#nocturnal polyuria

[munaeem]

Why You Need to Pee at 3 AM ?

The Sleep and Urinary Connection:The human body operates on a delicate balance, including the fine-tuning of bodily functions during sleep. When we sleep, the production of a hormone called vasopressin increases. Vasopressin plays a crucial role in regulating the body’s water balance by reducing urine production. Consequently, most people experience decreased urine output during the night,…

[suchananewsblog]

Overactive Bladder: How a Bladder Diary Can Help

Overactive bladder (OAB) is an umbrella term for several urinary symptoms. The most common symptom is a sudden urge to urinate that you can’t control. Other symptoms include leaking urine, frequent urination, and waking up at night to urinate.  OAB is a common condition, affecting as many as 40% of women and 30% of men in the United States. It can usually be managed with lifestyle changes,…

[mcatmemoranda]

GERD: gastroesophageal reflux disease. * Patients on twice-daily diuretics can take their second dose in the afternoon rather than the evening. ¶ Urinating while sitting comfortably on the toilet (men included), leaning slightly forward, and then waiting for 20 to 30 seconds to urinate again. Δ Good sleep hygiene includes sleeping in a quiet room with low lighting and appropriate temperature, avoiding nighttime use of electronic devices, and avoiding daytime naps. ◊ Patients should be referred to a physical therapist with expertise in pelvic floor rehabilitation.

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Definition and goals of management – Nocturia is a symptom, defined as any waking at night to void, most often considered clinically significant if a patient voids two or more times nightly. It is important to try to reduce the bother caused by the nocturia in addition to reducing nocturia episodes. (See 'Definition/Diagnosis' above and 'Management' above.)

●Recognition of underlying causes – Nocturia may be caused by conditions or disorders that result in low bladder volume voids, nocturnal polyuria, or sleep disturbances. Certain medical conditions may contribute to nocturia and should be treated as part of initial management. Many patients have multiple etiologies. (See 'Pathophysiology and associated conditions' above and 'Management' above.)

●Evaluation – Evaluation for nocturia should focus on patterns of fluid intake, other urinary symptoms, symptoms of possible underlying causes, and a focused physical examination. (See 'Evaluation' above.)

•A frequency-volume chart (ie, a voiding diary) will be helpful in determining the contributing causes of nocturia. Nocturnal polyuria is defined as the excretion of ≥35 percent of the 24-hour urine output during the hours of sleep (form 1). (See 'Frequency-volume chart' above.)

●Initial management – Initial measures should include adjustments in timing of fluid intake to earlier in the day, reducing salt intake if excessive, and eliminating nighttime diuretic use if present. A urinal or commode near the bed may be helpful. Fall risk at night should be considered (algorithm 1). (See 'Initial measures' above.)

●Pelvic floor muscle exercises – We suggest pelvic floor exercises for all patients (Grade 2B). Primary care providers should refer patients to physical therapists who specialize in this training. (See 'Behavioral treatment, including pelvic floor muscle exercises' above.)

●Pharmacologic treatment – Suggested initial treatment trials for nocturia include the following (algorithm 2):

•In men with nocturia related to benign prostatic hyperplasia (BPH), we suggest trials of alpha-1-adrenergic antagonists with or without 5-alpha reductase inhibitors (Grade 2B). (See 'Men with benign prostatic hyperplasia' above.)

•In patients without BPH who have low-volume voids, we suggest trials of bladder muscle relaxants (Grade 2C). (See 'Initial monotherapy: bladder relaxant therapies' above.)

•For postmenopausal women with continued nocturia despite a bladder muscle relaxant, we offer topical vaginal estrogen either alone or in combination with other therapies. (See 'Vaginal estrogen therapy (women only)' above.)

Because each of these therapies is associated with only a modest reduction in the number of nighttime voids and also has potential for side effects, many patients may choose no pharmacologic therapy.

●Refractory nocturia – For patients with refractory nocturia and who are <65 years of age, we consider treatment with desmopressin. Studies suggest that desmopressin has a small effect on nighttime voiding frequency that is of uncertain clinical significance. Baseline sodium levels must be normal, and patients must be able to recognize and report subtle fluid status changes and also be willing to undergo frequent monitoring of sodium levels in order to avoid severe hyponatremia. Desmopressin is a potentially inappropriate medication according to Beers criteria for medications for older adults. (See 'Desmopressin' above and "Drug prescribing for older adults", section on 'Beers criteria'.)

[mahehealthcare]

Understanding the Relationship between Kidney Disease and Sleep Problems        

Kidney disease, a condition that affects millions of people worldwide, can have a profound impact on various aspects of daily life, including sleep. Individuals with kidney disease often experience sleep problems, which can further worsen their overall health and quality of life. In this article, we will explore the reasons behind the correlation between kidney disease and sleep problems, shedding light on the intricate relationship between the two.

