Monday, January 23, 2023

Congestive Heart Failre

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Heart Failure Treatment Is A Team Effort

Pathophysiology of Congestive Heart Failure (CHF)

Heart failure management is a team effort, and you are the key player on the team. Your heart doctor will prescribe your medications and manage other medical problems. Other team members — including nurses, dietitians, pharmacists, exercise specialists, and social workers — will help you achieve success. But it is up to YOU to take your medications, make dietary changes, live a healthy lifestyle, keep your follow-up appointments, and be an active member of the team.

If you notice anything unusual, don’t wait until your next appointment to discuss it with your doctor. Call them right away if you have:

  • Unexplained weight gain
  • Swelling in your ankles, feet, legs, or belly that gets worse
  • Shortness of breath that gets worse or happens more often, especially if you wake up feeling that way
  • Bloating with a loss of appetite or nausea
  • Extreme fatigue or more trouble finishing your daily activities
  • A lung infection or a cough that gets worse
  • Fast heart rate
  • New irregular heartbeat

What Happens When Blood Backs Up In The Heart

If blood backs up in the heart, theres no room for the blood that’s returning from the body and lungs. So that blood stays in the blood vessels of the lungs and the body. Some fluid from the blood vessels leaks out into the tissues. This leads to fluid in the lungs and swelling in the legs and ankles .

What Are The Signs And Symptoms Of Congestive Heart Failure

Shortness of breath

The hallmark and most common symptom of left heart failure is shortness of breath and may occur:

  • While lying flat
  • While awakening the person from sleep or
  • Due to fluid accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the organs of the body when called upon in times of exertion or stress.
  • Chest Pain

  • Chest pain or angina may be associated, especially if the underlying cause of the failure is coronary heart disease.
  • Right heart failure, left heart failure, or both

  • People with right heart failure leak fluid into the tissue and organs that deliver blood to the right heart through the vena cava.
  • Backpressure in capillary blood vessels causes them to leak water into space between cells and commonly the fluid can be found in the lowest parts of the body.
  • Gravity causes fluid to accumulate in the feet and ankles but as more fluid accumulates, it may creep up to involve all of the lower legs.
  • Fluid can also accumulate within the liver causing it to swell and within the abdominal cavity .
  • Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension.
  • Depending upon their underlying illness and the clinical situation, patients may have symptoms of right heart failure, left heart failure, or both.
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    Edema And Heart Failure

    Edema is swelling that is caused by excess fluid trapped in the bodys tissue.

    The condition often occurs as the result of congestive heart failure. It can also be the result of medication, pregnancy, or another underlying condition, such as kidney disease or cirrhosis of the liver.

    Signs that you have edema include:

    • Swelling or puffiness of the tissue directly under the skin, especially in the legs or arms
    • Arms or legs start to feel full or heavy
    • Shiny or stretched skin
    • Skin that retains pits, or dimples, after being pressed for several seconds
    • Clothing or jewelry starts to feel tight and uncomfortable
    • Skin near the swelling feels tight or warm
    • It becomes more difficult to move the joints that are affected
    • Increased abdominal size

    What Are The Symptoms Of Heart Failure

    Congestive heart failure etiology and pathophysiology

    You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:

    • Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
    • Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen , and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
    • Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
    • Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.

    If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.

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    Stage B Treatment Options

    While stage A CHF is managed with lifestyle changes, the treatment plan for stage B typically includes taking medications regularly. People at this stage should still make the same lifestyle changes as those appropriate for stage A. However, your doctor may also prescribe additional treatments such as:

    • Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, if you arent taking any as part of your stage A treatment plan
    • Beta blockers if youve had a heart attack and your EF is 40% or lower, if you arent taking any as part of your stage A treatment plan
    • Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease, or congenital heart disease

    Which Dogs Are Most At Risk

    Congestive heart failure tends to happen more often in middle-aged and older dogs, but it can affect dogs of any age, breed, or sex, Dr. Klein explains. Certain breeds are predisposed to dilated cardiomyopathy, including the Doberman Pinscher, Great Dane, Boxer, and Cocker Spaniel, suggesting that there might be a genetic component to this disease.

    Small dog breeds may develop CHF due to mitral valve issues, which are the most common cause of this condition. Some large and giant dog breeds are prone to developing CHF because of issues like dilated heart muscles or cardiomyopathy.

