Monday, October 3, 2022

Treating Congestive Heart Failure

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How Does Heart Failure Affect The Quality Of Life And Lifestyle

Treatment of Congestive Heart Failure (CHF)

With the right care and treatment plan, many adults still enjoy life even though heart failure limits their activities. How well you feel depends on:

  • How well your heart muscle is working.
  • Your symptoms.
  • How well you respond to your treatment plan.
  • How well you follow your treatment plan.

This includes caring for yourself by:

  • Taking your medications.
  • Tracking and reporting new or worsening symptoms to your provider.
  • Keeping regular follow-up appointments with your healthcare provider.

Because heart failure is a chronic, long-term illness, talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know what you want. A living will details the treatments you do or dont want to prolong your life. Its a good idea to prepare a living will while you are well in case you arent able to make these decisions at a later time.

A note from Cleveland Clinic

If you have heart failure, you can take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments and track your symptoms. Talk to your healthcare provider about questions or concerns you have about your medications, lifestyle changes or any other part of your treatment plan.

References

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.

What Medications Are Available To Improve Heart Function

Although diuretics are the first-line agents for congestive heart failure, digoxin is first-line in people who also have atrial fibrillation.

According to Medscape, digoxin produces a small improvement in cardiac output by strengthening the heart muscles. Side effects of digoxin can be serious if dosing is too high.

According to Uptodate, digoxin poisoning can result in life-threatening cardiac arrhythmias, nausea, vomiting, abdominal pain, confusion, delirium, weakness, and electrolyte imbalances.

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What Is Heart Failure

Heart failure doesnât mean the heart has stopped working. Rather, it means that the heart works less efficiently than normal. Due to various possible causes, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart canât pump enough oxygen and nutrients to meet the body’s needs.

The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. The kidneys may respond by causing the body to retain fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.

Pharmacological Management Of Heart Failure

Congestive heart failure

Drugs used in heart failure include those used to initially manage mild to moderate failure and those used more commonly in severe to very severe conditions.

First Agents Used:

  • ACE Inhibitors: work by increasing vasodilation and decreasing workload of the heart in patients with CHF.
  • Diuretics: promote the removal from the body of excess water, salts, poisons, and accumulated metabolic products, such as urea. See also Aldosterone Receptor Antagonists
  • Glycosides and Congestive Heart Failure: a class of drugs that includes digoxin, digitoxin and ouabain. Such agents increase the force of contraction of the heart which underlies their use in some cases of heart failure.
  • Beta-Blockers : decrease the excessive activity of the sympathetic nervous system which is characteristic of CHF.
  • Selection of agents and their combinations depend on initial clinical state and on patient responsiveness to initial therapy

    Additional Agents:

  • More aggressive diuretic therapy eg Loop diuretics such as Furosemide , one of the most commonly used drugs in the treatment edema caused by congestive heart failure .
  • Vasodilators
  • Selection of agents and their combinations depend on initial clinical state and on patient responsiveness to initial therapy.

    An implantable cardioverter-defibrillator is indicated for primary prevention of sudden cardiac death in patients with HF who have an LVEF of less than or equal to 35%.

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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.

    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:

    • ACE inhibitors
    • hydralazine with nitrate
    • digoxin

    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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    Stage C Treatment Options

    Treatment at this stage focuses on managing your symptoms, optimizing your heart function, and preventing worsening of your condition.

    Medications to treat stage C heart failure include:

    • Diuretics to reduce fluid retention
    • Beta blockers to help make your heart work less hard
    • SGLT2 inhibitors to reduce the risk of cardiovascular death and hospitalization for heart failure
    • Angiotensin-converting enzyme inhibitors
    • Angiotensin II receptor blockers
    • Entresto , which reduces the risk of death and hospitalization among patients with chronic heart failure
    • Aldosterone antagonists
    • Digoxin to help the heart beat stronger and more regularly
    • Possible cardiac resynchronization therapy
    • Possible implantable cardiac defibrillator therapy

    In addition to the lifestyle changes for stages A and B, you may need to make the following changes:

    • Reduce your sodium intake
    • Restrict fluid intake
    • Keep track of your weight daily

    Remember that even if the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression of your condition to stage D.

    Congestive Heart Failure: Prevention Treatment And Research

    Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2

    Congestive heart failure is a serious condition in which the heart doesnt pump blood as efficiently as it should. Despite its name, heart failure doesnt mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it cant keep up with the bodys demand, and blood returns to the heart faster than it can be pumped outit becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the bodys other organs.

    The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contractsbut over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they dont receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse.

    More than 5 million people in the United States have congestive heart failure. Its the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause.

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    How Can I Improve My Quality Of Life With Heart Failure

    There are several things you can do to improve your quality of life if you have heart failure. Among them:

    • Eat a healthy diet. Limit your consumption of sodium to less than 1,500 milligrams each day. Eat foods high in fiber. Limit foods high in trans fat, cholesterol, and sugar. Reduce total daily intake of calories to lose weight if necessary.
    • Exercise regularly. A regular cardiovascular exercise program, prescribed by your doctor, will help improve your strength and make you feel better. It may also decrease heart failure progression.
    • Don’t overdo it. Plan your activities and include rest periods during the day. Certain activities, such as pushing or pulling heavy objects and shoveling may worsen heart failure and its symptoms.
    • Prevent respiratory infections. Ask your doctor about flu and pneumonia vaccines.
    • Take your medications as prescribed. Do not stop taking them without first contacting your doctor.
    • Get emotional or psychological support if needed. Heart failure can be difficult for your whole family. If you have questions, ask your doctor or nurse. If you need emotional support, social workers, psychologists, clergy, and heart failure support groups are a phone call away. Ask your doctor or nurse to point you in the right direction.

