Wednesday, February 1, 2023

Treatment Congestive Heart Failure

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What Kind Of Diet That Is Healthy For Your Heart

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

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.

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

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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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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Changes In The Body Systems Caused By Congestive Heart Failure

MNEMONIC

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.

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When Should I Call An Ambulance

If you have any of the symptoms below, call triple zero immediately and ask for an ambulance. If calling triple zero does not work on your mobile phone, try calling 112.

  • chest pain thats severe or worsening, or has lasted longer than 10 minutes
  • chest pain that feels heavy, crushing or tight
  • other symptoms, such as breathlessness, nausea, dizziness or a cold sweat
  • pain in your jaw or down your left arm

What Are The Complications Of Heart Failure

Some of the complications from heart failure include:

  • Irregular heartbeat.
  • History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but youve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. This category includes people who have heart failure and reduced EF due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

  • Shortness of breath.
  • Need to urinate while resting at night.
  • Rapid or irregular heartbeats .
  • A dry, hacking cough.
  • A full or hard stomach, loss of appetite or upset stomach .

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.Its important to let your doctor know if you have new symptoms or if your symptoms get worse.

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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.

How Is Heart Failure Diagnosed

Congestive Heart Failure (CHF) Pathophysiology, Nursing, Treatment, Symptoms | Heart Failure Part 1

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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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:

Anticoagulant Medications Can Reduce The Risk Of Blood Clots And Heart Attacks

A heart attack occurs when blood flow in the blood vessels of the heart is blocked. People with congestive heart failure may benefit from taking an anticoagulant medication to lower the risk of developing blood clots.

According to an article by Dr. Allison Tsao published for The American College of Cardiology, aspirin and warfarin have been proven to lower the risk of stroke and cardiac ischemia in patients with heart failure and risk factors such as diabetes, obesity, and atrial fibrillation.

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How Does Congestive Heart Failure Affect Your Sex Life And What Changes Do You Need To Make

When you are first diagnosed with heart disease, it is important to discuss with your doctor what types of physical activity are safe for you to engage in, including sexual intercourse.

The American Heart Association states that it is safe to have sex once your heart condition is stabilized. It is important to take your prescribed medications even if side effects have a negative impact on your sexual function because the health of your heart should be a priority.

Pharmacological Management Of Heart Failure

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 .
  • 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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    Life Expectancy With Congestive Heart Failure

    The life expectancy of someone with congestive heart failure depends on the type of heart failure, the cause, the stage of the disease, and how effective treatment is.

    When heart failure results from cardiomyopathy or coronary artery disease, a person typically has a less positive outlook than someone with heart failure in its earliest stage.

    Reduce Your Stress Levels And Stay Well

    Stress and lack of sleep correlate with high blood pressure and poor heart function. Reduce your stress levels by incorporating exercise and meditation.

    If you struggle with anxiety, anger management, or depression, consider speaking to a counselor or psychologist to develop coping strategies. Maintaining a regular sleep schedule is also important for your stress levels and overall well-being.

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    Factors That Can Worsen Symptoms Of Heart Failure

    The symptoms of heart failure can be worsened by a number of factors, including:

    • too much salt, fluid, or alcohol in the diet
    • some viral and bacterial infections
    • kidney diseases

    Treatment for heart failure may include:

    • medicines, such as
    • diuretics to remove excess fluid and improve symptoms of heart failure
    • mineralcortiocoid receptor antagonists are also recommended and used in most patients with heart failure to reduce mortality and hospitalisation
    • ACE inhibitors to open up blood vessels, reduce blood pressure and reduce sodium retention and water retention
    • certain beta-blockers to slow the heart rate and reduce its work
    • aldosterone blockers to reduce blood pressure and reduce the effects of damage to the heart muscle
    • ACE inhibitors, beta blockers and aldosterone blockers can increase survival and reduce the likelihood of hospitalisation.
  • addressing the underlying disorder for example, treatment of high blood pressure
  • lifestyle changes such as regular gentle physical activity, losing excess body fat, stopping smoking, adhering to healthy eating patterns with low salt, restricting alcohol and having adequate rest
  • surgery to replace narrowed or leaking heart valves
  • coronary bypass surgery in some cases
  • heart transplant in extreme cases.
  • How Is Congestive Heart Failure Treated

    Treatment of Congestive Heart Failure (CHF)

    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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    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

    How Can Quitting Smoking Improve Your Heart Health

    Smoking cigarettes can increase heart rate and blood pressure due to the effects of nicotine. Quitting smoking will prevent further damage to the heart and improve symptoms of congestive heart failure. Smoking also increases the risk of blood clots and therefore quitting smoking will lower the risk of heart attack.

