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[1] Luo Guangrong. Family Medicine,2018,(12):16-17.
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Heart failure, which is not a separate disease, but a severe stage of different heart disease, has a very high incidence in the elderly group, and the five-year survival rate is similar to that of malignant tumors. Many patients have many taboos in diet after being diagnosed with heart failure, and even if they pay attention to everything, it is still possible to cause irreparable disasters because of a small mistake.
In 2015, 69-year-old Chen Yun in Sichuan enjoyed more than ten years of retirement, but finally did not escape the disease. Chen Yun used to be a heavy food lover, but since she was diagnosed with high blood pressure five years ago, she has been forced to make changes in her eating habits.
After entering the winter, Chen Yun obviously felt that something was wrong, every morning after buying vegetables and climbing the stairs to get home, her chest seemed to be pressed by a boulder, only by sitting up straight could she slightly relieve this feeling of suffocation, but she still couldn't stop making a stubby wheezing sound. Chen Yun's wife also noticed it, and he suspected that Chen Yun had a precursor to a heart attack, and suggested that she go to the hospital for examination as soon as possible.
Chen Yun just agreed in her face, she didn't take it seriously in her heart, she just thought that she was old, and climbing the stairs might be a bit of a burden for her. Clinically speaking, if there is no bone disease, it is normal to have obvious asthma after climbing the 4~5th floor, but Chen Yun's family lives on the 2nd floor, and if such exercise does not stop wheezing, then it means that Chen Yun has developed heart or lung dysfunction.
This situation lasted for nearly a month, and Chen Yun's wheezing became more and more serious, and she even woke up in the middle of the night, and she needed to sit up and breathe to relieve it. On December 16th, Chen Yun habitually stepped into her slippers after getting up in the morning, but she felt that today's shoes were extremely tight, and it took extra effort to barely stuff them in.
Chen Yun's drowsiness disappeared in an instant, she sat back on the bed, and found that her calves and feet were pressed into a pit, and the edema was very serious, and she suddenly had a bad premonition in her heart, she was only afraid that she was suffering from kidney disease. She hurriedly woke up her husband, who was still asleep, and the two rushed to the hospital.
The doctor immediately examined her, but the result was a little surprising to Chen Yun, the good news was that there was no problem with her kidneys, and the bad news was that she suffered from heart failure. Imaging showed that Chen Yun's heart shadow was enlarged and left ventricular systolic function was reduced. a small amount of tricuspid regurgitation; mitral regurgitation, moderate regurgitation; mild pulmonary hypertension; A small amount of pericardial effusion. The laboratory results were troponin 0.022 ng/mL; NT-proBNP natriuretic peptide: 4980ng/L, all signs indicate that Chen Yun has severe heart failure.
Although both diabetic nephropathy and heart failure can cause edema, there are some differences between the two in other symptoms, and the main manifestation of diabetic nephropathy is proteinuria, which is the appearance of foam in the urine that is difficult to disappear. The abnormality of heart failure patients is mainly manifested in breathing, and may be like Chen Yun, chest tightness occurs at night, especially in the second half of the night. It is manifested as being awakened during sleep, requiring a pillow or sitting up to relieve it, and the chest tightness is relatively short, which is often mistaken for an angina attack.
The doctor prescribed heart protection and diuretic drugs for Chen Yun to relieve the load on the heart and delay the progression of the disease, and instructed Chen Yun to properly supplement seaweed after returning home. Because Chen Yun may excrete too much potassium ions in the body when using diuretics, and the potassium ions contained in seaweed are conducive to the body's maintenance of internal environment homeostasis and maintain the stable work of the myocardium, otherwise too low potassium ions may cause ventricular fibrillation, which poses a serious threat to life.
Chen Yun was indeed a little nervous when she returned home, after all, it was a heart disease, but she couldn't accept the taste of seaweed, so she only chose to take medicine and did not follow the doctor's dietary advice. Chen Yun insisted on taking the medicine for only a month before she had an accident, she suddenly felt a sharp tightness and pain in her chest in the park, and even had a terrible sense of impending death, and her friend quickly dialed 120 when she saw this.
As soon as she entered the emergency department, Chen Yun instantly lost consciousness and had convulsions, and the doctor found that her electrocardiogram showed a completely irregular waveform, and immediately judged that she had ventricular fibrillation, and immediately began defibrillation and rescue. Fortunately, Chen Yun was pulled back when her life was hanging by a thread, and the doctor found that her blood potassium was only 2.8mmol/L, which was seriously lower than normal, which was also the root cause of her ventricular fibrillation.
