Changes In The Body Systems Caused By Congestive Heart Failure
The inability of heart muscles to pump the blood properly leads to the significant negative changes in body systems caused by decreased blood flow to the vital organs and fluid retention:
- The respiratory body system is usually affected first Congestive heart failure due to the congestion of the lungs. The fluid starts to backup in the lungs and obstructs the normal functioning of the system such changes result in shortness of breath, cough, wheezing, etc.
- Muscular body system is also directly influenced by Congestive heart failure as less blood delivered to the muscles leads to persons feelings of weakness and tiredness
- Nervous body system can also be harmed by the consequences of Congestive heart failure, and less blood delivered to the brain leads to problems with its functioning resulting in confusion, dizziness, etc.
Types Of Heart Failure
The main types of heart failure are named for where they occur in the heart:
- Left-sided heart failure
- Biventricular heart failure
Clinicians also may classify heart failure as:
- Acute: You have active symptoms of heart failure, with either a new diagnosis or with long-term heart failure.
- Chronic: You have a history of heart failure, but your condition is relatively stable with no symptoms or with manageable symptoms.
How Is Heart Failure Diagnosed
Your doctor will ask you many questions about your symptoms and medical history. Youâll be asked about any conditions you have that may cause heart failure . Youâll be asked if you smoke, take drugs, drink alcohol , and about what drugs you take.
Youâll also get a complete physical exam. Your doctor will listen to your heart and look for signs of heart failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.
Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:
Other tests may be ordered, depending on your condition.
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A What Is The Differential Diagnosis For This Problem
Heart failure has been classified according to various different criteria: etiology, mechanism, stages, function and degree of compensation.
Etiologically, the most common predisposing conditions of Heart failure in the descending order of the population attributable risk are coronary artery disease, cigarette smoking, hypertension, obesity, diabetes and valvular heart disease. The less common ones include myocarditis, infiltrative disease, postpartum cardiomyopathy, HIV infection, substance abuse, drug-induced and others.
Patients with left ventricular dysfunction are often classified into two groups depending on their left ventricular ejection fraction : heart failure with reduced ejection fraction HFrEF or heart failure with preserved ejection fraction . Why is it important to categorise a patient with heart failure in this way? Most of the medications like B-blockers, ACE-inhibitors that have shown to improve survival in HF were studied in patients with reduced ejection fraction, whereas for patients with preserved ejection fraction, the management is mostly directed towards the underlying cause, for example, controlling hypertension in HFpEF from hypertensive heart disease.
The progressive nature of the HF has been classified into 4 stages by the American College of Cardiology Foundation/ American Heart Association:
Stage A: High risk for HF but without structural heart disease or HF symptoms
Stage B: Structural heart disease but without history of HF signs or symptoms
Surgical Options To Treat Underlying Causes Of Heart Failure
- Coronary artery bypass graft to prevent and treat heart failure caused by blocked arteries. During bypass surgery, blood vessels taken from another part of the body usually the leg are attached to the clogged artery to create a detour around the blockage. This is conventionally done through open-heart surgery, but some patients may be candidates for minimally invasive CABG, an alternative offered at UCSF.
- Angioplasty, another treatment for blocked arteries. A thin flexible tube called a catheter is inserted through a small incision in the groin or neck into a blood vessel. In one procedure, a balloon is introduced through the catheter into the center of a blocked blood vessel. When the balloon is inflated, the blockage material is compressed back against the walls of the artery. A small metal device, called a stent, may be inserted through the catheter to serve as a permanent barrier to keep the plaque compressed. In another type of procedure, instruments are introduced through the catheter to remove the plaque.
- Implantation of pacemakers and other devices such as artificial heart valves
- Repairing congenital heart defects
Surgical treatments for heart failure itself include:
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Your Heart Failure To
Eat a healthy diet. Limit the salt you eat to less than 1,500 milligrams each day. Eat foods high in fiber and potassium. Cut back on things high in saturated fat, cholesterol, and sugar. If you need to drop some weight, reduce the number of calories you eat.
