B Physical Examination Tips To Guide Management
The physical exam may be used to assess the response to therapy and guide management.
Blood pressure should be carefully followed, though with the advent of improved noninvasive monitoring, invasive arterial lines are rarely necessary. Hypotension has been associated with poor outcomes in the setting of AHF, and iatrogenic hypotension should be assiduously avoided. Hypertension can be one of the major precipitants of AHF and should be treated.
Heart rate is often a reflection rather than a cause of the AHF episode, and the initial tachycardia often improves in conjunction with the improvement in dyspnea. However, atrial fibrillation with rapid ventricular response is a well-known precipitant of AHF.
Tachycardia may occur due to the positive chronotropic effects of some drugs , excessive volume depletion, or the onset/ worsening of atrial and ventricular arrhythmias, especially atrial fibrillation. Bradycardia is less common and may be due to excess beta-blocker therapy.
Respiratory rate is often not as carefully assessed clinically, and may not be as reliably sensitive to therapy as other vital signs. Tachypnea may represent inadequate resolution of the initial episode of dyspnea or a new event, such as a pulmonary embolus. Fever is suggestive of underlying infectious process, particularly pneumonia or urinary tract infections, both of which can instigate AHF exacerbations.
Monitor Your Blood Pressure
Your doctor may also want you to keep track of your blood pressure, because over time, high blood pressure can put a strain on your heart, which causes the muscle to weaken and work less efficiently, according to Mayo Clinic. You can easily check your blood pressure from your kitchen with a home blood pressure monitor. Ask your doctor or nurse for advice on which monitor is best for you and how to use it. The AHA recommends using an automatic cuff-style biceps monitor. As with your weight, record your blood pressure and show your readings to your doctor at your appointments. If your pressure rises, your doctor may need to see you sooner than planned.
B What’s The Evidence For Specific Management And Treatment Recommendations
There are three main guidelines that address the treatment of patients with acute heart failure:
Lindenfeld, J, Albert, NM, Boehmer, JP. âHFSA 2010 comprehensive heart failure practice guidelineâ. J Card Fail. vol. 16. 2010. pp. e1-194. , and is updated.)
Hunt, SA, Abraham, WT, Chin, MH. â2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the International Society for Heart and Lung Transplantationâ. J Am Coll Cardiol. vol. 53. 2009. pp. e1-e90. was a new addition to this set of guidelines.)
McMurray, JJ, Adamopoulos, S, Anker, SD. âESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESCâ. Eur Heart J. 2012. (The ESC had an independent set of guidelines for AHF in 2005, which were incorporated into, and updated in, the 2008 and 2012 documents.
It should be noted that there is very limited clinical trial evidence upon which these guidelines are based. However, there are some central articles that inform current practice and perspectives, a brief selection of which follows with annotations:
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Case : Anemia With Functional Id In A Patient With Hf
The patient described in case 1 returned 2 years later. He had been getting more dyspneic and easily fatigued and required an extra dose of furosemide 40 mg every few days. LVEF had worsened to 20%. There was no history of bleeding stool sample was negative for occult blood. There was no history of acute or chronic infections, autoimmune diseases, malignancies, or recent trauma. His blood pressure was 108/70 mm Hg pulse was 70 bpm, and there were no signs of fluid retention.
Laboratory investigations confirmed anemia . The MCV, WBC, differential and platelet counts, serum creatinine, B12, and folate levels remained normal. Iron parameters now showed TSAT at 14% and ferritin level at 200 g/L. Peripheral blood smear examination showed normocytic anemia, but no other morphological abnormalities. The electrocardiogram and CXR remained unchanged. HF medications included carvedilol 25 mg twice daily, spironolactone 25 mg/d, sacubitril-valsartan 97/103 mg twice daily, and furosemide 40 mg twice daily, and an extra dose whenever required.
What Are The Stages Of Heart Failure
Heart failure is a chronic long-term condition that gets worse with time. There are four stages of heart failure . The stages range from “high risk of developing heart failure” to “advanced heart failure,” and provide treatment plans. Ask your healthcare provider what stage of heart failure you are in. These stages are different from the New York Heart Association clinical classifications of heart failure that reflect the severity of symptoms or functional limits due to heart failure.
As the condition gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. You cannot go backwards through the stages. For example, if you are in Stage B, you cannot be in Stage A again. The goal of treatment is to keep you from progressing through the stages or to slow down the progression.
Treatment at each stage of heart failure may involve changes to medications, lifestyle behaviors and cardiac devices. You can compare your treatment plan with those listed for each stage of heart failure. The treatments listed are based on current treatment guidelines. The table outlines a basic plan of care that may apply to you. If you have any questions about any part of your treatment plan, ask a member of your healthcare team.