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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.

    Other Medications That Might Be Prescribed

    What Is The Treatment For Congestive Heart Failure

    Your doctor may also prescribe other less commonly used drugs depending on your additional health problems. These drugs include:

    • Anticoagulants : These drugs may be prescribed if you are a heart failure patient with atrial fibrillation or have another problem with your heart. Anticoagulants are not used to treat heart failure without the presence of atrial fibrillation.
    • Cholesterol-lowering drugs : Your doctor may prescribe this class of medication if you have high cholesterol or have had a heart attack. This class of drugs is not used to treat heart failure, but other conditions as indicated.
    • Digoxin: Some heart failure patients might be prescribed this drug if the doctor feels its warranted.

    Additional medication information:

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    Pathogenesis Congestive Cardiac Failure

    Heart failure may be caused by one of the following factors either singly or in combination.

    Intrinsic Pump Failure: The most common and most important cause of heart failure is the weakening of the ventricular muscle due to disease so that the heart fails to act as an efficient pump. The various diseases which may culminate in pump failure by these mechanisms are as under:

  • Ischaemic heart disease,
  • Metabolic disorders like beriberi,
  • Disorders of the rhythm e.g. atrial fibrillation and flutter.
  • Increased workload on the heart: Increased mechanical load on the heart results in increased myocardial demand resulting in myocardial failure. Increased load on the heart may be in the form of pressure load or volume load.

    Increased pressure load may occur in the following states:

  • Systemic and pulmonary arterial hypertension.
  • Valvular disease e.g. mitral stenosis, aortic stenosis, pulmonary stenosis.
  • Chronic lung diseases.
  • Increased volume load occurs when a ventricle is required to eject more than the normal volume of the blood resulting in cardiac failure. This is seen in the following conditions:

  • Valvular insufficiency
  • Arteriovenous shunts
  • Hypoxia due to lung diseases.
  • Impaired filling of cardiac chambers: Decreased cardiac output and cardiac failure may result from extracardiac causes or defects in filling of the heart in pericarditis.

    Heart Replacement Surgery Is A Last Resort When All Other Treatment Options Have Failed

    Surgery to replace the heart is a consideration when all other treatment options have failed. It may take months to years to find a compatible heart donor and there is also the risk that your body may reject the transplanted heart.

    Dr. Robert Higgins at Johns Hopkins Hospital is leading a team to develop an artificial heart. The newest technology will require many clinical trials before it becomes accepted as a treatment.

    People who are interested may elect to participate in clinical research studies to test the effectiveness and safety of new medical advances.

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    Surgery And Medical Device Options

    The goal of surgery is to make your heart work better.

    . Routes blood around a blocked artery. Learn more about heart bypass surgery.

    Cardiac resynchronization therapy . When your heartbeat is off-kilter, it can make heart failure worse. This treatment uses a pacemaker that sends timed electrical impulses to both of your heart’s lower chambers so they pump better and more in sync. Your doctor may call it a biventricular pacemaker. They could also pair it with an ICD . Read more on CRT, also called biventricular pacing, for heart failure.

    Heart transplant. This is done when heart failure is so severe that it doesn’t respond to any other treatments. Get more information on heart transplant for heart failure.

    Heart valve surgery. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing it. A surgeon can repair or replace the valves. Find out more on heart valve disease.

    Implantable cardioverter-defibrillator . This device is similar to a pacemaker. It’s put under your skin in your chest. Wires lead through your veins and into your heart to keep track of your heart rhythm. If your heart starts to beat at a dangerous rhythm, or if it stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also act as a pacemaker and speed your heart up if it’s going too slow. Learn more about ICDs for heart failure.

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