Congestive Heart Failure Exacerbation

Initial Actions And Primary Survey

Similar to other patients in the Emergecny Department initial actions include establishing IV access,provding supplimental O2 as needed, and vital sign monitor. These patients may require ECG and CXR

If 100% O2 by non-rebreather fails to increase O2 saturation to at least 95%, noninvasive oxygenation/ventilation such as CPAP or BiPAP may assist in correcting hypoxia. If there is a failure to improve oxygenation, if the patient cannot tolerate the mask, or has a decline in mental status such that they are unable to protect their airway, then endotracheal intubation is required. The use of NIPPV used early can improve work of breathing as well as oxygenation, however caution should be taken as increased intra-thoracic pressure can reduce preload and worsen hypotension.

Hypotension can be difficult to manage in this patient population secondary to existing fluid overload. Early vasopressor support may be needed. Frequently patients with CHF exacerbation with present with significant hypertension. Nitroglycerin can be a useful medication in helping to reduce preload and reduce progression of pulmonary edema.

Outlook For Heart Failure

Heart failure is a serious long-term condition that will usually continue to get slowly worse over time.

It can severely limit the activities you’re able to do and is often eventually fatal.

But it’s very difficult to tell how the condition will progress on an individual basis.

It’s very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.

Weigh Yourself Each Day

Your doctor may recommend you do this to check whether you have any extra fluids. If you put on more than 2kg over a few days, your body is retaining fluid, not fat. Your doctor will help you work out your target weight this is your weight with no extra fluid, and is the weight at which your body and heart work best. Weigh yourself every morning each day at the same time . Use digital scales, and use these on a firm surface, eg, lino or tiles. Then record your weight on your heart failure action plan and remember to bring it with you to every appointment with your healthcare team.Other than weighing yourself, you also need to check for swelling. Check whether your rings, waistband, socks or shoes feel tighter. You can also press firmly into the skin of your ankle, shin and knee with your finger. If your finger makes a dent that doesnt quickly fill, you have swelling. You should also monitor any changes in your breathing. If you are more short of breath than usual or have more swelling, you are likely to retain more fluid. Follow the steps in your action plan as discussed with your healthcare team or contact your doctor if you are concerned about any aspect of your health.

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Surgery And Percutaneous Procedures

Surgery may be appropriate when certain underlying disorders are present. Surgery in patients with advanced HF should be done in a specialized center.

Surgical closure of congenital or acquired intracardiac shunts can be curative.

If HF is primarily due to a valvular disorder Overview of Cardiac Valvular Disorders Any heart valve can become stenotic or insufficient , causing hemodynamic changes long before symptoms. Most often, valvular stenosis or insufficiency… read more , valve repair or replacement should be considered. Patients with primary mitral regurgitation are more likely to benefit than patients with mitral regurgitation secondary to LV dilation, in whom poor myocardial function is likely to continue postoperatively. Surgery is preferably done before myocardial dilation and damage become irreversible. More recently, percutaneous mitral valve repair procedure, in which a clip is applied to approximate the anterior and posterior mitral leaflets, has been shown to reduce death and HF hospitalization in carefully selected patients with symptomatic HF despite optimal medical management and moderate to severe or severe mitral regurgitation with preserved LV size is a syndrome of ventricular dysfunction. Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid… read more ).

How Can I Care For Myself With Heart Failure

Managing heart failure well needs the input of your GP, who knows about any other health issues you have that affect health failure. Other healthcare team members that may be involved include a heart specialist, heart failure nurse, dietitian and pharmacist.

There are also things you can do to monitor and improve your symptoms, including:

• having a heart failure action plan
• weighing yourself each day at the same time

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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.

Facts About Heart Failure In The United States

• About 6.2 million adults in the United States have heart failure.1
• In 2018, heart failure was mentioned on 379,800 death certificates .1
• Heart failure costs the nation an estimated $30.7 billion in 2012.2 This total includes the cost of health care services, medicines to treat heart failure, and missed days of work.

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How Is A Flare

In hospital, your doctor will try to find out the cause of your flare-up by doing blood tests, an electrocardiogram , a chest x-ray or an echocardiogram .

Treatment of a flare-up depends on the cause. It may include:

• a higher dose of your diuretics by mouth or you may be given the medicine through a vein instead
• oxygen if your oxygen level is low
• nebulised bronchodilators to help open your airways
• antibiotics if you have an infection
• pain relief medicines if you have any pain
• treatment of heart attack such as aspirin if you have a heart attack.