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    What Treatment Can You Provide For A Dog With Congestive Heart Failure

    A general practice veterinarian can provide a referral to a board-certified veterinary cardiologist who specializes in treating patients with heart issues. With their continued monitoring and guidance, they are the ones who can give the best advice on the management and prognosis of the patient such as nutrition, medication, and activity, Dr. Klein says.

    For instance, they can recommend an appropriate amount of exercise or a low-sodium diet to reduce pressure on the heart. In addition, a veterinary cardiologist may prescribe medications to help remove fluids and slow the progression of CHF.

    Heart Failuresigns And Symptoms

    Treatment of Congestive Heart Failure (CHF)

    Heart failure is a condition in which the heart fails to function properly. The terms “heart failure” and “congestive heart failure ” don’t mean that the heart has actually “failed” or stopped but mean one or more chambers of the heart “fail” to keep up with the volume of blood flowing through them.

    Heart failure is brought on by a variety of underlying diseases and health problems.

    Your condition may involve the left side, the right side or both sides of the heart. Each side has two chambers:

    • An atrium or upper chamber
    • A ventricle or lower chamber

    Any one of these four chambers may not be able to keep up with the volume of blood flowing through it.

    Two types of heart dysfunction can lead to heart failure, including:

    • Systolic Heart Failure This is the most common cause of heart failure and occurs when the heart is weak and enlarged. The muscle of the left ventricle loses some of its ability to contract or shorten. In turn, it may not have the muscle power to pump the amount of oxygenated and nutrient-filled blood the body needs.
    • Diastolic Failure The muscle becomes stiff and loses some of its ability to relax. As a result, the affected chamber has trouble filling with blood during the rest period that occurs between each heartbeat. Often the walls of the heart thicken, and the size of the left chamber may be normal or reduced.

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    Can Heart Failure Be Prevented

    You may be able to prevent or delay heart failure if you:

    • Work with your provider to manage any health conditions that increase your risk of developing heart failure
    • Make healthy changes in your eating, exercise, and other daily habits to help prevent heart disease

    NIH: National Heart, Lung, and Blood Institute

    What Is Congestive Heart Failure

    Congestive heart failure is a term that refers to the heart’s inability to pump adequate blood to the body. There are many causes of CHF in dogs. The two most common causes are:

    • mitral valve insufficiency . MVI is a leaky mitral valve, which is the valve between the left atrium and the left ventricle.
    • dilated cardiomyopathy .

    For further information on these specific causes, please see the handouts “Dilated Cardiomyopathy in Dogs” and “Mitral Valve Disease in Dogs”.

    Clinical signs of CHF vary depending on whether the dog has left- or right-sided heart failure.

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    What Is The Outlook For People With Heart Failure

    With the right care, heart failure may not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan.

    Everyone with a long-term illness, such as heart failure, should discuss their desires for extended medical care with their doctor and family. An “advance directive” or “living will” is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time.

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    Do Dogs Have Heart Attacks

    CONGESTIVE HEART FAILURE

    In humans a heart attack usually refers to myocardial infarction . Myocardial infarction refers to death of the cells in an area of the heart muscle or myocardium. Cell death is usually due to oxygen deprivation caused by obstruction of the coronary blood vessels that supply blood to the heart muscles. Heart attacks are rare in dogs but unexpected and sudden death in dogs diagnosed with any form of heart disease is possible.

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    Pacemakers And Other Devices

    The heart has its own electrical system that regulates the heartbeat. With every heartbeat, there’s an electrical signal that travels through your heart, causing it to contract and pump blood around the body.

    For some people with heart failure, the electrical system doesnt work properly. People with heart failure have an increased risk of abnormal heart rhythms , like atrial fibrillation. If you have an abnormal heart rhythm, you may need a pacemaker or device to regulate the heart rate and rhythm.

    When To Get Medical Advice

    See a GP if you experience persistent or gradually worsening symptoms of heart failure.

    Call 999 for an ambulance or go to your nearest A& E department as soon as possible if you have sudden or very severe symptoms.

    A number of tests can be used to help check how well your heart is working, including blood tests, an ECG and an echocardiogram.

