Heart Failure

[keithfazzani]

I am researching a soldier who is reported as having died of heart failure as a POW in Aleppo. I undertand heart failure to be a progressive disease occuring over some time causing oedema etc. I also know that myocardial infarction (heart attacks) are frequently mis-reported in the modern press as Heart Failure. Could anyone with medical knowledge out there tell me whether the cause of death when given as Heart Failure in WW1 was in fact likely to have been a heart attack? I realise it is a rather persnickety question but was just curious.

[Dai Bach y Sowldiwr]

51 minutes ago, keithfazzani said:

Could anyone with medical knowledge out there tell me whether the cause of death when given as Heart Failure in WW1 was in fact likely to have been a heart attack?

Not very often I'd say.

Although Heart Failure could be a bit of a catch all diagnosis, clinically, doctors of that era were generally pretty good diagnosticians, even though perhaps they couldn't do much about it.

Heart failure has a 1001 causes, but in those days, structural conditions of the heart- Rheumatic Fever, functional conditions- myocarditis, and systemic causes like anaemia and poor nutrition were far more common than today.

Most of the soldiers would have been under 40, and although an awful lot of them smoked, I wouldn't expect a particularly high incidence of ischaemic heart disease including Myocardial Infarction (aka Heart Attack).

Some cases of heat failure in that cohort might have had Heart failure due to MI but I suspect that most cases of heart failure were correctly diagnosed.

What caused that heart failure may be documented in servicemens' records, and I wouldn't expect a particularly high incidence of IHD in this age group.

 

[keithfazzani]

Thanks

[Dai Bach y Sowldiwr]

Have you any examples that make you suspect that to be the case Keith?

I've seen a few records of men whose cause of death was attributed to HF, often as a complication of Rheumatic Fever.

I can't say that any would have raised any suspicion if I was a coroner.

An MI causing death in an under 40 would be pretty unusual.

[kenf48]

Given the conditions suffered by prisoners of the Turks who were worked to death, coupled with heatstroke,starvation, dysentery and debility, no doubt Dai can give a medical opinion but, from a lay point of view I'd have thought complications from any one of which could lead to heart failure.  The extensive library notes starvation can cause the heart muscle to be reduced in size causing low blood pressure and a slowed pulse eventually leading to cardiac arrest and kidney failure.

 

The Turks did not concentrate their POWs in large camps but formed Labour Camps and set the POWs to work.  If they could not work they were not fed, once that happened the outcome was inevitable.

 

Ken

[Dai Bach y Sowldiwr]

15 minutes ago, kenf48 said:

Given the conditions suffered by prisoners of the Turks who were worked to death, coupled with heatstroke,starvation, dysentery and debility, no doubt Dai can give a medical opinion but, from a lay point of view I'd have thought complications from any one of which could lead to heart failure.

Yes, that's correct.

The other thing that might be useful to explain is what 'Heart Failure' means.

Modern day definitions vary from country to country and can be a bit technical, but for the Great War period, it's reasonable to say that they meant the inability of the heart to maintain an output of blood, sufficient to maintain all the organs of the body.

The heart is just a pump, and failure means its output becomes less and less as time goes on.

That can happen quickly (Acute) or slowly (Chronic).

 

Reduction in output, for whatever reason causes a backlog of fluid further upstream.

The diagnosis of Heart failure was  made in those days by observing that backlog of fluid in the lungs, legs or neck veins.

[MaureenE]

I've sometimes wondered what the mechanism was that caused people with cholera to die so quickly, often is seems within hours of being diagnosed. What this connected  to the heart?

 

Cheers

Maureen 

[seaJane]

Acute dehydration related to accompanying dysentery, if I recall correctly. But I'd have to check.

[keithfazzani]

Thanks to all, have a much clearer idea of what may have happened.

[PhilB]

I suppose that, strictly speaking, all deaths are heart failure?

[healdav]

3 hours ago, PhilB said:

I suppose that, strictly speaking, all deaths are heart failure?

