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Can Acute Heart Failures Be Caused By Infections?
Question: My mom was taken to the ER on Wednesday March 28, 2018 couldn't walk and speech was garbled, It was a UTI. She already was in a hospital for Congestive Heart Failure from March 06,2018 to March 24, 2018. She recovered with excellent progress. It was her stay at a rehabilitation center is where she caught a UTI. I noticed when I came to visit her at the rehabilitation center she did not look well, I removed her from the rehab center and the next morning March 28, 2018 she was schelduled to see her doctor at 8:30am. I took her to the ER which is where i was told she had a UTI and her blood culture came back gram negative ecoli in the blood. We are currrently still in the ICU with intravenous antibiotics the infection was so severe. She is also on do but amine to keep her blood pressure up. She is on the antibiotic Rocephrin, and Lasix and fluids. Her white count has come from 26 down to 14 over the last couple of days. Currently her blood culture shows negative of any bacteria.
However, her blood pressuresugar want to drop low, when put back on dobutamine it returns to normal. As of Monday April 02, 2018 5:30pm her heart rate was good. At 6:00pm she started having AFIB where her hart rate stays between 100- 125. Her blood pressure readings 104/66 (71), 97/57 (67), 90/62 (69), 85/58 (65), 95/51 (62), 106/51 (64). High heart rate, Low Blood Pressure, and she has a hard time staying awake. She seems extremely fatigued, or exhausted. She wakes up in spurts and says she is OK no pain but she just can not seem to stay awake. She saysaid I want to stay awake but I feel fatigued. I am thinking to request another blood culture or urine culture, could the UTI infection be still around or is something being overlooked?
However, her blood pressuresugar want to drop low, when put back on dobutamine it returns to normal. As of Monday April 02, 2018 5:30pm her heart rate was good. At 6:00pm she started having AFIB where her hart rate stays between 100- 125. Her blood pressure readings 104/66 (71), 97/57 (67), 90/62 (69), 85/58 (65), 95/51 (62), 106/51 (64). High heart rate, Low Blood Pressure, and she has a hard time staying awake. She seems extremely fatigued, or exhausted. She wakes up in spurts and says she is OK no pain but she just can not seem to stay awake. She saysaid I want to stay awake but I feel fatigued. I am thinking to request another blood culture or urine culture, could the UTI infection be still around or is something being overlooked?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
I carefully reviewed your mom's medical history and would like to explain that she is suffering from acutely decompensated heart failure.
Infections are well-known triggering factors leading to exacerbation of acute heart failure in previously controlled chronic congestive heart failure.
Despite the fact that her UTI (though clinically severe with obvious sepsis, confirmed also by very high leukocytes count) seems properly controlled with negative resulting blood culture,needs to be further investigated with additional tests:
- inflammation tests (PCR & ESR),
- microbiological urine culture
If after the above mentioned tests result normal can be concluded with confidence that her UTI has been safely eradicated.
From the other side, the main concerning issue is heart failure decompensation due to the occurrence of acute infection.
In such case the pro-inflammatory body response, increased body metabolic requirements, elevated circulating toxins, pulmonary dysfunction, electrolytes imbalance, etc. all may lead to unfavorable cardiovascular conditions, increased cardiac filling pressures, congestion deterioration, cardiac arrhythmia exacerbation and deterioration and overall severe HF clinical symptomatology.
So, coming to this point, I would say that despite the fact her urine culture and inflammation test appear normal, the main challenge is heart failure control in this new clinical condition.
A proper fluids and electrolytes balance, coupled with maintaining of a sufficient cardiac output and decongestive therapy will lead to beneficial results with clinical improvement and faster rehabilitation.
She needs to look after her blood glucose levels during the subsequent days after discharge and what is more important to perform a cardiology followup visit within the next two weeks.
This strategy has been shown effective in reducing early rehospitalization and regarding therapy optimization.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
I would explain as follows:
Detailed Answer:
Hello,
I carefully reviewed your mom's medical history and would like to explain that she is suffering from acutely decompensated heart failure.
Infections are well-known triggering factors leading to exacerbation of acute heart failure in previously controlled chronic congestive heart failure.
Despite the fact that her UTI (though clinically severe with obvious sepsis, confirmed also by very high leukocytes count) seems properly controlled with negative resulting blood culture,needs to be further investigated with additional tests:
- inflammation tests (PCR & ESR),
- microbiological urine culture
If after the above mentioned tests result normal can be concluded with confidence that her UTI has been safely eradicated.
From the other side, the main concerning issue is heart failure decompensation due to the occurrence of acute infection.
In such case the pro-inflammatory body response, increased body metabolic requirements, elevated circulating toxins, pulmonary dysfunction, electrolytes imbalance, etc. all may lead to unfavorable cardiovascular conditions, increased cardiac filling pressures, congestion deterioration, cardiac arrhythmia exacerbation and deterioration and overall severe HF clinical symptomatology.
So, coming to this point, I would say that despite the fact her urine culture and inflammation test appear normal, the main challenge is heart failure control in this new clinical condition.
A proper fluids and electrolytes balance, coupled with maintaining of a sufficient cardiac output and decongestive therapy will lead to beneficial results with clinical improvement and faster rehabilitation.
She needs to look after her blood glucose levels during the subsequent days after discharge and what is more important to perform a cardiology followup visit within the next two weeks.
This strategy has been shown effective in reducing early rehospitalization and regarding therapy optimization.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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