A Summary Of Heart Failure

Heart failure may convey that the heart isn’t working anymore, but what it really means is that the heart isn’t pumping as well as it should be (REF). Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen (REF). At first, the heart tries to make up for this by enlarging, developing more muscle mass, and pumping faster. As this happens, the blood vessels narrow to keep blood pressure up and the body diverts blood away from less important tissues and organs to maintain flow to the heart and brain (REF). Eventually, the body and heart cannot keep up and the patient begins to feel fatigue, breathing problems, weight gain with swelling in the feet, legs, ankles or stomach, and other symptoms that eventually leads to a hospital visit. The body’s coping mechanisms give us better understanding on why many are unaware of their condition until years after the heart declines (REF).

Systolic heart failure is characterized by enlarged ventricles that are unable to fully contract to pump enough blood into circulation to adequately perfuse tissues. The enlargement in ventricles is due to an increased end-systolic volume. If the heart is not able to sufficiently pump the expected volume of blood with each contraction, which in a normal healthy heart is 50-60%, there will be a residual volume left in the heart after every pump (Heart Healthy Women, 2012). With the next period of filling, the heart will receive the same amount of blood volume from the atria combined with that residual volume from the previous contraction. This causes the ventricles to have to dilate to accommodate this increase in volume. The dilation causes the walls of the ventricles to stretch and become thin and weak. Also the myocardium, the muscle layer of the heart, will stretch and not be able to adequately make a full and forceful enough contraction to push blood from the ventricles (Lehne, 2010).

Heart Failure is a progressive heart disease when the muscle of the heart is weakened so that it cannot pump blood as it should; the blood backs up into the blood vessels around the lungs and the other parts of the body (NHS Choice, 2015). In heart failure, the heart is not able to maintain a normal range cardiac output to meet the metabolic needs of the body (Kemp and Conte, 2012). Heart failure is a major worldwide public health problem, it is the end stage of heart disease and it could lead to high mortality. At present, heart failure is usually associated with old age, given the dramatic increase in the population of older people (ACCF/AHA, 2013). In the USA, there are about 5.7 million adults who have heart failure, about half of the people die within 5 years of diagnosis, and it costs the nation an estimated $30.7 billion each year (ACCF/AHA, 2013).

After a period of time, the heart muscles of the left ventricle begin to weaken. The weakening of the left ventricle will lead to decreased empting of the heart (systolic heart failure) which results in decreased cardiac output again. Since the left ventricle does not empty completely, blood begins to back up into the left atrium and then to the pulmonary circulation thus resulting in pulmonary congestion and dyspnea (Story 2012, 104). If left untreated, the blood will back up and affect the right side of the heart causing biventricular heart failure (both right and left heart failure). In right sided heart failure, the right ventricle weakens and cannot empty completely. This incomplete emptying causes blood to back up into the systemic circulation causing systemic edema (Lewis et al. 2014, 771).

The heart is an organ that pumps oxygenated blood to the body and deoxygenated blood to the lungs. Heart failure is when the heart can’t pump blood very well. If the heart fails to work properly, a major system called the circulatory system won’t work properly and therefore the whole human body will fail to work properly because the cells won’t be able get oxygenated blood and use the oxygen to undergo cellular respiration and make energy.

The diagnosis is made when an ejection fraction of less than 40% is found during an echocardiogram test. Patients with known systolic heart failure and current or prior symptoms are Stage C. Most common symptoms include, shortness of breath, fatigue and reduced ability to exercise. Stage D is patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care. Other risk factors for heart failure are some diabetes medications, sleep apnea, congenital heart defects, viruses, and irregular heartbeats. Heart Failure can be treated and managed but not cured. It is a chronic condition.

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., Peterson E. D., Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among medicare beneficiaries hospitalized for heart failure. Jama, 303(17), 1716-1722.

Some symptoms of heart failure are weight gain, swollen feet and ankles, fast or irregular pulse, palpitations, fatigue, weakness, loss of appetite, faintness, nocturia, shortness of breath especially during physical activities or while at rest, enlarged abdomen and liver.