1. Disrupted Fluid Balance:

One of the primary functions of the kidneys is to regulate fluid balance in the body. However, in people with kidney disease, this balance becomes disrupted, leading to excessive fluid retention or depletion. This imbalance can result in nocturnal polyuria, where individuals produce an excessive amount of urine during the night, causing frequent awakenings and disrupted sleep patterns.

2. Electrolyte Imbalance:

Kidneys play a crucial role in maintaining the proper levels of electrolytes, such as sodium, potassium, and calcium, in the body. When kidney function is compromised, electrolyte imbalances can occur, disrupting normal bodily functions. These imbalances can lead to muscle cramps, restless leg syndrome (RLS), and periodic limb movements during sleep (PLMS), all of which can significantly disturb sleep.

3. Sleep Apnea:

Kidney disease is often associated with a higher risk of developing sleep apnea, a sleep disorder characterized by pauses in breathing during sleep. The accumulation of fluid in the body due to impaired kidney function can cause fluid retention in the neck and upper airways, leading to narrowed air passages and increased episodes of apnea. Sleep apnea not only disrupts sleep but can also contribute to other health complications.

4. Uremic Toxins:

As kidney function declines, the body's ability to eliminate waste products, including uremic toxins, diminishes. The accumulation of these toxins in the bloodstream can lead to symptoms such as nausea, itching, and restlessness, making it challenging for individuals with kidney disease to fall asleep and stay asleep throughout the night.

Conclusion:

Sleep problems are a common occurrence in individuals with kidney disease. The disruption of fluid balance, electrolyte imbalances, sleep apnea, and the accumulation of uremic toxins all contribute to the complex relationship between kidney disease and sleep problems. Recognizing and addressing these issues is crucial for improving the quality of life for those living with kidney disease.

Mahe Health Care, a leading healthcare provider, understands the challenges faced by individuals with kidney disease. With a multidisciplinary team of experts, they offer comprehensive care and support to manage kidney disease and its associated complications, including sleep problems. By addressing the underlying causes and providing tailored treatment plans, Mahe Health Care aims to improve the overall well-being of their patients, enhancing their sleep quality and overall quality of life.

[elitonebyelidah]

Nocturia: Main Causes and Remedies

When you have to wake up more than once to urinate at night, you may always think it is because of the fluids you take before bedtime. However, it could be because you are suffering from nocturia, which forces one to wake up many times to urinate. While it is not a disease, it could be signaling some other conditions, but a medical expert can help to diagnose that.

Main Causes of Nocturia

The major causes of Nocturia include decreased bladder capacity, Overactive Bladder¸ sleep disruptions, the body producing excess urine at night, or other underlying health conditions.

Excess Urine Production

During the day, especially for people who spend most of their time standing or sitting, excess fluid accumulates in the legs. As one rests at night, the fluid flows back to the kidneys and is converted to urine. Excess urine production during the night is called nocturnal polyuria and is among the most common nocturia causes, estimated to contribute up to 88% of cases.

This urine production may also be a result of consuming excess fluids before bed. It could also be because of consuming diuretics. Some of the fluids you can avoid include caffeine and alcohol.

Sleep Disruptions

Sleep problems may also provoke cases of Nocturia. Obstructive sleep apnea (OSA) is one of the culprits, as it causes pauses in breathing during the night, disrupting sleep. It does this by reducing airflow and oxygen levels, which influences hormones, which may then induce excess urine production and nocturia.

Decreased Bladder Capacity

The bladder naturally has a capacity that it can hold at any given time. The capacity may diminish due to urinary tract inflammations, heightened urge incontinence, and bladder stones. If the capacity is inadequate, it may lead to nocturia.

Tips for Managing Nocturia for Better Sleep

A medical expert may diagnose and advise you on the best remedies you can take in this case. Most of the remedies will include medications or adjustments to existing medications. Lifestyle changes may also help, including:

Reducing the amounts of fluids that you take before bedtime.

Reducing or avoiding taking diuretic fluids, including coffee, chocolate, alcohol, and carbonated and caffeinated drinks.

Keeping your legs elevated for some time before bedtime to help in reducing the reabsorption and subsequent conversion of peripheral edema to urine when you sleep.

[urologytreatment]

Why do we get the urge to frequently urinate at night?

Nighttime urination (nocturia) is a normal part of aging, but it can also be an indication of a medical problem such as diabetes, heart disease, or bladder problems. Some medical problems that result in nerve damage.