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Signs Symptoms And Complications
Symptoms of heart failure depend on the type of heart failure you have and how serious it is. If you have mild heart failure, you may not notice any symptoms except during hard physical work. Symptoms can depend on whether you have left-sided or right-sided heart failure. However, you can have symptoms of both types. Symptoms usually get worse as your heart grows weaker.
Heart failure can lead to serious and life-threatening complications.
A Appropriate Prophylaxis And Other Measures To Prevent Readmission
An episode of AHF often can be seen as representing a failure of outpatient CHF management. It is imperative that this admission be viewed as an opportunity to prevent future decompensations through active education handouts and checklists without individual instruction are rarely effective. This education should include, but not be limited to, instruction on:
Low-salt and weight loss diets
Daily use of a scale and a mechanism to record body weights, including directions on the specific actions to take in the event of a change in body weight
Self-titration of diuretics, in appropriate patients. For example, if weight increases by 3 to 5 lb above baseline, double the diuretic dose for 3 to 5 days. If body weight returns to baseline, resume prior dose of diuretics. If symptoms of hypotension ensue, hold diuretics, and if the symptoms of hypotension do not resolve, call care provider. If weight does not improve or if increasing symptoms of dyspnea or other symptoms of congestion, call a care provider.
Chronic heart failure management programs, if available
Exercise or rehabilitation program
Other health-related issues such as smoking cessation
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How To Treat Heart Disease
This article was medically reviewed by Dale K. Mueller, MD. Dr. Mueller is a Cardiothoracic Surgeon with the Cardiothoracic & Vascular Surgical Associates group in Jacksonville, Florida. Dr. Mueller has over 25 years of experience as a surgeon and he completed his fellowship at Rush-Presbyterian-St. Luke’s Medical Center in 1999. Dr. Mueller is a member of the Society of Thoracic Surgeons, Cook County Alumni Association, and Rush Surgical Society. He is board certified by the American Board of Surgeons.There are 21 references cited in this article, which can be found at the bottom of the page. This article has been viewed 22,075 times.
Heart disease causes more deaths in the United States each year than any other medical condition. While there is no cure for heart disease, there are many methods available for managing its symptoms. Whether you change your lifestyle, take medication, or opt for surgery, taking control of your heart health is an important step in fighting your heart disease.
Angiotensin Converting Enzyme Inhibitors
ACE inhibitors relax and widen your blood vessels. This helps to improve the flow of blood around your body, which reduces the amount of work your heart has to do.
ACE inhibitors have been shown to improve the symptoms of heart failure, reduce the need for hospital admission and improve life expectancy caused by heart failure.
Your symptoms should improve within a few weeks of starting treatment.
The main side effects of ACE inhibitors are dizziness and a cough. You will need to have regular blood tests, at least once every year, while taking an ACE inhibitor.
If you are taking an ACE inhibitor, you should check with your doctor or pharmacist before taking any other medicines. In particular, nonsteroidal anti-inflammatory medicines should not be taken with an ACE inhibitor. You should also avoid products containing high levels of potassium, such as salt substitutes.
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Discuss Weight Monitoring With The Professional:
During the treatment for heart failure, it is important to monitor your weight carefully. You can ask your doctors or the professional to help. Weight gain can make the symptoms of heart failure and renal failure worse. It also can lead to some serious problems which are accompanied with heart disease. When you gain weight, it means that you retain fluids. If it happens, it is time for you to change your treatments.
Types Of Heart Failure
The types of heart failure are classified by the ejection fraction , which is the percentage of blood pumped out by the heart with each beat and is a measure of how well the heart is pumping. A normal left ventricle ejects about 55 to 60% of the blood in it.
In heart failure with reduced ejection fraction :
The heart contracts less forcefully and pumps out a lower percentage of the blood that is returned to it. As a result, more blood remains in the heart. Blood then accumulates in the lungs, veins, or both.
In heart failure with preserved ejection fraction :
The heart is stiff and does not relax normally after contracting, which impairs its ability to fill with blood. The heart contracts normally, so it is able to pump a normal proportion of blood out of the ventricles, but the total amount pumped with each contraction may be less. Sometimes the stiff heart compensates for its poor filling by pumping out an even higher proportion of the blood than it normally does. However, eventually, as in systolic heart failure, the blood returning to the heart accumulates in the lungs or veins.
Heart failure with mid-range ejection fraction is a newer concept that includes people whose ejection fraction is somewhere between preserved and reduced ejection fraction.
