West Dorset ICD Support Group

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Minutes of Meetings

www.westdorseticd.org.uk

Affiliated to the British Heart Foundation


The fiftieth meeting of the West Dorset ICD Support Group for ICD patients and carers was held at The Dorford Centre, Dorchester on Thursday, 14th October 2021.

Attendance: 20 members, comprising Committee members, patients, carers and an Arrhythmia Specialist Nurse.

Apologies were received from three members.


MEETING NOTES

Acting Group Chair Tony Down welcomed members old and new to the first meeting of the group for some time, and introduced speaker Rebecca (Becky) Wetherall, Heart Failure Nurse from Dorset County Hospital. Becky said she was one of two hospital based Heart Failure nurses at the hospital, and the team comprised a further three community based Heart Failure nurses.

Heart failure means that the heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff. Heart failure does not mean your heart has stopped working. It just needs some support to help it work better. It can occur at any age, but is most common in older people. It cannot usually be cured, but the symptoms can often be controlled.

There are a variety of reasons or causes for Heart Failure occurring. These include (but are not limited to) one or more of the following:
• coronary heart disease - where the arteries that supply blood to the heart become clogged up with fatty substances (atherosclerosis), which may cause angina or a heart attack
• drinking too much alcohol, or using recreational drugs
• the use of some prescription drugs
• high blood pressure - this can put extra strain on the heart, which over time can lead to heart failure
• cardiomyopathy - conditions affecting the heart muscle
• heart rhythm problems (arrhythmias), such as atrial fibrillation
• damage or other problems with the heart valves
• congenital heart disease - birth defects that affect the normal workings of the heart

The symptoms of heart failure include:
• breathlessness - this may occur after activity or at rest; it may be worse when you're lying down, and you may wake up at night needing to catch your breath
• fatigue - you may feel tired most of the time and find exercise exhausting
• swollen ankles and legs - this is caused by a build-up of fluid (oedema); it may be better in the morning and get worse later in the day
• a persistent cough, which may be worse at night
• wheezing
• a bloated abdomen
• loss of appetite
• weight gain or weight loss
• a fast heart rate
• a pounding, fluttering or irregular heartbeat (palpitations)

Diagnosing the condition often begins with your GP. Tests you may have to diagnose heart failure include:
• blood tests - BNP (Brain Natriuretic Peptic), which if raised, will increase the suspicion that the symptoms might be related to heart failure. Also, other blood tests to check for anaemia, kidney, and liver function.
• an electrocardiogram (ECG) - this records the electrical activity of your heart to check for problems
• an echocardiogram - a type of ultrasound scan where sound waves are used to examine your heart
• breathing tests - you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness
• a chest X-ray - to check whether your heart is bigger than it should be, whether there is fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms

The severity of heart failure is described by using stage descriptions. The stage describes how severe your heart failure is. It's given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:

Class Patient Symptoms
I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnoea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnoea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Medicines for heart failure. Most people with heart failure are treated with medication. Often you will need to take 2 or 3 different medicines.
Some of the main medicines for heart failure include:
• ACE inhibitors
• angiotensin-2 receptor blockers (ARBs)
• beta blockers, e.g. Bisoprolol etc
• mineral corticoid receptor antagonists
• diuretics (water tablets)
• ivabradine
• sacubitril valsartan (Entresto)
• hydralazine with nitrate
• digoxin
• Dapagliflozin

Becky described what each of these drugs does, and why some patients may be on one set and dosage of drugs, and another patient on a quite different combination and dosage, as you may need to try a number of different medicines before you find a combination that controls your symptoms but doesn't cause unpleasant side effects.

Non-pharmacological treatments which go alongside the medicines as part of the treatment include:
• daily weighing
• low salt diet
• fluid management
• management of diet and alcohol use
• ensuring vaccinations are up to date (flu, Covid etc)
• psychological support/ counselling
• education
• implantable devices, e.g. a pacemaker or ICD in some suitable cases

Becky asked if there were any questions from the floor. One member said they could testify to the range of unwanted side effects from different drugs in the same class, as a particular beta blocker they had taken caused nightmares, but a substitute seemed to not cause the same effect. Becky stressed it was important not to stop taking a prescribed medicine. However, if it caused unwanted side affects you should get in contact with the prescriber so that the medication can be revised or reviewed.

Another member asked how Becky's service received referrals, and Becky said she mostly received these from GP's and from hospital Consultants and in respect of inpatients at the hospital.

Becky was asked about the ‘normal' rate for blood pressure and for resting pulse rate. In respect of pulse rate Becky said as far as her service was concerned, 60-80 bpm was considered the ‘normal' range, but this could be as low as 50bpm or up to 90bpm and still be considered ‘normal' for a particular patient. In terms of blood pressure she thought it a good idea to have a blood pressure monitor at home, and to know your usual blood pressure if you attended a medical appointment. High blood pressure is 140/90mmHg or higher (clinic reading). Many people with heart failure have a low blood pressure (at around 90/60mmHg). The important thing is knowing what is normal for you and seeking review if it is too high or too low (with symptoms of dizziness/feeling faint).

At the conclusion of the presentation, WDICDSG members expressed their appreciation to Becky for her presentation with a round of applause. Tony Down presented a small gift on behalf of the group to say thank you for her excellent and informative talk.


Part Two

Group Business Matters

Competition results

A quiz identifying dog breeds, supplied and run by Tony Down, resulted in a number of prize-winners.

Date of next meeting

The next meeting will take place at the Dorford Centre on Thursday, 20th January 2022. Dr Boston-Griffiths, Consultant Cardiologist will give a presentation. This will be followed by a short AGM.

 

 

 

Many thanks to Boston Scientific for sponsoring our October 2021 and January 2022 meeting venue.