You may also wake up requiring to pee as a result of lifestyle variables (such as your diet) or medications you take. Because nocturia can cause sleep deprivation, daytime fatigue, poor concentration, depression, and loss of productivity, it's necessary to consult with a Urologist in Pune.

The most Common Causes of Frequent Urination at Night are-

Age-

One of the most important characteristics connected with nocturia is age. The majority of people who have the ailment are over the age of 60, while lower age can also be a factor in midnight urination. The disorder known as nocturnal polyuria is one well-known aging-related cause. (NP). As a result, the body produces large amounts of pee when sleeping. With age, the prevalence of nocturnal polyuria rises. The disorder affects approximately 77% of older women and 93% of older men. Younger people (particularly children) experience nocturia because their bladders have not yet gained their full size. The amount of urine produced at night may be greater than the organ's capacity.

Lifestyle and Diet-

The need to urinate at night might also be caused by a change in food. These variables can cause nocturia either directly (by causing the body to produce urine) or indirectly (by causing the body to produce urine). (By compressing the bladder).

Some of the most prevalent dietary components that contribute to nighttime urination include:

Caffeine and alcohol: Coffee, soda, and other caffeine-containing beverages, as well as alcoholic beverages, have diuretic qualities that enhance urine output.

Dietary salt: Excess salt (sodium) in the diet can cause nocturia in those who are obese or have low cardiac output. Sodium promotes fluid retention. When the bladder is full, the fluid may be expelled at night.

Hyper hydration: Drinking too much water before bedtime can easily result in a middle-of-the-night bathroom visit.

Low-fiber diet: Chronic constipation can occur if your diet is deficient in nutritional fibre. The accumulation of stool at night can cause the gut to stretch and put pressure on the bladder, giving you the urge to pee.

Pregnancy-

Nocturia can develop at any stage of pregnancy for a variety of reasons.

Early pregnancy: Progesterone levels rise in early pregnancy, causing bloating and water retention. This increases the likelihood of overnight urination. Nocturia can be an early indicator of pregnancy in some circumstances.

Later pregnancy: Frequent urination is usual throughout the second and third trimesters because the womb has begun to compress the bladder. Certain body positions at night can worsen the compression and cause nocturia.

After pregnancy: People may experience bladder and pelvic organ prolapse, which means the organs have slipped out of place. Both can cause urinary tract obstruction.

Medications-

Nocturia can also be caused by some drugs. This can occur in several ways:

A medication may cause the release of acetylcholine, a chemical that causes bladder contractions.

A medication may hinder the release of norepinephrine, a hormone that relaxes the bladder and other smooth muscle organs.

A diuretic effect occurs when a medicine helps the kidneys to excrete more salt and water from the body.

Acute Infection/ Conditions-

Nocturia can be a sign of acute urinary tract (urologic) diseases such as:

Kidney stones or bladder stones

Bladder infection (interstitial cystitis)

Kidney infection (pyelonephritis)

Urinary tract infection (UTI)

In acute situations, inflammation might cause a quick need to urinate due to urinary tract contractions. (Urinary urgency). Nocturia is frequently the continuation of a person's daytime urine urgency. When the cause of the inflammation is eliminated, the nocturia usually improves.

Chronic Disease/ Conditions-

Nocturia can sometimes be a sign of a more serious disease. In some cases, it might last a long period and be difficult to treat. Some of the causes are urinary-related, while others are not. The following are the common chronic causes of frequent urination at night

Benign prostatic hyperplasia (BPH)

Bladder cancer

Congestive heart failure (CHF)

Diabetes

Hypertension

Multiple sclerosis (MS)

Overactive bladder (OAB)

Parkinson's disease (PD)

Sleep apnea

Overweight/obesity

Neurogenic bladder

It can be annoying to your sleep if you have to wake up in the middle of the night to pee. While nocturia can be caused by something as simple as drinking too close to going to bed or having a small bladder, it can also be caused by certain medications and health conditions. Chronic disorders that destroy nerves, such as MS, can also cause bladder difficulties. Making adjustments to your lifestyle (such as decreasing weight or cutting back on alcohol) may assist with nocturia in certain circumstances. There are also therapies for many of the disorders that can cause it, which you can discuss with your provider. If you find that getting up to pee frequently disrupts your sleep, Consult the Best Urologist in Pune.