A person's symptoms can provide important clues to the presence of heart failure. (Cadwallader p. 1143). Some of these include: JVD, SOB, frequent coughing when lying down, edema, acites, fatigue, syncope, vertigo, and sudden death. (Cadwallader p. 1142).

There are two types of heart failure: systolic heart failure and diastolic heart failure. In systolic heart failure, left ventricle have difficulty contracting and ejecting blood into the circulation, which causes reduced left ventricular fraction. On the other hand, diastolic heart failure has a slow and delayed relaxation and chamber rigidity increase, which then causes inadequate filling of blood and slows down the ability to eject blood efficiently. Calcium is not

Heart failure describes a medical condition when the heart is unable to pump sufficient blood to the body [85]. While heart failure does not mean the immediate stopping of the heart, it is a serious and fatal condition. A study has found that the 4-year mortality rate for chronic heart failure was 43% for patients with preserved systolic function, and 54% for patients with reduced systolic function [86]. Heart failure is prevalent, with about 2-3% of adults worldwide showing signs of heart failure [86]. The economic burden from heart failure is high. In the United States alone, the healthcare cost associated to heart failure is $39.2 billion [87].

Congestive heart failure (CHF) affect nearly 26 million people worldwide. (Kumar, Pachori, & Acharya, 2017). This a condition that is seen when the heart is unable to provide sufficient blood supply to fulfill the requirement of the body (Kumar, Pachori, & Acharya, 2017). The body need an adequate amount of blood to survive. CHF affect the heart pumping power of the heart and in return reduce the pumping power of the ventricles. Because of this blood moves through the heart and body slowly which causes pressure in the chambers to increase (Kumar, Pachori, & Acharya, 2017). The individuals experience symptoms because the heart cannot pump enough oxygen and nutrients blood to meet the body’s need. Some of the common symptoms of CHF are dyspnea, edema, and fatigue (Kumar, Pachori, & Acharya, 2017). Patients may also have these symptoms epigastric pain and difficulty breathing while lying flat which is relieved by sitting up

Patient R.M. is an eighty-year-old Caucasian male. His religion is Christian. R.M. was retired from work. He is a husband, father and grandfather per his wife. R.M. had no known allergies and is a full code status. He has a past medical history of diabetes, coronary artery disease, heart valve disease, atrial fibrillation, congestive heart failure (HF), hypertension and kidney disease. His wife was at bedside attentive to his care. The diagnostic tests performed showed he had severe congestive heart failure and was in need of an arterial graft in his coronary arteries. The nurse on shift was Vivian and the doctor assigned to R.M. was Doctor Linton. The development level that R.M. falls in at eighty years old was integrity versus despair. He displayed the characteristics of being in the category of despair.

Project PULSE will be offered to adult active duty servicemen and women, dependent family members, and military retirees who are over 50 years of age and have admitted with a new or preexisting diagnosis heart failure. Tricare beneficiaries who utilize Fort Belvoir Community Hospital’s primary care clinic or any of its specialty care clinics will be eligible to participate. The program does excluded patient’s who have civilian primary care providers however, participation with the Fort Belvoir Heart Failure Clinic for follow-up care will be required as per program instructions.

Heart failure affects over 5 million people and carries a high rate of mortality. Ivabradine, a new agent has been added to the current medical options for managing heart failure. It is a selective inhibitor of sino-atrial node and slows its firing rate, prolonging diastolic depolarization without any negative inotropic effects. In 2006, BEAUTIFUL trial evaluated patients with stable coronary artery disease and heart failure and found a significant reduction of coronary events, coronary revascularization and fatal and nonfatal myocardial infarction in patients with heart rate of >70 bpm. SHIFT trial observed patients with chronic heart failure with low ejection fraction and showed significantly reduced rate of hospitalization and deaths due to heart failure with Ivabradine. These trials resulted in this agent’s approval in Europe for chronic stable angina and chronic heart failure and in USA for reducing hospitalizations with chronic heart failure. Ivabradine has also been tried in other conditions like inappropriate sinus tachycardia, cardiogenic shock and is in phase II trial for patients with newly diagnosed multiple organ dysfunction syndrome.