After this incident, Chen Yun was completely honest, even if he was no longer willing, he obediently drank seaweed soup every day, and her husband couldn't help laughing when he looked at his distorted face every time he drank soup like drinking medicine. A year has passed like this, Chen Yun's condition has not recurred, she and her husband have come to her daughter's city, and everything seems to be back on track.
On November 3, Chen Yun felt weak all over her body as soon as she got up, especially her lower limbs, and it was difficult to even walk to the toilet. Chen Yun finally realized that something was wrong, and with the last bit of strength, she dialed 120 and her daughter's phone.
Time seems to have returned to a year ago, I don't know whether it was lucky or unlucky, Chen Yun fell into a coma as soon as she was connected to ECG monitoring. This time the situation was even more urgent, the monitor sent out a sharp alarm, and the heart rate curve on the screen became undulating, this time Chen Yun had cardiac arrest!
After the rescue of medical staff, Chen Yun's vital signs gradually returned to normal, and the person also woke up slowly. Chen Yun's husband hurriedly arrived, and the doctor quickly asked him about Chen Yun's medical history, and said that the reason for Chen Yun's cardiac arrest this time was because of high blood potassium.
The husband was shocked when he heard this, and said that it was impossible, he said that Chen Yun suffered from heart failure and had been taking diuretics, and had ventricular fibrillation due to low blood potassium before, and then took seaweed soup every day to supplement potassium. Speaking of this, he paused for a moment and asked tentatively, "Is it the problem with the nori soup?" ”
The doctor shook his head and said that if he had low blood potassium due to medication, then there was no problem with taking seaweed soup. But the doctor is usually related to diet, in order to find out the cause, the doctor asked Chen Yun's eating habits more deeply, and finally found the real cause.
The doctor said: "If you just take the seaweed soup normally, then she can't have this situation at all, the problem is another food she eats after drinking the soup!" The combination of the two caused your wife's heart to stop, and she should never touch such food again when she comes home this time! ”
Chen Yun hates all kinds of seafood, every time she drinks seaweed soup, she is dizzy, after drinking it in one go, she will peel an orange and put it in her mouth to suppress the taste, which has been the case for a year, and usually eats a few from time to time. But what she didn't know was that the potassium content in oranges was relatively high, and Chen Yun, as an elderly man who was nearly 70 years old, had long been less metabolic than back then, and even if diuretics were used, it was not enough to offset the potassium ions accumulated in the body over the years, which caused cardiac arrest caused by high blood potassium.
Many middle-aged and elderly people are taking diuretics, but they are not aware that there are corresponding precautions when using these drugs.
1. It should not be taken at night
When people sleep at night, the blood flow is slow, and taking diuretics will increase the blood viscosity, which is easy to induce cardiovascular and cerebrovascular diseases. In addition, diuretics can increase urination at night, affect sleep quality, and intermittently increase cardiovascular burden.
2. Regularly test electrolytes
Because diuretics have a certain effect on blood potassium, blood lipids, blood glucose, blood uric acid and sexual function, patients who take diuretics for a long time must go to the hospital regularly to check the above indicators. Serum creatinine, serum potassium, serum calcium, uric acid and two-hour postprandial blood glucose must be measured within the first six weeks, and long-term use should be repeated at least twice a year.
3. Start with a small dose
The elderly are more sensitive to diuretics, so it is important to control the dose when taking diuretics, and it is advisable to take small doses, as high doses will increase the risk of orthostatic hypotension and water and electrolyte imbalances, and must be prohibited. Orthostatic hypotension is also a condition that people who use diuretics need to pay attention to and prevent, when standing suddenly from a lying or sitting position, due to volume depletion, transient cerebral ischemia is easy to cause dizziness, unsteady standing, and even falling.
In addition to medication, self-management is also an essential part of treatment. Older patients with heart failure should reduce or avoid risk factors that damage the heart, such as quitting smoking, quitting alcohol, and losing weight in obese patients. The diet is based on small meals and frequent meals, and the dietary principle is light and easy to digest.
Patients with heart failure are prone to gastrointestinal blood stasis, resulting in malabsorption and nutritional imbalance, patients can supplement eggs, lean meat, fish, and eat more fresh fruits, vegetables and crude fiber foods to keep the stool smooth. Avoid eating raw, cold, hard, greasy, irritating and gas-producing foods. Stick to a low-salt diet with no more than 5 grams of salt per day.
Because heart failure is an irreversible disease, the elderly should be treated correctly and positively in the early stage of the disease, so as to prolong the life as much as possible while ensuring the quality of life.
(Note: "A 59-year-old woman was diagnosed with chronic heart failure, a bowl of seaweed soup every day, and a follow-up visit a year later: What are you eating?") The names of the people are pseudonyms, and some of the pictures are network pictures; Reprinting and plagiarism are prohibited in the article)