[nocdurna]

Medicine For Nocturia | Medication For Frequent Night Urination

Nocturia may cause you to wake up feeling tired even after a full night’s sleep. It may also disrupt your sleep pattern. NOCDURNA is prescribed to treat nocturia caused by nocturnal polyuria.  For further details visit a website: https://www.nocdurna.com

[wordstitta]

Definition of nocturnal

This diary is used to keep track of things like the kind and amount of liquids you drink, trips to bathroom, etc. Your health care provider may also ask you to keep a bladder diary in order to help with a diagnosis. You'll be asked about your symptoms and health history. You and your health care provider will want to learn the cause of your nocturia. Often, several of these issues may be going on at once. Nocturnal polyuria (when your body produces too much urine at night for your bladder to hold).Edema in the lower limbs, or leg swelling.Enlarged prostate (prostatic hyperplasia (BPH).Bladder obstruction ( stones), inflammation or other problems that affect bladder capacity (like bladder surgery or fibrosis from radiation).Heart disease, vascular disease or congestive heart failure.Underlying health conditions can cause nocturia. Sleep disorders, like insomnia or sleep apnea.The timing or dose of medicines, such as: diuretic medicine (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.Behavioral patterns (you've trained your body to wake up during the night to use the bathroom, even if you don't necessarily have to go).Drinking too much fluid before bedtime (especially caffeine or alcohol).The following lifestyle habits are known to cause nocturia in either men or women: Or it could be from certain medication, illnesses or reduced bladder capacity. Nocturia can be from a simple habit like drinking too much fluid (especially caffeine or alcohol) before bed. The sphincter muscles then open and urine is released out of the body. This pushes urine out of the bladder and through the urethra. Once you are ready to urinate, the brain sends a signal to the bladder. It is kept closed with sphincter muscles. The urethra is a tube that carries urine from the bladder, out of the body. The muscular neck (end) of the bladder stays closed to store urine. The muscles in the lower part of the pelvis hold the bladder in place. The brain and the bladder work together to control urinary function. The bladder holds urine until you are ready to empty it. Urine travels from the kidneys to the bladder through the ureters (the tubes that join them). Normally, the kidneys make about 1½ to 2 quarts of urine each day in an adult less in children. Urine forms when the kidneys clean your blood. The "urinary tract" includes the organs in your body that make, store and remove urine.

[hiretrust]

Definition of nocturnal

Urinating more volume (if polyuria is present).Waking up more than once a night to urinate.This can cause disruptions in a normal sleep cycle. People who have nocturia wake up more than once a night to urinate. Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. Interstitial cystitis (pain in the bladder).Bladder infection or recurrent urinary tract infection.The causes of an inability of the bladder to fully fill can include: Benign prostatic hyperplasia (men), a non-cancerous overgrowth of the prostate that obstructs the flow of urine.The causes of an inability to fully empty your bladder can include: This can also occur due to difficulty sleeping - you may wake up for one reason, but then go to the bathroom while you’re awake, which will make you think that you woke up because you had to urinate. This is usually due to an inability of the bladder to fully empty (this is why it fills up faster) or the inability of the bladder to fill completely before developing the urge to urinate (low bladder volume). The total amount of urine produced is not elevated. If you have nocturnal urinary frequency, you may urinate in small amounts or urinate more frequently. Drinking too much fluid before bedtime, especially coffee, caffeinated beverages or alcohol.Certain drugs, including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.Sleeping disorders, such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep).Edema of lower extremities (swelling of the legs).The causes of nocturnal polyuria can include: It can re-enter your veins and be filtered by your kidneys, producing urine. Once you lie down to sleep, gravity no longer holds the fluid in your legs. This is usually due to fluid retention during the day that often accumulated in the feet or legs. Their urine volume during the day is normal or reduced. Those with nocturnal polyuria experience a high urine volume only at night. Diabetes insipidus, gestational diabetes (occurs during pregnancy).Untreated diabetes (Type 1 and Type 2).It can also happen if something is in the urine, pulling the extra water out, such as sugar (glucose). This is usually caused by there being too much water filtered by the kidneys. People with polyuria urinate >3,000mL in 24 hours. There are many possible causes of nocturia, depending on the type.

[scaleupconsulting]

Nocturnal Polyuria Causes | Medicine For Nocturia

The leading cause of nocturia is nocturnal polyuria (NP), a condition where the bladder contracts during sleep and fills with small amounts of urine. This frequent urination results in interrupted sleep, which can lead to excessive daytime sleepiness, fatigue, or loss of energy. For more information, visit: https://www.nocdurna.com/frequent-nighttime-urination/

[bluebliss]

Is Nocturia keeping you Awake in the Night?

Nocturia is a condition that keeps you awake at night as you have the urge to urinate frequently. This affects both men and women and increases with age. Most people wake up once during the night to urinate, which is considered normal. But, waking up more than once is a sign that something is wrong.

What are the different types of Nocturia and their causes?

Now let us look into the types of nocturia and their causes:

Polyuria: People suffering from Polyurea urinate >2500 liters in 24 hours. This happens when there is too much water that is being filtered by the kidneys. High fluid intake, high diabetes, and gestational diabetes could be the cause of polyurea.

