Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name's Dr. Warrick Bishop and I'd like to welcome you to my podcast channel. Thank you for joining me. Today I'd like to tell you about a special patient of mine called Mary. Well, about five to ten years ago, I had this terrific old girl whose name was Mary. She was in her mid-80s. She was notable for her bright blue eyes and her equally bright blue dressing gown. She was also notable for her three daughters who cared enormously for Mary and had great expectation from me as her cardiologist. Mary's problem was one of cardiac failure and what that meant was that for Reasons to do with her heart, she would retain fluid within her body and that fluid would end up in her lungs and in her legs, really making her quite puffy when it came to breathing and swollen and puffy with regard to her legs. Mary had a terrible time and in fact over the course of a couple of years, She was in and out of hospital almost every four to six weeks. She would present very short of breath, swollen, gasping. She would be admitted to hospital. We would dry her out using medications to make her pass fluid. These are called diuretics. She would be in hospital for maybe three to five days and then we would send her home. Each time I would adjust her medications to make sure that I thought they were just right prior to discharge and then look forward to seeing her in the clinic to ensure that she was travelling well. Unfortunately, she still, over that period of time, was able to end up in hospital, in extremis, very unwell. There was one very important day when I remember as I was tending to Mary on the ward, I was putting in a drip, preparing to give her the special medication she needed to take the fluid from her lungs and from her legs. I turned to her and said, Mary, when did this episode start? And she said, oh, doctor, it probably started five or six days ago. And I said, well, did it gradually get worse and worse? And she said, yes, it did. And I said, well, why didn't you come and see me? And she said, because I was due to see you in two days' time and I thought I could wait. Well, that conversation, that moment was defining for me. I realised at that time that this patient, that Mary had a good understanding. of realising she was deteriorating, and she potentially could be part of the solution to her recurrent admissions. What she was doing was dutifully taking exactly what I asked her to take, which is what you would want your patient to do. But what was completely and utterly apparent was that she needed a slightly higher dose of the fluid tablet to drain the fluid away as soon as there was the beginning of swelling in the legs, as soon as there was the beginning of shortness of breath. So this led me to a long conversation with Mary and with her closely and eagerly involved daughters. I constructed a response rate or an adjustment of her dose based on her symptoms and signs. I simply put in place the regular discharge medication which included a fluid tablet but gave Mary... and her daughter's clear instructions that should there be any retention of fluid, that that fluid tablet be doubled immediately. And if the fluid didn't come away, if the fluid continued to build up, they needed to increase the fluid tablet again. Once the ankles and the breathing were back to normal, they could return to the usual dose of fluid tablet, which was prescribed and provided at the time of discharge. This simple dose adjustment and increase of her fluid diuretic therapy, when she had the first inkling of symptoms, worked incredibly well for Mary. Four weeks later, I saw her in my rooms. No problem. Eight weeks later, I saw her again in my rooms. No problem. Mary and the daughters had completely grasped the idea that from time to time, fluid levels in the body fluctuate and that they had a mechanism for stopping it progressing and spiralling out of control. That simple intervention kept Mary out of hospital for over 18 months to follow. This started me on a completely different journey with cardiac failure. It made me realise how important it is to engage the patient and look at that individual from a day-to-day basis, is the person who is best placed to understand their particular needs. I realised that cardiac failure, if we could care for it at home, was better than caring for it in the clinic and definitely better than trying to care for it in the hospital. Now, of course, those dose adjustments at home don't always work. But for Mary and for so many of my patients subsequently, it's been a great starting point. Well, what is cardiac failure? What is it all about? It affects about 1 in 10 people at 75 years of age or older. And in the Western world, in major Western world economies, it will account for about... 10% of the total healthcare budget. It is rapidly becoming a pandemic and it is rapidly usurping coronary artery disease as the major heart-related condition. My hope over following podcasts is to talk about what heart failure is. How do we understand it? What do we do to diagnose it? And if we do diagnose it, what can we do to treat it? I look forward to sharing with you as we progress. I would like to thank you for joining me today. I hope you've enjoyed the case that I've described. Many thanks again for being part of this podcast channel. And of course, as always, I wish you the very best. Thank you and goodbye. If you love this podcast, feel free to leave us a review.