It depends whether the heart or the other organs fails first.

[Dai Bach y Sowldiwr]

12 hours ago, seaJane said:

Acute dehydration related to accompanying dysentery, if I recall correctly. But I'd have to check.

Don't be so modest sJ.

You know that's the right answer.

Edited 19 January , 2017 by Dai Bach y Sowldiwr

[PhilB]

43 minutes ago, healdav said:

It depends whether the heart or the other organs fails first.

Even if they fail, you're still alive if your heart is beating?

Edited 19 January , 2017 by PhilB

[seaJane]

2 hours ago, Dai Bach y Sowldiwr said:

Don't be so modest sJ.

You know that's the right answer.

But I'm not a medic, Dai - I'm an off-the-rails medievalist with an expertise in rare books and a memory like flypaper

 

 

 

Edited 19 January , 2017 by seaJane
trypo

[MaureenE]

15 hours ago, seaJane said:

Acute dehydration related to accompanying dysentery, if I recall correctly. But I'd have to check.

 

3 hours ago, Dai Bach y Sowldiwr said:

Don't be so modest sJ.

You know that's the right answer.

Thank you both. I was aware of this in general terms, but I wondered what was the mechanism after this. Did this then cause you to have a heart attack (M I) or perhaps heart rhythm problems, or was the brain effected, did the infection actually get into the brain, or was there cerebral bleeding etc

 

Cheers

Maureen

[Dai Bach y Sowldiwr]

1 hour ago, Maureene said:

I was aware of this in general terms, but I wondered what was the mechanism after this. Did this then cause you to have a heart attack (M I) or perhaps heart rhythm problems, or was the brain effected, did the infection actually get into the brain, or was there cerebral bleeding etc

 

The basic problem is massive loss of fluid, often quite suddenly  in Cholera.

If that fluid isn't replaced just as quickly, then the body becomes dehydrated at first, then goes into 'shock'.

(Not frightened shock, or electric shock, but hypovolaemic shock).

This means your blood volume drops in a similar way as if you'd lost a couple of pints of blood or more. (OK,you haven't lost the red and white cells ...yet).

All your organs need perfusing at a fairly steady flow rate and perfusion pressure, but if your blood volume is depleted, then that can't happen.

Any or many or all your organs will then begin to fail, but the kidneys and brain are particularly sensitive.

Big fluid inbalances do bad things to the Sodium, Potassium, bicarbonate levels as well as pH of your blood, and unless those can be corrected as well, then the outlook is bad.

Coagulation factors can be up the creek too, leading to bleeding into brain or into the intestine.

Although obviously the very last thing to happen is your heart stops or goes very irregular, you don't necessarily need to have  an MI at the same time.

Such failures could be termed multi-organ failures.

The cholera bacterium I think does have a direct effect on the brain via a toxin.

The biggest primary problem though is the acute fluid loss, and treatment of that alone has saved countless lives over the years.

[MaureenE]

Many thanks Dai for this detailed information. Much appreciated.

 

Would the medical profession have been aware of this during WWI in places such as Mesopotamia, or was the technology just not available? I guess intravenous drips are much later?

 

Cheers

Maureen

Edited 19 January , 2017 by Maureene

[Guest]

Mate,

 

Was your man a Gallipoli vetern?

 

I have large numbers of soldiers who suffered from cardiac problems during and after this campainge.

 

So many in fact that I believe it was a major problem during and after.

 

DAH and other types from heart problems sent many home or to an early grave.

 

Cheers

 

S.B

[PHalsall]

Just a thought but how did your soldier get to Aleppo? PoWs taken throughout palestine were marched great distances from wherever they were caught to camps in turkey, they all (i understand) passed through Aleppo en route, maybe after walking 500-700 miles in the sun, semi naked and no boots. The dehydration, maybe accompanied by dysentery, or physiological stress in general might be enough. Im no medic by the way, but your man might have a back story that explains his poor condition.