Nocturnal Polyurea: Noctural polyurea is the urge to pee only at night. Whereas their urine volume is normal durig the day. The fluid gets accumulated in the legs during the day leading to swelling of the legs. But, when you rest, the fluid from the swollen foot traces back to the kidneys, increasing the urge to urinate in the night. The causes of Nocturnal Polyurea may be a diet high in sodium, congestive heart failure, drinking too much fluids before bedtime, congestive heart failure,obstructive sleep apnea.

What are the symptoms associated with Nocturia?

The symptoms associated with Nocturia are:

Waking up more than once to urinate.

Sleeplessness and tiredness even after waking up.

Urinating in high volume.

What are the treatment options for Nocturia?

If you feel you are suffering from nocturea it is advisible to see the urologist. The best Urology Hospital in Bangalore will have all the facilities and experts to treat Nocturia. Let us look into the treatment available to treat Nocturia.

Restricting fluids in the evening.

Place the leg at an elevated position while sleeping.

Wearing compression stockings that prevent fluid accumulation.

The best Urologist in Bangalore may also prescribe a few medication to cure Nocturia.

[mcatmemoranda]

From Bates’ Guide to Physical Examination & History Taking, 12th edition:

Symptoms are subjective concerns, or what the patient tells you. Signs are considered one type of objective information, or what you observe. Knowing these differences helps you group together the different types of patient information. These distinctions are equally important for organizing written and oral presentations about patients into a logical and understandable format.

Each principal symptom should be well characterized, and should include the seven attributes of a symptom: (1) location; (2) quality; (3) quantity or severity; (4) timing, including onset, duration, and frequency; (5) the setting in which it occurs; (6) factors that have aggravated or relieved the symptom; and (7) associated manifestations. It is also important to query the “pertinent positives” and “pertinent negatives” drawn from sections of the Review of Systems that are relevant to the Chief Complaint(s). The presence or absence of these additional symptoms helps you generate the differential diagnosis, which includes the most likely and, at times, the most serious diagnoses, even if less likely, which could explain the patient's condition.

I often don’t ask additional social history questions, such as hobbies, education, etc. I should ask more of those questions. It does help build rapport if you ask patients those types of questions...

The Personal and Social History captures the patient's personality and interests, sources of support, coping style, strengths, and concerns. It should include occupation and the last year of schooling; home situation and significant others; sources of stress, both recent and long-term; important life experiences such as military service, job history, financial situation, and retirement; leisure activities; religious affiliation and spiritual beliefs; and activities of daily living (ADLs). Baseline level of function is particularly important in older or disabled patients. The Personal and Social History includes lifestyle habits that promote health or create risk, such as exercise and diet, including frequency of exercise, usual daily food intake, dietary supplements or restrictions, and use of coffee, tea, and other caffeinated beverages, and safety measures, including use of seat belts, bicycle helmets, sunblock, smoke detectors, and other devices related to specific hazards. Include sexual orientation and practices and any alternative health care practices. Avoid restricting the Personal and Social History to only tobacco, drug, and alcohol use. An expanded Personal and Social History personalizes your relationship with the patient and builds rapport.

The Review of Systems

General: Usual weight, recent weight change, clothing that fits more tightly or loosely than before; weakness, fatigue, or fever.

Skin: Rashes, lumps, sores, itching, dryness, changes in color; changes in hair or nails; changes in size or color of moles.

Head, Eyes, Ears, Nose, Throat (HEENT):

Head: Headache, head injury, dizziness, lightheadedness.

Eyes: Vision, glasses or contact lenses, last examination, pain, redness, excessive tearing, double or blurred vision, spots, specks, flashing lights, glaucoma, cataracts.

Ears: Hearing, tinnitus, vertigo, earaches, infection, discharge. If hearing is decreased, use or nonuse of hearing aids.

Nose and sinuses: Frequent colds, nasal stuffiness, discharge, or itching, hay fever, nosebleeds, sinus trouble.

Throat (or mouth and pharynx): Condition of teeth and gums, bleeding gums, dentures, if any, and how they fit, last dental examination, sore tongue, dry mouth, frequent sore throats, hoarseness.

Neck: “Swollen glands,” goiter, lumps, pain, or stiffness in the neck.

Breasts: Lumps, pain, or discomfort, nipple discharge, self-examination practices.

Respiratory: Cough, sputum (color, quantity; presence of blood or hemoptysis), shortness of breath (dyspnea), wheezing, pain with a deep breath (pleuritic pain), last chest x-ray. You may wish to include asthma, bronchitis, emphysema, pneumonia, and tuberculosis.