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    Is Chf Due Mainly To Heart Valve Disease

    CHF is most commonly caused by valvular insufficiency. It is estimated that 80% of the canine CHF cases are caused by MVI. However, there are many other causes. Disease of the heart muscle , irregularities of rhythm, and narrowing of some of the major blood vessels can also cause CHF. Initially, MVI results in left-sided congestive heart failure. If left untreated, the heart failure may progress to involve both sides of the heart.

    What Medications Should I Avoid If I Have Heart Failure

    An Osmosis Video: Congestive Heart Failure (CHF) Explained

    There are several different types of medications that are best avoided in those with heart failure including:

    • Nonsteroidal anti-inflammatory medications such as Motrin or Aleve. For relief of aches, pains, or fever take Tylenol instead.
    • Most calcium channel blockers
    • Some nutritional supplements, such as salt substitutes, and growth hormone therapies
    • Antacids that contain sodium

    If youâre taking any of these drugs, discuss them with your doctor.

    Itâs important to know the names of your medications, what theyâre used for, and how often and at what times you take them. Keep a list of your medications and bring them with you to each of your doctor visits. Never stop taking your medications without discussing it with your doctor. Even if you have no symptoms, your medications decrease the work of your heart so that it can pump more effectively.

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    Sleep Apnea And Heart Failure

    People who have sleep apnea experience interruptions in breathing that can last 10 seconds or more and occur repeatedly throughout the night, as many as 30 times or more in the span of an hour.

    This chronic disruption of the normal sleep cycle can leave individuals with the condition feeling exhausted and sleepy during the day, and it will put them at an increased risk of health problems associated with inadequate sleep, including irritability, problems with memory or concentration, anxiety, and depression.

    Sleep apnea is commonly found in people with heart failure.

    How Is Congestive Heart Failure Treated

    Doctors will assess the current health status of the patient to establish a baseline, and develop a long-term health plan. This may involve the optimization of medicines and therapies, adding new medication, or possibly enrollment in a clinical trial.

    Stabilizing and/or reversing a patients condition often involves long-term, collaborative follow-up with a referring cardiologist or physician.

    In serious situations, advanced therapies, which include mechanical solutions, a heart transplant, or hospice, may be offered.

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    How Is Heart Failure Treated

    Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every treatment plan. Your healthcare provider will talk to you about the best treatment plan for you. Treatment is the same, regardless of gender.

    As heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you cant move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure.

    Stage A treatment

    The usual treatment plan for people with Stage A heart failure includes:

    • Regular exercise, being active, walking every day.
    • Stopping the use of tobacco products.
    • Treatment for high blood pressure .
    • Treatment for high cholesterol.
    • Not drinking alcohol or using recreational drugs.
    • Angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
    • Beta-blocker if you have high blood pressure.

    Stage B treatment

    The usual treatment plan for people with Stage B heart failure includes:

    Stage C treatment

    The usual treatment plan for people with Stage C HF-rEF includes:

    If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.

    Stage D treatment

    Congestive Heart Failure Drugs

    Congestive Heart Failure

    There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.

    ACE inhibitors

    Angiotensin-converting enzyme inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cant tolerate ACE inhibitors.

    You may be prescribed one of the following:

    voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall.

    ACE inhibitors shouldnt be taken with the following medications without consulting a doctor, because they may cause an adverse reaction:

    • Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene , eplerenone , and spironolactone .
    • Nonsteroidal anti-inflammatory drugs .NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitors effect on your blood pressure.

    Beta-blockers

    This may be achieved with:

    Diuretics

    Your doctor may recommend:

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    Acute Decompensated Heart Failure

    Heart failure
    Acute interstitial pulmonary edema. Note enlarged heart size, apical vascular redistribution , and small bilateral pleural effusions .
    Cardiology

    Acute decompensated heart failure is a sudden worsening of the signs and symptoms of heart failure, which typically includes difficulty breathing , leg or feet swelling, and fatigue. ADHF is a common and potentially serious cause of acute respiratory distress. The condition is caused by severe congestion of multiple organs by fluid that is inadequately circulated by the failing heart. An attack of can be caused by underlying medical illness, such as myocardial infarction, an abnormal heart rhythm, infection, or thyroid disease.

    Treatment consists of reducing the fluid level with diuretics and improving heart function with nitrates, or levosimendan other treatments such as aquapheresis ultra-filtration may also be required.

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