Exercise regularly. A regular program that’s OK’d by your doctor will improve your symptoms and strength and make you feel better. It may also slow your heart failure.
Don’t overdo it. Plan out your activities and include rest periods during the day.
Prevent lung infections. Ask your doctor about flu and pneumonia vaccines.
Take your medications as prescribed. Don’t stop taking them without first asking your doctor. Even if you have no symptoms, the drugs help your heart pump better.
Get emotional or psychological support, if you need it. Don’t face things alone. Get the backing you need from social workers, psychologists, clergy, and support groups. Ask your doctor to point you in the right direction.
Other Drugs For Heart Failure
Many people with heart disease take either aspirin or clopidogrel . These drugs help prevent blood clots from forming in your arteries. This can lower your risk of a stroke or heart attack.
Coumadin is recommended for people with heart failure who have a higher risk for blood clots. You will need to have extra blood tests to make sure your dose is correct. You may also need to make changes to your diet.
Drugs used less commonly for heart failure include:
- Digoxin to help increase the heart’s pumping strength and slow the heart rate.
- Hydralazine and nitrates to open up arteries and help the heart muscle pump better. These drugs are mainly used by people who are unable to tolerate ACE inhibitors and angiotensin receptor blockers.
- Calcium channel blockers to control blood pressure or angina from coronary artery disease .
Statins and other cholesterol-lowering drugs are used when needed.
Antiarrhythmic medicines are sometimes used by heart failure people who have abnormal heart rhythms. One such drug is amiodarone.
Another medicine, Ivabradine , acts to lower the heart rate and may help people with heart failure by reducing the heart’s workload.
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Monitoring Congestive Heart Failure
If you are living with congestive heart failure, your doctor will help you determine the best way to monitor your condition and reduce your chance of future hospitalizations.
Self-Management SkillsDoctors recommend that people with congestive heart failure develop good self-management skills to help manage their conditions. These self-management skills include:
- Weighing yourself and recording your weight daily, reporting any gains of more than 2-3 pounds over two days or 4-5 pounds over one week to your doctor
- Following a low-sodium diet
- Taking all the medications your doctor prescribes
Your doctor can also provide recommendations for limiting your fluid intake, getting regular exercise, and quitting smoking, all of which can help manage your heart failure.
CardioMEMS HF SystemSelect patients may be eligible for the CardioMEMS HF System. Approved by the U.S. Food and Drug Administration in 2014, the system uses a small sensor implanted in your pulmonary artery and an external electronic system to transmit information directly to your doctor’s office.
With the CardioMEMS HF System, you take daily readings of our pulmonary artery pressure from home. The readings are delivered securely to your doctor’s office through an external electronic system, and can help your doctor determine if your condition is getting worse before you have symptoms. Your doctor can then adjust your medication or treatment plan and help you avoid hospitalization.
What Are The Symptoms Of Heart Failure
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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Imaging And Other Tests
Other tests provide pictures of the heart and surrounding structures or show how well the heart is working:
- Electrocardiogram : An electrocardiogram test uses small sensors to measure heart rate , rhythm and electrical impulses.
- Chest X-ray: A chest X-ray is a picture of your lungs, heart and surrounding structures. It can show whether there is fluid in your lungs from heart failure, or if your heart muscle is enlarged.
- Echocardiogram : Echocardiography uses sound waves to create images of your heart. It can show how thick the heart muscle has become, as well as measure ejection fraction.
- MRI: MRI is an advanced imaging test that takes pictures of the heart and surrounding structures. It helps determine your heart function and size and whether there are any changes in the heart muscle. A cardiac MRI may help your doctors identify causes of heart failure.
Medicines For Heart Failure
Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines.
Some of the main medicines for heart failure include:
- SGLT2 inhibitors
You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects.
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What Makes Yale Medicines Approach To Treating Congestive Heart Failure Unique
Yale Medicines team comprises heart failure cardiologists and cardiac surgeons, dedicated advanced-practice, registered nurses and nurse coordinators, dietitians, exercise physiologists, financial counselors, immunologists specializing in transplants, psychologists, and specialists in palliative care.