Cardiovascular: “Heart trouble”; high blood pressure; rheumatic fever; heart murmurs; chest pain or discomfort; palpitations; shortness of breath; need to use pillows at night to ease breathing (orthopnea); need to sit up at night to ease breathing (paroxysmal nocturnal dyspnea); swelling in the hands, ankles, or feet (edema); results of past electrocardiograms or other cardiovascular tests.

Gastrointestinal: Trouble swallowing, heartburn, appetite, nausea. Bowel movements, stool color and size, change in bowel habits, pain with defecation, rectal bleeding or black or tarry stools, hemorrhoids, constipation, diarrhea. Abdominal pain, food intolerance, excessive belching or passing of gas. Jaundice, liver, or gallbladder trouble; hepatitis.

Peripheral vascular: Intermittent leg pain with exertion (claudication); leg cramps; varicose veins; past clots in the veins; swelling in calves, legs, or feet; color change in fingertips or toes during cold weather; swelling with redness or tenderness.

Urinary: Frequency of urination, polyuria, nocturia, urgency, burning or pain during urination, blood in the urine (hematuria), urinary infections, kidney or flank pain, kidney stones, ureteral colic, suprapubic pain, incontinence; in males, reduced caliber or force of the urinary stream, hesitancy, dribbling.

Genital: Male: Hernias, discharge from or sores on the penis, testicular pain or masses, scrotal pain or swelling, history of sexually transmitted infections and their treatments. Sexual habits, interest, function, satisfaction, birth control methods, condom use, and problems. Concerns about HIV infection. Female: Age at menarche, regularity, frequency, and duration of periods, amount of bleeding; bleeding between periods or after intercourse, last menstrual period, dysmenorrhea, premenstrual tension. Age at menopause, menopausal symptoms, postmenopausal bleeding. If the patient was born before 1971, exposure to diethylstilbestrol (DES) from maternal use during pregnancy (linked to cervical carcinoma). Vaginal discharge, itching, sores, lumps, sexually transmitted infections and treatments. Number of pregnancies, number and type of deliveries, number of abortions (spontaneous and induced), complications of pregnancy, birth-control methods. Sexual preference, interest, function, satisfaction, any problems, including dyspareunia. Concerns about HIV infection.

Musculoskeletal: Muscle or joint pain, stiffness, arthritis, gout, backache. If present, describe location of affected joints or muscles, any swelling, redness, pain, tenderness, stiffness, weakness, or limitation of motion or activity; include timing of symptoms (e.g., morning or evening), duration, and any history of trauma. Neck or low back pain. Joint pain with systemic symptoms such as fever, chills, rash, anorexia, weight loss, or weakness.

Psychiatric: Nervousness, tension, mood, including depression, memory change, suicidal ideation, suicide plans or attempts. Past counseling, psychotherapy, or psychiatric admissions.

Neurologic: Changes in mood, attention, or speech; changes in orientation, memory, insight, or judgment; headache, dizziness, vertigo, fainting, blackouts; weakness, paralysis, numbness or loss of sensation, tingling or “pins and needles,” tremors or other involuntary movements, seizures.

Hematologic: Anemia, easy bruising or bleeding, past transfusions, transfusion reactions.

Endocrine: “Thyroid trouble,” heat or cold intolerance, excessive sweating, excessive thirst or hunger, polyuria, change in glove or shoe size.

This book recommends examining the patient from the patient's right side, moving to the opposite side or foot of the bed or examining table as necessary. This is the standard position for the physical examination and has several advantages compared with the left side: Estimates of jugular venous pressure are more reliable, the palpating hand rests more comfortably on the apical impulse, the right kidney is more frequently palpable than the left, and examining tables are frequently positioned to accommodate a right-handed approach.

[your-dietician]

When the Symptoms of Heart Failure Are Getting Worse

New Post has been published on https://depression-md.com/when-the-symptoms-of-heart-failure-are-getting-worse/

When the Symptoms of Heart Failure Are Getting Worse

If you are living with heart failure that is no longer responding to conventional heart therapies and your symptoms are getting worse, you may have advanced heart disease. 

About 6.2 million people are living with heart failure in the United States, and that number is expected to rise. Because improvements in the treatment of heart failure have allowed people with this condition to survive substantially longer than they used to, the number of people that reach an advanced phase of the disease—also called end-stage, refractory, or terminal heart failure—is steadily growing.

Heart failure is a slowly progressive condition that can be managed but not cured without getting a heart transplant. Fortunately, medical advances have improved the quality of life to such a degree that people can engage more fully in end-of-life decisions like palliative care.

This article discusses advanced-stage heart failure in detail.

