What is the prognosis for heart failure with kidney issues?

Question

Hello doctor,

My dad has been hospitalized twice in the last four weeks for severe heart failure. He is currently still in hospital. The left wall of the heart does not function. Kidney function at its lowest was 26, which further moved to 28 when taken off heart medications. Liver function is impaired. There is swelling in the feet and legs. Recently, he was given an IV (intravenous injection) injection of Dopamine. After taking an IV injection of Dopamine within hours, his heart was racing, with pain in his shoulder blades and retching. His latest blood pressure is 89/60 mm Hg. He was in a confused stage. There were bouts of feeling very cold and shivery. He is not sleeping well, and he has an appetite. What is the prognosis? Please help me.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Sorry to hear about your father's health. Seems like he is in cardiogenic shock with multi-organ dysfunction. The present prognosis is not good, but if he has some actual issues on the background of previous heart failures like acute heart attack, severe infection, drug overdose, etc., in that case treating the inciting issue will make the prognosis better. As he is on inotropic support, Ihope this will maintain his blood pressure. If not, dual support can be started.

In the case of cardiogenic shock, mechanical circulatory support can also be started if available on a temporary or permanent basis. Kindly share his echocardiography report and angiography if done, as well as other reports like complete blood count, chest X-ray, etc., and tell us about his urine output in six hours and 24 hours. So that I can guide you accordingly.

I hope I clarified your doubts.

Thanks and regards.

Answer 2

Hi,

Welcome back to icliniq.com.

These are renal and liver function tests, which are deranged, as you told me (attachments removed to protect the patient’s identity). Multi-organ dysfunction does make the prognosis worse. Kindly share his electrocardiogram (ECG), angiography, and chest X-ray. Take care of your father.

Feel free to reach out if you have any further questions or doubts.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

Sad to know about his condition. If his left ventricle is weak and blood pressure is low and an acute cause is to be treated, then the blood pressure is supported with IV (intravenous injection) normal saline infusion if no fluid is overloaded. If it does not raise blood pressure or fluid overload is there then IV (intravenous injection) medicines can be started to raise the blood pressure. One of them is an IV injection of Norepinephrine (a combination of catecholamine and Phenethylamine) and the other is Dobutamine (beta blockers). Take the medications after consulting your specialist doctor.Some patients recover from life-threatening situations and then regular heart failure medicines can be started. Take care of your father. Thanks and regards.

Answer 4

Hi,

Welcome back to icliniq.com.

When the left ventricle fails, fluid accumulates in the lungs, which is known as pulmonary edema (swelling). When the right ventricle fails, fluid accumulates in the body. In the case of biventricular failure, fluid accumulates in both the right and left ventricles. If there is no adequate urine output with Furosemide, then the combination of Furosemide (lactose monohydrate NF, magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF) and Metolazone (Quinazoline) is given; if these medications are not helping then, ultrafiltration is done with a dialysis machine in which fluid is removed with the help of a dialysis machine.

I hope I clarified your doubts. Thanks and regards.