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. …show more content…
Patients with severe asthma should not be given beta blockers, although those with milder symptoms may be able to tolerate these medications. Careful initiation and monitoring is
Symptoms of congestive heart failure consist of fatigue, dependent edema, fluid build-up in the lungs, increase in urination because of the extra fluid, nausea, vomiting, abdominal pain, and decreased appetite (Fundukian, 2011). Diagnosis of CHF is done first by physical examination, such as heart rate, and heart sounds or murmurs. If a physician believes more tests are needed, common ones include an electrocardiogram or chest x-ray to detect previous heart attacks, arrhythmia, or heart enlargement, and echocardiogram using ultrasound to image the heart muscle, valves, and blood flow patterns. The physician may also want to do a heart catheterization, to allow the arteries of the heart to be visualized using angiography. Upon getting a diagnosis of CHF, the physician will usually start with asking the patient to change things in their diet, such going to a low sodium diet. They may also want to prescribe medications. Types of medications could include angiotensin converting enzyme (ACE) inhibitors, which block formation of angiotensin II hormone, angiotensin receptor blockers (ARB) to block the action of angiotensin II at the receptor site, and diuretics, just to name a few (Fundukian, 2011).
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, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow. Examples of Beta Blocker include; Metoprolol (Lopressor), Atenolol (Tenormin) and Carvedilol (Coreg).
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.
The second step in managing patients with CHF is using evidence-based treatment options. Beta-blockers have proven to be effective at increasing left ventricular function; however, the majority of patients are not receiving adequate dosages of the medication. According to Driscoll et al
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,
Heart failure describes a syndrome in which the patient has a dysfunctional heart incapable of sustaining an adequate cardiac output, and this syndrome is responsible for a large portion of cardiovascular-related deaths2. There are two types of left ventricular dysfunction, one is systolic dysfunction which has implications in defective ventricular ejection and contraction, and the other is diastolic dysfunction which has implications in dysfunctional ventricular relaxation and filling2. Heart failure patients with systolic dysfunction have an ejection fraction of less than 40%, and heart failure patients with diastolic dysfunction have an ejection fraction of greater than 40%. In the case study, the patient has a left ventricular ejection fraction of 25% which means that he is suffering from systolic dysfunction.
Well written paper on beta blockers in controlling hypertension. In my experience, I had seen more than 80% of patients are prescribed with antihypertensive drugs in their medical chart. A beta blocker is one of the most common drugs in a geriatric setting especially atenolol. Beta blockers are the standard of therapy for many cardiovascular conditions and it is the main line of treatment in decreasing risk of stroke. According to Ladage, Schwinger, and Brixius (2013) beta blocker was more effective in decreasing mortality and morbidity rate in acute coronary syndrome patients. Atenolol is a water soluble and had longer half-lives with non-metabolized actions and excreted via the kidneys (Ladage et al., 2013). The exercise capacity increases in patients who are on beta-blockers, like bisoprolol, nebivolol, carvedilol (Ladage et al., 2013). A recent meta-analysis study showed patients who are untreated with hypertension, they are at risk of developing chronic kidney diseases, cardiovascular complications, and cerebrovascular complications (Butt & Harvey, 2015). In one study, mainly geriatric population who are taking atenolol had shown greater mortality rate and increase arterial pressure (Testa et al., 2014).
Congestive heart failure patients may need multiple medications. Each medication option treats a different symptom or contributing factor and comes
Diuretics and digitalis constitute conventional therapy for congestive heart failure, but systemic vasodilators offer an innovative approach in acute and chronic heart failure by decreasing the increase in systolic wall ventricular stress by reducing aortic and/or impedance reduces cardiac venous return. As a result, vasodilators increase cardiac output (CO) by decreasing peripheral vascular resistance (PVR) and/or decrease left ventricular end-diastolic pressure (LVEDP) by decreasing venous
The writing on the role of Beta-blockers in the treatment of heart failure is elaborative and absorbing. The brief explanation about the mechanism Beta blocker is illuminating. Beta blocker use can help to manage heart failure. Beta blockers blocks the effects of the epinephrine (adrenaline). When beta blockers are taken, then the heart rate gets slow and heart demand of oxygen decreases, consequently the blood pressure is reduced (Staff, 2016). Beta blockers have different kinds of with slight differences. Depending on the circumstances, different beta blockers are utilized. The beta blockers can vary in terms of side-effects, as well as in term of the amount that a patient need to take per day. Depending upon the patient condition and treatment
Rate control is the older therapeutic strategy but it is still a primary therapy for AF. Beta-blockers and calcium channel blockers are both effective and well resistant therapies which can be used in a wide range of acute and long-term clinical conditions, as well as both contribute in controlling hypertension. It's investigated that oral beta-blockers are more favorable than calcium channel blockers for patients with ischemic heart disease, CHF and depressed left ventricular function. Digoxin is effective for controlling heart rate especially in sedentary elderly and concomitant CHF patients due to its effectiveness in improving ventricular function. Other potential advantages of rate control include less adverse drug effects and less hospitalization. However, it has some disadvantages including risk of toxicity, chronotropic incompetence and difficulties in achieving dose adjustments in patients with compromised renal function adding that it is not preferred in younger patients and those with a history of
According to National Clearinghouse Guidelines, several classes of drugs should be considered in the treatment of systolic heart failure. Angiotensin-converting Enzyme (ACE) inhibitors and Beta Blockers are the treatment of choice for systolic heart failure. Some beta-blockers have demonstrated the benefit of improving clinical symptoms, increasing ventricular function, and decreasing hospitalizations and mortality in systolic heart failure patients. If Ms. Boehmer has intolerance to ACE inhibitors, she may benefit from the combination of Hydralazine and Isosorbide dinitrate (especially beneficial for African Americans with heart failure) or Angiotensin II receptor blockers (ARB). Digoxin can improve Ms. Boehmer’s symptoms. Digoxin is beneficial
Approximately 2-3 million Americans, more than one percent of the population, are currently affected by this medical problem with numbers increasing frequently (Drug Store News, 1997). Congestive heart failure tends to be more common in the elderly, men, and also African Americans. Congestive heart failure has become the most common cause for current hospital admissions. Among causing prolonged hospital stays congestive heart failure has a very high mortality rate, which has declined since recent medical advancements.
Beta 2 antagonists that can be inhaled are long term asthma control medicines that can be taken every day. They may also have risks for certain people as well. When you are taking these medications it is now recommended they be used along with corticosteroids that can be inhaled.