Nipitphon Na Chiangmai / EyeEm / Getty Images

Advanced Stages

In advanced heart failure, the heart no longer pumps enough blood, either because the heart cannot fill up with enough blood or can’t pump forcefully enough to meet the body’s needs. The heart still beats, but it is weak and damaged. Even more, the body is unable to compensate for the reduced blood the heart can pump. As a result, fluid often backs up into the lungs, liver, abdomen, or legs.

The most common symptoms of advanced heart failure are shortness of breath and chest pain at rest, or with minimal exertion.

The New York Heart Association classification system is the simplest and most widely used method to gauge symptom severity.

Class I

No limitations of physical activity

No heart failure symptoms

Class II

Mild limitation of physical activity

Heart failure symptoms with significant exertion; comfortable at rest or with mild activity

Class III

Marked limitation of physical activity

Heart failure symptoms with mild exertion; only comfortable at rest

Class IV

Discomfort with any activity

Heart failure symptoms occur at rest

Another classification system is the American Heart Association and American College of Cardiology’s A-to-D staging system. In this system, advanced heart failure is stage D.

Stage A: You have been diagnosed with coronary artery disease, hypertension, or diabetes mellitus, but you have yet to develop left ventricular hypertrophy, distortion of the chamber, or impaired function on echocardiogram

Stage B: You are asymptomatic but demonstrate left ventricular hypertrophy and/or impaired left ventricular function on echocardiogram.

Stage C: You have had symptoms of heart failure, but it is managed with standard treatment.

Stage D (advanced or refractory): You experience symptoms on minimal exertion or at rest in spite of optimal medical therapy and deteriorate clinically requiring repeated hospitalizations.

Heart failure is considered end-stage when life expectancy is predicted to be six months or less. Palliative or hospice care and novel research therapies are usually discussed during the final stage of heart failure.

Symptoms

Common symptoms of left-sided heart failure include:

Chest pain

Fatigue

Weakness

Shortness of breath, especially on exertion

Orthopnea, or shortness of breath when lying down

Paroxysmal nocturnal dyspnea, or awakening at night with shortness of breath

Exercise intolerance

Fast or irregular heartbeat

Peripheral edema, or swelling of the feet, angle, legs

Weight gain

Nausea

Persistent coughing or wheezing

Having to urinate more than usual (polyuria) or at night (nocturia)

When the heart is weak, fluid builds up throughout the body, causing problems. Symptoms include swelling of the feet, legs, and/or belly and having more shortness of breath. You may also feel nauseous and lose your appetite. Other common signs of progressing illness are feeling dizzy or faint and cold hands and feet due to poor blood circulation.

These common symptoms become worse as heart failure progresses and may look different at advanced stages.

Shortness of Breath

A weak heart cannot pump blood forward so it backlogs into the lungs making it difficult to breathe. During advanced heart failure, you may experience shortness of breath, or dyspnea, even with minimal exertion.

This shortness of breath is likely due to fluid overload on and around the heart and may feel like suffocating, smothering, and hungering for air.

Edema

Severe heart failure can result in blood and fluid pooling in the legs and abdomen. The body can usually accommodate large increases in volume, about five liters, but in severe heart failure, the extra fluid is enough to expand the extracellular compartments of the body.

Swelling is usually most pronounced in the feet and ankles, but the development of ascites—fluid buildup around the liver and abdomen—has an especially poor prognosis.

Of note, edema in heart failure is different from edema caused by other conditions, in that it creates a dimple when pressed. Therefore, edema caused by heart failure is also called pitting edema.

Sudden Weight Gain

During heart failure exacerbations, it is not uncommon for the body to rapidly gain weight as a result of fluid retention, sometimes as high as five pounds or more in a day.

Sleep Problems

In advanced heart failure, fluid accumulates in the lungs and more diuretic medicine is needed. Unfortunately, diuretic resistance develops in the final stages of heart failure as the body kicks fluid-retaining systems into high gear. 

When you lie down, fluid accumulation in the lungs signals the body to wake up to prevent asphyxiation. This phenomenon is called paroxysmal nocturnal dyspnea. It is not uncommon for people to wake up multiple times in the night or find it hard to find a comfortable sleeping position.

Many people with heart failure also have sleep apnea, so they may misattribute their symptoms. If you have heart failure and are frequently waking up in the middle of the night, it may be a sign of worsening heart failure, so you should contact a healthcare provider immediately. 

Coughing and Wheezing

Fluid in the lungs, or pulmonary edema, can cause coughing or wheezing. In more severe cases, these symptoms can resemble asthma, hence the going usage of the term cardiac asthma to describe these symptoms.

Symptoms of severe cough, wheezing, and spitting up pink-colored sputum should not be taken lightly, and you should contact a medical professional at the first sight of these symptoms. 

