When 43-year-old Barbara Harris found herself panting as she climbed the steps to her front door, she knew something was wrong. She was overweight and had high blood pressure, but she’d never been sick like this. In the hospital, she was shocked when her doctors told her she was suffering from mild congestive heart failure. Because her high blood pressure had gone untreated for years, her heart muscle had been damaged and was now unable to pump enough blood for her body’s needs. Blood returning to the heart was backing up, resulting in fluid buildup in her lungs and making her short of breath.
She also had a mild heart murmur, probably a remnant of a childhood bout with rheumatic fever. An echocardiogram (an ultrasound of the heart) confirmed that her mitral valve was slightly leaky, allowing blood back into the atrium and forcing her heart to work harder to pump it out. Harris was treated for two days and went home with medication to lower her blood pressure and decrease the buildup of fluid.
Two weeks later, on a cold February evening, she was back in the hospital.
“It was OK at first when I went home,” she told us from her hospital bed. I was working that month on the inpatient wards as an attending physician, along with a resident and a medical student. Harris adjusted the prongs of the oxygen tubing in her nostrils. “But it started again pretty quickly. I didn’t even want to walk anymore; it got too hard. I’m out of breath. And my ankles are killing me.” I pressed one of her ankles, leaving a little dent in the warm flesh, and asked her to rotate her feet. Wincing, she moved them a tiny bit. Ankle swelling could be a sign of heart failure, but mild cases do not usually cause pain. It was probably a red herring.
