., aortic dissection). We defined SOB suggestive of CHF as a principal diagnosis of SOB (ICD-9-CM code: 786.05) for the ED visit with a CHF code (428.0-428.4) as a secondary diagnosis but no diagnosis for other conditions that may trigger SOB (e.g., pneumothorax). Outcome measures included annual number of ED visits and subsequent admissions, weighted for national estimates (2006-2013). We performed a trend analysis in rates over time, which accounted for US census population, for ED visits and subsequent admissions, using a generalized linear regression model with a Poisson distribution and a Wald test. Results: The number of ED visits for CP suggestive of CAD per 100,000 population increased 24.3% from 197 in 2006 to 245 in 2013 (p<0.01), while subsequent admissions for CP suggestive of CAD decreased by 36.1% from 90 in 2006 to 58 in 2013 (p<0.01). However, we found a consistently small number of ED visits for SOB suggestive of CHF over time, from 4 ED visits in 2006 to 5 ED visits in 2013 (p>0.1). Similarly, subsequent admissions for SOB suggestive of CHF were relatively low and stable, from 0.61 admissions per 100,000 in 2006 to 0.72 admissions in 2013 (p>0.1). Conclusions: Our results showed an increasing trend for ED visits and a decreasing trend for subsequent admissions over time for CP suggestive of CAD. However, there appeared no change for ED visits and subsequent admissions over time for SOB suggestive of CHF. Future research is warranted to examine possible reasons for the different ED visit rates for symptoms associated with major diseases such as CAD and CHF.

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