Treatment

If your symptoms do not respond to changes in medications, you may have a condition called acutely decompensated heart failure (ADHF).

Many times symptoms of advanced heart failure respond to a course of treatment in the hospital and you feel much better upon discharge, but sadly some people do not improve to the point where they can go home on oral medications alone. This is due, in part, to the ineffectiveness of diuretics, a term called diuretic resistance—or decreased natriuresis and diuresis—as a result of the body’s overactivation of the SNS system—the part of the nervous system that increases heart rate, blood pressure, breathing rate, and pupil size—and the RAAS system, which regulates blood pressure.

Sometimes medications may work to some degree but make you feel worse. Decreased cardiac output worsens kidney function and activates the SNS and RAAS systems, enhancing sodium and water retention. Once-helpful diuretics can actually worsen heart failure by worsening the glomerular filtration rate of the kidneys and hyponatremia, or low sodium levels. 

Diuretics may also instigate electrolyte abnormalities, further complicating treatment. 

So what are the options at this point? You’ll likely need advanced treatments such as:

Constant intravenous (IV) medications: Continuous IV medications are used for those who are getting partial relief and desire a higher quality of life. They are often used as a bridge to transplant or palliative care. Also, most insurance companies cover this service, so it is widely available to those who cannot afford other end-of-life treatment options.

Mechanical circulatory support (partial or total artificial hearts): An intra-aortic balloon pump (IABP) or ventricular assist devices (VADs) can aid the heart in pumping and effectively delivering blood to the body, but they are mostly used as a bridge to recovery or heart transplantation. IABP has emerged as the single most effective and widely used circulatory assist device, but the invasive nature of the procedure needed to place the device comes with risks of thromboembolism, bleeding, and infection.

Heart transplant: Heart transplantation is the treatment of choice for patients with heart failure refractory to medical therapy, but there are more people in need of a heart transplant than there are donors. According to the International Society for Heart and Lung Transplant, patient survival at one and three years for patients who received cardiac transplantation was approximately 85% and 79%, respectively.

Maintaining your heart failure self-care routine is vital to preserving and improving your quality of life no matter which treatment options you choose. This includes:

Limiting your salt to 2,000 mg of sodium per day

Restricting fluids like water, sodas, coffee, and soups to help avoid fluid buildup

Keeping a log of your weight and symptoms, and knowing the side effect profile of new and current medications

Receiving vaccinations for pneumonia and influenza

Continuing to treat pre-existing health conditions like high blood pressure and diabetes

Prognosis

Heart failure is associated with very high morbidity and mortality. Eighty percent of men and 70% of women over the age of 65 who are diagnosed with heart failure will die within eight years.

Stage D heart failure has a more grim prognosis. Despite improving special therapeutic interventions, the one‐year mortality rate of refractory heart failure is approximately 50%.

The most common cause of death is progressive heart failure, but sudden death may account for up to 45% of all deaths. Also, Black people are 1.5 times more likely to die of heart failure compared to White people, underscoring the health disparities that persist in the United States.

Symptoms of advanced heart failure are manifestations of severely low cardiac output. The following signs may be indicative that someone is dying of heart failure, especially if frequent hospitalizations and specialized treatment regimens are not leading to clinical improvement: 

Early satiety

Poor appetite

Abdominal pain

Nausea

Coughing up pink sputum

Renal insufficiency

Forgetfulness and memory problems

Coping

Heart failure can have a significant impact on your mental and emotional health. Feelings of anger, sadness, and fear are natural. Talking to your friends and family about how you are feeling, and seeking professional help if necessary, may help you to feel better and avoid heat-of-the-moment decisions that you may regret later.

The progression of heart failure can be unpredictable, which makes it difficult to know when to have conversations about end-of-life care. It’s important to discuss things as early as possible, giving people the time to think about treatment options and where they want to be cared for toward the end of their life. This may help them achieve some peace of mind and a sense of control.

While you have the final say on your treatment options and end-of-life care, shared decision-making that includes trusted healthcare professionals and your family means that you don’t have to make crucial decisions alone.

A Word From Verywell

If your heart function doesn’t improve or worsens in spite of the best possible self-care and medical treatments, you may have to consider other options like heart surgery, continuous infusion of intravenous drugs, and heart transplant.

Research shows people are happiest and most satisfied with their end-of-life decisions when they’ve made them with their doctors and family members, a process called shared decision-making. During this time you may want to discuss end-of-life measures like palliative care and assigning a power of attorney.

Living with advanced heart failure is not easy, and end-of-life conversations can be difficult. While you may feel scared or like you are losing control, leaning on your family and friends during these difficult times can assure that all your end-of-life needs and wishes are met.

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