Acute Decompensested Heart Failure Case Study

The prevalence of congestive heart failure is on the increase both in the United States and all over the world, and it is the leading cause of hospitalization in the elderly population. Congestive heart failure is a progressive disease generally seen in the elderly, which if not properly managed, can lead to repeated hospital admissions or death. Heart failure means that the heart muscle is weakened. A weakened heart muscle may not be strong enough to pump an adequate amount of blood out of its chambers. To compensate for its diminished pumping capacity, the heart may enlarge. Commonly, the heart's pumping inefficiency causes a buildup of blood in the

Acute-decompensated heart failure (ADHF) is one of the most frequent diagnoses in patients who attend emergency departments (EDs) worldwide, especially in Western countries1,2. In Spain, ADHF constitutes the leading cause of medical hospitalization through EDs3. Despite the substantial resource and economic implications of hospitalization, the final decision of emergency physicians to admit ADHF patients mainly relies on their subjective and personal clinical experience rather than on objective-supported evidence4,5. This decision is complex and challenging, as a wide spectrum of clinical presentations ranging from minor forms of decompensation to life-threatening illness can be observed in ADHF, and these are often complicated by the presence

Therapeutic measures for a patient with congestive heart failure would be daily weights, dietary sodium restrictions, positioning in high or semi-Fowler’s position, frequent vital signs, oxygen by cannula or mask, medical devices: pacemakers, internal cardiac defibrillator, biventricular cardiac pacemaker, ventricular assist device, medications: digoxin, diuretics, inotropes, nesiritide, beta blockers, surgery: heart valve repair or replacement, coronary

Beta-blockers have been recently reported to decrease mortality in heart failure patients. Mortality and hospitalization rates for patients with the disease are high and continue to rise. Despite the magnitude of the problem, treatment of congestive heart failure is often inadequate. Primary care physicians care for most patients with heart failure. Beta-blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left ventricular systolic dysfunction. Unless contraindicated, beta-blockers should be considered a mainstay of therapy in these patients to improve symptoms and mortality and to decrease hospitalizations. Beta-blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Congestive Heart Failure is when the heart's pumping power is weaker than normal. It does not mean the heart has stopped working. The blood moves through the heart and body at a slower rate, and pressure in the heart increases. This means; the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. This only keeps the blood moving for a short while. The heart muscle walls weaken and are unable to pump as strongly. This makes the kidneys respond by causing the body to retain fluid and sodium. When the body builds up with fluids, it becomes congested. Many conditions can cause heart

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

An elderly male with congestive heart failure was brought to a clinic because he was experiencing atrial fibrillation and had a ventricular response of 110 beats/min with palpitations and shortness of breath1. Medications that he was taking includes angiotensin-converting enzyme inhibitor, Lisinopril, Carvediol, Digoxin, and Furosemide1. His left ventricular ejection fraction has been reduced to 25%1. Further examinations showed that he had edema in his legs and crackles at the base of his lungs1. He was then told to increase the dosage of Furosemide by taking the drug twice daily instead of once, and doubling the dose per administration1. One week later, the electrocardiogram revealed that he had ventricular arrhythmias such as premature

For years health care providers have been using drugs like beta blockers or ACE inhibitors to treat patients with heart failure, but with cardiovascular disease still being a leading cause of death, it is evident that current treatments have been lacking the ability to produce adequate results. However, with the newest heart failure drug on the market a positive change has finally come for heart failure patients. The new heart failure drug reigns far more superior when compared to the treatments healthcare professionals already use and can potentially alter the foundation of heart failure treatments altogether.

Congestive heart failure patients may need multiple medications. Each medication option treats a different symptom or contributing factor and comes

The chronic disease burden has increased the need for a statewide and national approach in its detection, prevention, and treatment of heart failure. In the state of Indiana heart disease is shown to be leading the way with a total of 13,394 individuals who have died in 2013 (Indiana State, 2013). The health indicators show that although the mortality rate has decreased from 42.3 per 100,000 in 2001 to 37.3 per 100,000 hospitalization rates have increased (Center for Disease, 2011). Heart failure rehospitalization rate has increased from 2007-2011 especially in those who are over the age of 85. In 2011, there were a total of 41.9 per 1,000 hospitalizations due to heart failure. This is gradually increasing from the Healthy People 2020

The first article, Treatment of Heart Failure Guided by Plasma Aminoterminal Brain Natriuretic Peptide (N-BNP) Concentrations, has aimed to explore if the utilization of N-BNP in intense treatment of HF including drugs will result in better outcomes compared to treatment based on standard clinical assessments. The study was a randomized, controlled study; double blinded. The primary outcomes/endpoints were total cardiovascular events as defined by death or any hospital visit or admission related to CV events. Secondary outcomes were lower BNP levels, LV functions and quality of life. A statistical significance if p value is < 0.001. Hospital stay r/t heart failure was more numerous in the control group (p<

Congestive cardiac failure (CCF) is a complex and lethal clinical syndrome with high morbidity (Australian Institute of Health and Welfare, 2011). The specific data about incidence of chronic heart failure is unknown due to difficulties in collecting self-reporting data (Australian Institute of Health and Welfare, 2011). Some patients may not report their conditions, because it is mildly symptomatic and difficult to realize the symptoms when they are on the early stage of CCF (Urden, 2014). Therefore, the estimated data on incidence of CCF from National health Survey may be

In year 2000 and 2010, an estimated 1 million hospitalizations for Congestive Heart Failure (CHF), of which most of these hospitalizations were for those aged 65 and over, the share of CHF hospitalizations for those under age 65 increased from 23% to 29% over this time period (Hall, Levant, & DeFrances, 2012). According to Held (2009), acute decompensated heart failure (ADHF) ensues when cardiac output fails to meet the demand of the body’s metabolic needs. The fluid volume overload makes the unstable condition necessitates instant treatment for the reason that it impairs perfusion to systemic organs, endangering their function.

The efficacy of ACE-I has been widely evaluated in clinical trials and observational studies. In 1983, Captopril multicenter research group investigated the efficacy of Captopril in a 92 cohort with heart failure refractory to digitalis and diuretic therapy. In this randomized, double blind trial, 50 patients were assigned to Captopril and 42 were assigned to placebo group. Over 2-week dosage titration and 10-week evaluation period, the Captopril group revealed improvement in exercise tolerance and specific symptoms of heart failure, including dyspnea, fatigue and orthopnea, and the reduction of edema. Captopril therapy were concluded as an effect adjunctive treatment to digitalis and diuretic drugs for patients with refractory heart failure. (14) Later on, other ACE-I, such as Enalapril, were shown to be effective in treating patients with congestive heart failure, by reducing left ventricular dimension, in randomized clinical studies.(15-17) The Heart Outcomes Prevention Evaluation Study Investigators conducted a factorial study to evaluate the ACE-I, Ramipril, for improving outcomes among patients with high risk for cardiovascular events, but without left ventricular dysfunction or heart failure. Ramipril significantly reduced the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have heart failure. (18) Cattran et al. performed a registry study in Toronto Glomerulonephritis in patients with severe immunoglobulin