Diastolic Dysfunction Essay

The role of diuretics in heart failure is to reduce the fluid retention by diuresis (1). Patient should be monitored closely to prevent over diuresis that will subsequently lead to hypotension and renal impairment. Diuretic used is commonly associated with hypokalemia (1). Thus, additional potassium needs to be given concurrent to diuretic treatment (1). Patient’s daily weight must be recorded and aimed for reduction of body weight >4.5 kg in 5 days after treatment (7). Angiotensin converting enzyme inhibitor (ACE-I) is a first line agent in treating heart failure, especially when there is evidence of reduced in ejection fraction <40% as it improve survival rate of patient (1). Patient needs to be advised regarding side effects of the drug which are, dry cough, hypotension, renal insufficiency, hyperkalemia and angioedema. Antihypertensive agents that can be given in patient with heart failure are beta blocker, ACE-I and aldosterone antagonist. If the blood pressure is persistently high despite treatment with beta blocker, ACE-I and ARB, calcium channel blocker such as amlodipine can be added as this drugs has negative inotropic effect

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

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 Society of America, 2010). HF is accountable for 25% of all readmission within 30 days in the United States and represents an estimated $17 million dollars in healthcare spending (Desai, 2012). HF is most commonly seen in person’s age 65 or greater with common clinical presentations of dyspnea with exertion, orthopnea, edema in lower extremities and weight gain Patients often experience frequent exacerbations and decompensations (Anderson, 2014). The Heart Failure Society of America (2010) published the Comprehensive Heart Failure Practice Guidelines with the underlying goal to improve symptoms and to optimize the patient’s volume status. These guidelines include evidence based recommendations for “prevention, evaluation, disease management, and pharmacologic and device therapy” (Heart Failure Society of America, 2010, p 476). The Institute for Healthcare Improvement (n.d.) supports the balance of evidence based treatment during acute admission but asserts that it is equally as important to assess and provide patient education for self-management after

There are a plethora of treatments available for patients with heart failure including but not limited to diuretics, ACE inhibitors, angiotensin receptor blockers, and oral nitrates. The Vasodilator heart failure (V-HEFT) studies show that enalapril has less cumulative mortality among study participants when compared to patients taking a combination of isosorbide dinitrate and hydralazine. (MGMT) This is not to say that the combination of isosorbide dinitrate and hydralazine is not efficacious because when compared to placebo, mortality rates improved with the combination treatment.

According to Rutten (2003), in general practice majority of the patients with HF where elderly women suffering from chronic hypertension, whereas there seems to be a higher number of men with CHF being treated by a cardiologist as appose to the general physician (Rutten, 2003). Cardiol (2011) agreed that women with CHF seems to be more common. In postmenopausal women are more vulnerable as oestrogen affects the synthesis of collagen and inhibition of the renin-angiotensin system.

Heart failure due to resistance to ventricular filling caused by an abnormality in the diastolic function. (Hart, RHIA, CCS, CCS-P, Stegman, MBA, CCS, and Ford, RHIT, CCS)

This method demonstrates impaired relaxation and filling because it delivers straight measurement of ventricular diastolic pressure. But, the balance of benefit, harm and cost can debate against its use to diagnose diastolic dysfunction. The other technique which can be used to diagnose diastolic heart failure is Doppler echocardiography. Doppler echocardiography is used to assess cardiac diastolic function, which can confirm the diagnosis of diastolic heart failure. For example, according to the online article, “Diastolic heart failure: challenges of diagnosis and treatment” states “echocardiographic measurement of tau, the time constant of left ventricular pressure decay during isovolunteric relaxation, can be performed to assess left ventricular stiffness.” Doppler echocardiography plays an important role to evaluate the characteristic of diastolic Trans-mitral-value- blood flow. Doppler echocardiography helps to measure the peak velocities of blood flow during early diastolic filling (E wave) and atrial contraction (A wave) and then ratio is calculated. When the heart is working normal, the early filling E-wave velocity is greater than the A-wave velocity and E to A wave ratio is 1.5. But, in diastolic dysfunction, this correlation reverses, because stiffness increases and the relaxation of heart occur slowly and E to A wave ratio decreases to 1.0. Also, as the diastolic

In the United States, over 5 million patients have heart failure (HF) and approximately 20 million patients have chronic kidney disease (CKD). Both conditions are linked by multiple risk factors including obesity, hypertension, diabetes mellitus, tobacco abuse, and increasing age. The presence of HF increases the risk of CKD and vice versa. Nearly one third of all patients with HF and 70% of Medicare patients with HF have Stage III CKD or greater and approximately 50% of dialysis dependent end stage renal disease (ESRD) patients will develop HF.

Currently there is no cure for heart failure, the majority of treatments only manage the symptoms of the condition and often a combination of medications is used to tolerate these symptoms and improve quality of life. Unfortunately many medications that are given to patients with heart failure bring side effects that can sometimes lead to even more health complications. An example of a commonly prescribed drug that has a primary purpose of reducing blood pressure, thus improving heart and lung muscle function, is the Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors dilate blood vessels and decrease the workload of the heart. When a chemical called angiotensin II is present in the bloodstream, it stimulates blood vessels to become

CHF is prevalent in those who are 65 and older and the factors that contribute to heart failure in adults are ischemic and hypertensive heart disease. Aging is associated with impaired left ventricular filling that is due to changes in the myocardial relaxation. A progressive increase in systolic blood pressure with aging contributes to the development of left ventricular hypertrophy and altered diastolic filling. Another reason for heart failure with aging is that the heart becomes stiffer and less compliant with age. Clinical manifestations of heart failure are nocturia, nocturnal incontinence, edema, impaired perfusion, and exertional dyspnea, orthopnea, and impaired exercise intolerance. Diagnosis of CHF are based on history, physical examination, chest radiograph, and electrocardiographic findings. The treatments include Ace inhibitors, exercise programs, sodium restriction, and sometimes bed rest (Grossman & Porth, 2014). Room 582 is currently taking Lasix for his heart failure.

Diastolic dysfunction is the result of several diseases such as, diabetes mellitus, hypertension, obesity, and chronic kidney disease, which provoke a systemic inflammatory state with high circulating levels of glycoprotein and tumor necrosis factor. This inflammatory state leads to coronary micro vascular endothelial dysfunction with reduced vasodilator response to acetylcholine as a result of low nitric oxide availability and increase in reactive oxygen species production. Diastolic dysfunction will also be the result of an abnormal active process of relaxation linked to an abnormal calcium handling mechanism. This increase in stiffness and decrease in arterial compliance lead to an abnormal vasodilator response to exercise, which causes

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

Reduction in the rate of cardiovascular events and total mortality has been accomplished by decreasing BP in hypertensive patients with the help of pharmacological treatment, however, it involves ambulatory elderly patients with few comorbidities and few medication use.

It has also been shown that the utilisation of ACE inhibitors in patients will lower the incidence of new type 2 diabetes (Gillespie et al., 2005). Trials with a total of over 60,000 patients have shown the ACE inhibitors reduced symptoms in the coronary artery disease as well as type 2 diabetes however further results have shown it had no effect on patients in terms of reducing cardiovascular, cerebrovascular problems (Gillespie et al., 2005). Conversely other research trials have shown that the use of Telmisartan inhibitors was able to moderately reduce the risk of strokes, myocardial infarction and cardiovascular death (Effects of the angiotensin-receptor blocker Telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial, 2008). ACE inhibitors have also been proven to be able to help patients with asymptomatic left ventricular systolic dysfunction (McMurray et al.,