    How Can I Prevent Heart Failure

    You can prevent heart failure by preventing coronary heart disease and heart attack. The best way to do this is to reduce or eliminate the risk factors that lead to heart failure. You could:

    If you have had a heart attack, its even more important to manage your risk factors and follow your treatment plan. Make sure you check in frequently with your healthcare team.

    Some risk factors such as your age, whether you have other health conditions, or your genes may be outside your control. Speak with your doctor if you have concerns about developing heart failure, and how you can manage it.

    Read Also: How Do Heart Rate Monitors Work

    Our Favorite Online Support Groups

    Sponsored by the American Association of Heart Failure Nurses, this online support community for anyone who has been affected by heart failure allows you to connect with others and to hear from real medical experts. There is also a resource section that has information on things like low-salt cookbooks and patient tips for getting through the holidays.

    This network has tracks for various heart conditions, where you can post questions, share your story, and learn more about your condition. Once you sign up to become a part of the community, you will receive personalized content based on your condition and concerns.

    What Kind Of Diet That Is Healthy For Your Heart

    Congestive Heart Failure : Symptoms, Causes, and Treatment

    Eat foods that are low in saturated fat, trans fat, sodium, and cholesterol. These nutrients tend to raise blood pressure and increase the risk of blood clots, both which can be detrimental to heart health.

    The DASH diet published by the American Heart Association for managing blood pressure recommends plenty of fruits, vegetables, whole-grains, nut and legumes, low-fat dairy products, skinless chicken and fish, and vegetable oils. Red meats and sweetened foods and beverages should be limited.

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    What Are The Treatment Options For Congestive Heart Failure

    According to the American Heart Association, main treatment options for congestive heart failure include lifestyle modification, monitored cardiac rehabilitation, prescription medications, electronic heart implants, and surgical procedures. This article will explain in detail the specific treatment options in these broad categories.

    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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    What Is The Importance Of Ejection Fraction

    Your ejection fraction is one way to measure the severity of your condition. If its below normal, it can mean that you have heart failure. Your ejection fraction tells your healthcare provider how good of a job your left or right ventricle is doing at pumping blood. Usually, your EF number is talking about how much blood your left ventricle is pumping out because its your heart’s main pumping chamber.

    Several non-invasive tests can measure your EF. With this information, your healthcare provider can decide how to treat you or find out if a treatment is working as it should.

    A normal left ventricular ejection fraction is 53% to 70%. An LVEF of 65%, for example, means that 65% of the total amount of blood in your left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.

    How Much Alcohol Can You Drink If You Have Congestive Heart Failure

    Congestive Heart Failure: Symptoms, Causes, and Treatment Options – St. Mark’s Hospital

    Alcohol increases the risk of high blood pressure, which can exacerbate congestive heart failure. Therefore, people with congestive heart failure should drink alcohol in moderation.

    The American Heart Association recommends limiting alcohol to 1 drink per day for women and 1-2 drinks per day for men.

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    Treatment And Medication Options For Congestive Heart Failure

    Heart failure is a chronic condition, and there is no cure. However, once youve been diagnosed, there are several things you can do to treat the condition and manage it so that it does not progress. Chief among them are lifestyle changes. That includes exercising and maintaining a heart-healthy diet thats low in saturated fat, trans fats, and cholesterol.

    Can Surgery Be Used To Treat Heart Failure

    In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart’s function. Procedures used include:

    • Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is . Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.
    • Heart valve surgery. Diseased heart valves can be treated both surgically and non-surgically .
    • Implantable left ventricular assist device . The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.
    • Heart transplant. A heart transplant is considered when heart failure is so severe that it doesn’t respond to all other therapies, but the person’s health is otherwise good.

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    Epidemiology Of Congestive Heart Failure And Evolution Of Treatment

    Congestive heart failure continues to be a major health problem. Despite significant advances in the prevention and treatment of cardiovascular diseases, the incidence and prevalence of congestive heart failure have been increasing in recent years. Contributing factors include increased survival in patients with coronary artery disease , an aging population and significant advances in the control of other potentially lethal diseases.

    In the past two decades, the treatment of congestive heart failure has evolved and is now directed at the attenuation of neurohormonal activation using angiotensin-converting enzyme inhibitors, beta blockers7 and, more recently, spironolactone .8 Because neurohormonal antagonists have been shown to prolong survival in patients with congestive heart failure,8â11 the role of digoxin has become less certain.

    What Causes Heart Failure

    MNEMONIC

    Heart failure is caused by many conditions that damage the heart muscle, including:

    • Coronary artery disease.Coronary artery disease , a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
    • Heart attack. A heart attack happens when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesnât work the way it should.
    • Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
    • Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can happen when several diseases or conditions are present at once.

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