Your healthcare team will let you know what is causing your flare-up and talk to you about the best treatment option for you.

Have A Healthy Body Weight

Losing weight if you are overweight helps takes the strain off your heart and can help you feel better. If you are underweight or have a poor appetite, having foods that are higher in calories and protein, or high-energy drinks, can help boost your energy. Ask your doctor, nurse or dietitian for advice on how to reach a healthy weight.

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Systolic And Diastolic Failure

Systolic and diastolic heart failure each result in a decrease in stroke volume. This leads to activation of peripheral and central baroreflexes and chemoreflexes that are capable of eliciting marked increases in sympathetic nerve traffic.

Although there are commonalities in the neurohormonal responses to decreased stroke volume, the neurohormone-mediated events that follow have been most clearly elucidated for individuals with systolic heart failure. The ensuing elevation in plasma norepinephrine directly correlates with the degree of cardiac dysfunction and has significant prognostic implications. Norepinephrine, while directly toxic to cardiac myocytes, is also responsible for a variety of signal-transduction abnormalities, such as downregulation of beta1-adrenergic receptors, uncoupling of beta2-adrenergic receptors, and increased activity of inhibitory G-protein. Changes in beta1-adrenergic receptors result in overexpression and promote myocardial hypertrophy.

What Tests Will I Need

Healthcare providers use a variety of tests to assess your symptoms, such as:

• Electrocardiogram to record and assess the hearts electrical activity.
• Chest X-ray to check for fluid build-up in the heart or lungs.
• Echocardiogram to show heart movement and blood flow.
• Angiography or heart catheterization to examine the hearts blood vessels.

You may also need lab tests that include:

• BNP blood test to check for hormones that occur when pressures change inside the heart.
• Basic metabolic panel which shows signs of kidney or thyroid issues.

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Atrial Natriuretic Peptide And B

ANP and BNP are endogenously generated peptides activated in response to atrial and ventricular volume/pressure expansion. ANP and BNP are released from the atria and ventricles, respectively, and both promote vasodilation and natriuresis. Their hemodynamic effects are mediated by decreases in ventricular filling pressures, owing to reductions in cardiac preload and afterload. BNP, in particular, produces selective afferent arteriolar vasodilation and inhibits sodium reabsorption in the proximal convoluted tubule. It also inhibits renin and aldosterone release and, therefore, adrenergic activation. ANP and BNP are elevated in chronic heart failure. BNP especially has potentially important diagnostic, therapeutic, and prognostic implications.

For more information, see the Medscape Drugs & Diseases article Natriuretic Peptides in Congestive Heart Failure.

What Should I Do If I Have A Flare

The best way to manage a heart failure flare-up is to have a heart failure action plan. A heart failure action plan is a written document that provides you with instructions and information on how to manage your heart failure on a daily basis, and how to recognise and cope with worsening symptoms.You can develop your heart failure action plan with your healthcare provider and fit the plan to suit how severe your heart failure is and your wishes. When you have a flare-up, follow the steps on your action plan as discussed with your healthcare provider. At each visit, you and your healthcare provider can review your plan and make adjustments as needed.

However, having an action plan doesn’t replace your doctor. It means you can respond quickly and recognise symptoms that require you to seek medical attention. You should still see your doctor as soon as possible after a flare-up. Tell your doctor or nurse if your symptoms don’t improve after following the steps on your action plan.

You may need to go to hospital for severe flare-ups.

See your doctor or go to the nearest emergency department if you or someone you care for has heart failure and experiences the following:
sudden chest pain that lasts more than a few minutes sweating and weakness increased swelling of your ankles or tummy.

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Heart Failure With Preserved Ejection Fraction

In diastolic heart failure , the same pathophysiologic processes occur that lead to decreased cardiac output in systolic heart failure, but they do so in response to a different set of hemodynamic and circulatory environmental factors that depress cardiac output.

In HFpEF, altered relaxation and increased stiffness of the ventricle occur in response to an increase in ventricular afterload . The impaired relaxation of the ventricle then leads to impaired diastolic filling of the left ventricle .

Morris et al found that right venticular subendocardial systolic dysfunction and diastolic dysfunction, as detected by echocardiographic strain rate imaging, are common in patients with HFpEF. This dysfunction is potentially associated with the same fibrotic processes that affect the subendocardial layer of the LV and, to a lesser extent, with RV pressure overload. It may play a role in the symptomatology of patients with HFpEF.