With a multidisciplinary approach, Yale Medicine physicians include the patients desires as well as input from the family to develop a comprehensive treatment plan that’s right for them.
Systolic Heart Failure Symptoms
The hallmark feature of systolic heart failure is shortness of breath, also called dyspnea.
A person with early systolic heart failure might get short of breath only when exercising. But a person with advanced systolic heart failure might have trouble breathing when simply walking across the room or even when resting.
Other signs of systolic heart failure are:
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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
Adverse Effects Of Digoxin
Adverse reactions to digoxin are usually dose dependent and occur at dosages higher than those needed to achieve a therapeutic effect. The actual incidence of digoxin toxicity may be lower than is historically reported.28 Adverse reactions are less common when digoxin is used in the recommended dosage range and careful attention is given to concurrent medications and medical conditions.
|Drugs that increase the serum digoxin concentration by reducing clearance or volume of distribution:|
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Practical Options To Maximize Target Dosing
While there is little to no evidence on what specific strategies work best, given the benefits of target dosing highlighted above, we propose practical considerations for providers. Although these strategies are largely empiric and require prospective validation, they hold promise. Every effort to maximize target dosing of HF therapy should be made as evidence suggests that target doses of at least select components of GDMT may reduce mortality and morbidity. Furthermore, more structured implementation and employment of a dedicated nurse facilitator may improve guideline-directed dose titration. In a small, randomized clinical trial, target dosing of beta-blockers was achieved to a greater extent over a median of 12 months in the nursing facilitator group compared with routine clinical practice. Although this study did not find utility of clinical reminders to patients and providers, new algorithms leveraging natural language processing in the electronic health records may allow for specific targeting of patients at suboptimal dosing regimens. In many cases, nurse- or pharmacist-driven dosing protocols can result in faster up-titration with more frequent visits and greater number of medication changes. This may partly relate to developing better patient rapport, improving recognition of common adverse drug-related effects, and appropriately responding to patient symptom reporting.
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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Surgery For Heart Failure
Your doctor may recommend surgery to implant a medical device that helps the heart function more effectively:
- Pacemaker, which maintains a steady heart beat in people with a slow or irregular heartbeat
- Implantable cardioverter defibrillator , which monitors the heart for fast rhythm and delivers an electrical shock to reset normal rhythm
- Left ventricular assist device , which takes over the pumping action of the heart
People with advanced heart failure may be candidates for heart transplantation. A heart transplant replaces the diseased heart with a donated heart from a person who has died.
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:
- Aldosterone antagonists
- Selective sinus node inhibitors
- SGLT2 inhibitor
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.
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Treating The Underlying Causes
A number of conditions can contribute to heart failure. Treatment of these other factors may range from surgery or angioplasty to open clogged blood vessels in patients with coronary artery disease to medications prescribed to control high blood pressure, diabetes, anemia or thyroid disease. In addition, it’s particularly important to treat abnormal heart rhythms called arrhythmias in patients with heart failure.
Digoxin In Patients With Preserved Left Ventricular Systolic Function
Much has been learned about the effective treatment of patients who have congestive heart failure associated with left ventricular systolic dysfunction. In contrast, little is known about how best to treat patients with preserved left ventricular systolic function.
As many as 30 percent of patients with congestive heart failure have a normal or nearly normal left ventricular ejection fraction. In these patients, congestive heart failure is often described as âleft ventricular diastolic dysfunction.â Left ventricular diastolic dysfunction is considered to be a diagnosis of exclusion in patients with congestive heart failure and preserved left ventricular systolic function.
Diagnostic tools such as radionuclide angiography and Doppler echocardiography have made it possible to identify patients who have normal or nearly normal left ventricular systolic function but abnormal left ventricular filling parameters. The majority of patients with congestive heart failure who have only diastolic dysfunction have no identified diagnosis. Most of these patients are elderly or have a history of hypertension. Some patients have coronary artery disease without extensive scar tissue. Such patients also commonly have diabetes mellitus.
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