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Stage D And Reduced E
Patients with Stage D HF-rEF have advanced symptoms that do not get better with treatment. This is the final stage of heart failure.
Stage D treatment
The usual treatment plan for patients with Stage D heart failure includes:
- Treatments listed in Stages A, B and C.
- Evaluation for more advanced treatment options, including:
- Heart transplant.
- Research therapies.
Get Support And Know Your Options
Living with heart failure may cause fear, anxiety, depression, and stress. Talk to your healthcare team or a professional counselor. They can help you find or learn ways to cope.
- Get treatment for depression. If you are depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
- Join a patient support group. You can learn how other people who have similar symptoms have coped with them. Your doctor may be able to help you find local support groups, or you can check with an area medical center.
- Seek support from family and friends. Letting your loved ones know how you feel and what they can do to help can help lower your stress and anxiety.
- Know your treatment options. If your heart failure is very serious, palliative or hospice care can improve your quality of life and help make your daily life more comfortable. This type of care focuses on managing your symptoms, helping you avoid unnecessary tests or treatments, and providing support to your loved ones.
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Is There A Treatment For Heart Failure
There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.
The goals of treating heart failure are to try to keep it from getting worse , to ease symptoms, and to improve quality of life.
Some common types of medicines used to treat it are:
- ACE inhibitors
- Aldosterone antagonists
- Selective sinus node inhibitors
- Soluble guanylate cyclase stimulator
Your doctor may also recommend a program called cardiac rehabilitation to help you exercise safely and keep up a heart-healthy lifestyle. It usually includes workouts that are designed just for you, education, and tips to lower your chance of heart trouble, like quitting smoking or changing your diet.
Cardiac rehab also offers emotional support. You can meet people like you who can help you stay on track.
If You Have Fluid Retention
Diuretics. Diuretics such as furosemide and torsemide help the body eliminate excess fluid that can cause swelling or shortness of breath. Although the reasons why heart disease impairs the body’s ability to maintain fluid balance are complex, most people who require a diuretic need it indefinitely. “This is one of the most important drugs to individualize, since the optimal dose can vary from 10 milligrams to 400 mg a day, depending on how well the kidneys are working,” says Dr. Stevenson.
Additional Drugs To Consider
Hydralazine-nitrate. This combination of blood pressurelowering medications can be added when someone taking an ACE inhibitor or ARB plus a beta blocker continues to have severe symptoms. The combination was studied extensively in African Americans with heart failure, many of whom experienced increased survival and quality of life and a decrease in the number of hospitalizations. Since that time, it has proved useful in people of other races.
Eplerenone or spironolactone. These agents primarily decrease the formation of abnormal fibers that make the heart stiffer and less elastic, although they also help eliminate excess fluid. People who take these drugs are at higher risk for developing very high potassium levels, which can be fatal. Kidney function must be carefully reviewed before either agent is prescribed, and both kidney function and potassium levels must be monitored during therapy.
Heart Failure Treatment Is A Team Effort
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
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Diagnosis And Treatment Of Congestive Heart Failure In Dogs
Heart disease may be discovered after a routine examination reveals a heart murmur. Although most dogs in congestive heart failure will show some signs of illness, early disease may not be apparent until the veterinarian listens to the heart.
If your dog has already been diagnosed with some form of heart disease, then it is extremely important to see your primary vet or veterinary cardiologist regularly to monitor the progression of the heart disease. Signs of CHF may be detected before outwards signs are present.
Diagnostic tests used to detect and monitor heart disease include the electrocardiogram , echocardiogram , and thoracic radiographs . Your vet will need to periodically repeat these tests to assess the severity of heart disease.
Treatment of CHF is aimed at managing the underlying heart disease and reducing fluid accumulation. Several different medications are typically used to treat heart disease and may need to be adjusted when CHF develops. Surgery may be recommended if there is a structural abnormality in the heart that can be repaired. A low-sodium diet can also be helpful.
Most cases of left-sided CHF are treated with diuretics. Other heart medications may be used as well.
What You Need To Know
- Cardiomyopathy, a name for any disease of the heart muscle, is one condition that often leads to heart failure.
- Symptoms of heart failure include shortness of breath, swelling in the legs and feet, and abdominal pain or nausea.
- Diagnosis includes tests for the existence of heart failure, followed by tests to evaluate the cause of the heart failure.
- Treatment for heart failure begins with lifestyle changes and medications. In more advanced cases, surgery may be needed.
- People can and do live with heart failure. Close self-monitoring and sticking to the doctors recommended diet, medication and exercise plans are essential to improving quality of life.
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