Information For Healthcare Providers On Heart Failure

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

The following information on heart failure is taken from Auckland Regional HealthPathways, NZ, accessed March 2021:

Practice point
Check new onset shortness of breath Unless history and physical examination clearly indicate a non-cardiac cause for their symptoms, evaluate all patients for heart failure who present with new onset shortness of breath on exertion, orthopnoea, or paroxysmal nocturnal shortness of breath.

The following information on managing exacerbations of heart failure is taken from Auckland Regional HealthPathways, NZ, accessed March 2021:

Red flags

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Look After Your Mental Health

You also need to look after your mental health. You might have lots of different feelings while coping with your symptoms, such as anxiety, stress or depression.

Try to avoid stressful situations. If you get stressed, use relaxation techniques such as taking 6 slow, deep breaths. Doing something where you feel useful and gain a sense of achievement can help you regain balance in your life. It also helps to have plenty of rest and get a good night’s sleep, as this allows your body and mind to restore. Talking to family/whnau members can also help. If you need more support, ask your healthcare team for a referral to a psychologist or counsellor.

How Is Acute Heart Failure Diagnosed

Healthcare providers perform a rapid assessment that includes:

• Your health history, including your personal or family history of heart disease. Theyll want to know about other health conditions like whether you use tobacco products and any medications you take.
• A physical exam to learn more about your symptoms and how severe they are. This includes listening to your heart and checking for signs of edema.

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About Congestive Heart Failure

Heart failure, sometimes called congestive cardiac failure , is a condition in which the heart muscle is weakened and cant pump as well as it usually does. The main pumping chambers of the heart can change size and thickness, and either cant contract or cant relax as well as they should. This triggers fluid retention, particularly in the lungs, legs and abdomen.

The major causes of heart failure include coronary heart disease and heart attack, high blood pressure, damage to the heart muscle , heart valve problems and abnormal heart rhythms. Of these, coronary heart disease and heart attack are the most common causes.

The major factors that contribute to coronary heart disease include:

• reduced emotional and social wellbeing
• physical inactivity.

Heart failure is more common in elderly people. The survival rate for people with this disorder depends on the severity of their condition.

Most common treatments for heart failure are medications and self-managed lifestyle changes. Some less-common treatments may require insertion of implantable cardiac devices or valve replacement.

Who Experiences Acute Heart Failure

Acute heart failure occurs in people with or without previous heart issues:

• Acute decompensated heart failure occurs in people with heart conditions, such as coronary artery disease.
• De novo acute heart failure occurs in people with no history of heart disease. They have ongoing health conditions, like diabetes, that damage their heart.

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Key Points About Heart Failure

Heart failure means your hearts pumping action is getting weaker. It doesnt mean your heart is about to stop.

There are many conditions that can cause heart failure.

Symptoms develop slowly and can vary. They include shortness of breath, swelling of your ankles, legs or tummy, tiredness and being less able to exercise. Your sleep may be disturbed.

Symptoms can get worse and become particularly severe during a flare-up .

Heart failure can’t be cured, but there are treatments to help manage it.

There are many things that you, your family/whnau and your healthcare team can do to help you feel better and stay well for as long as possible.

See your doctor or go to the nearest emergency department if you or someone you care for has heart failure and experiences the following:
sudden chest pain that lasts more than a few minutes sweating and weakness increased swelling of ankles or abdomen coughing for no reason.

What Medications Should I Avoid If I Have Heart Failure

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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Receive The Best Care For Your Heart And Stay Safe With Dispatchhealth

Anyone with a history of heart disease knows the stress associated with this condition. What seems like minor symptoms for others, such as fatigue, can be especially scary when youre constantly on the lookout for symptoms related to your illness. When it comes to your heart, you should be assessed if you think something is wrong. DispatchHealth offers a better solution than travelling to an urgent care facility for non-life-threating situations. When heart failure exacerbations occur, DispatchHealth will come to you and evaluate the situation. Our experienced medical staff has the ability to use an EKG to assess heart rhythms and develop a treatment plan. To schedule an appointment, you can call, click here, or download our app.

If this is an emergency, please call 911 or go to the nearest emergency department.

What Is Chf Exacerbation

CHF, or congestive heart failure, is a chronic heart condition in which the heart isnt able to meet the bodys demand for oxygen. Individuals with CHF could experience shortness of breath, swelling, fatigue, or irregular heartbeats as a result of their condition. These symptoms may flare up during a CHF exacerbation, which is a temporary but dangerous worsening of symptoms. Lets dive into CHF exacerbation what causes it and how to treat it.

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