Diastolic Heart Failure

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).

Heart failure can be attributed to either right sided, left or both. Left-sided heart failure is of two types, systolic failure and diastolic failure. Systolic failure is the when the left ventricle loses its ability to contract normally. The heart cannot pump with enough force to push enough blood into circulation. Diastolic failure is when the left ventricle loses its ability to relax normally. Which results in the heart not being able to fill with blood during the resting period. Both result in a decrease in cardiac output. (AHA, 2012). A decrease in the cardiac output into the systemic circulation causes blood to accumulate in the left ventricle, left atrium, and pulmonary circulation. This increase

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,

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

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.

Congestive heart failure (CHF) is a syndrome that occurs when the heart cannot pump sufficient blood to meet the tissues metabolic and oxygen needs. As a result, intravascular/ interstitial volume overload and poor tissue perfusion occurs. An individual with heart failure experiences reduced exercise tolerance, a reduced quality of life and shortened life span. The most common cause of heart failure is coronary artery disease (CAD). The incidence of heart failure increases with age. Approximately 1% of people over the age of 50 and 10% of people over the age of 80 experience heart failure. The prognosis depends on underlying cause and response to treatment. Heart failure may be classified according to the side of the heart affected.

In 2012, my cousin suffered a severe heart attack which lead to heart failure. After witnessing someone I love suffer a life-changing event, it was important to find ways in which I could help. During her time in the hospital I cared for her children, encouraging them to remain positive around their mother, explaining how important their presence was to her recovery. I assisted in organizing a fundraiser that provided financial benefits for medical expenses. An extended hospital stay can create a feeling of isolation, and the fundraiser served as a physical reminder of the amount of support she had behind her during this battle. Childcare and fundraising were both pivotal ways in which I made a difference, but being present with my cousin at

Heart failure is when the heart cannot keep up with the immense demands placed on it by the body, and it starts to compensate causing remodeling of the cardiac cells due to stronger cardiac contractions. The heart chambers expand so they can fill with more blood to pump to the rest of the body, and the heart rate will increase to meet these demands (American Heart Association, 2015). Heart failure is the inability of the heart to fill and pump effectively enough to meet the metabolic demands of the body resulting in pulmonary and venous congestion (Lam et al., 2007). Over time the body can no longer compensate, and the person becomes symptomatic and progresses into worsening heart failure. The pulmonary and venous congestion or “fluid overload” will manifest itself in the form of lower extremity edema, shortness of breath, fatigue and even chest pain, which interferes with quality of life (Colucci, 2015).

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.

The U. S healthcare system undergone major changes in the past 100 years. Scientific advancement coupled with increased sophistication of the health care workforce including physicians and nurses have given an international reputation to U.S health system. Even though weakness can be found like lack of primary health access, high infant mortality rate and increased numbers of uninsured people in U.S. A growing demand of patients with chronic illness over the age of sixty-five, is challenging to the health system.

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

Diastolic heart failure is also known as heart failure with preserved systolic function or heart failure with normal ejection fraction. Diastolic heart failure can occur alone or with systolic heart failure. Approximately 550,000 individuals in the United States are diagnosed with heart failure and half of them have diastolic heart failure. Diastolic heart failure is mainly common in elderly people with age of 65 or older. Also, it is mainly diagnosed in women than men (Huether and McCance 2012).

The study done by Arnold et al, from the Heart Outcomes Prevention Evaluation (HOPE) study demonstrated that an angiotensin-converting enzyme inhibitor for those at high cardiovascular risk reduced the risk of development of HF, especially among those with higher baseline blood pressures, with a relative risk of 0.67.22 A sub-study of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) assessed the relative effect of chlorthalidone, lisinopril, and amlodipine in preventing HF and revealed that diuretics are superior to calcium channel blockers in preventing HF in hypertensive individuals.23,24 Iribarren et al, demonstrated that among those with diabetes, suggesting the importance of diabetes treatment for the prevention of diastolic dysfunction progression.25 The Hong Kong diastolic heart failure study shows that in an elderly group of heart failure patients with normal EF, diuretics

Left Ventricular Systolic Dysfunction (LVSD) is an abnormal cardiovascular symptom characterized by a reduction in the left ventricular ejection fraction (LVEF), a measurement of the percentage of blood leaving the heart with each contraction. LVEF is commonly measured using echocardiography and calculated as the ratio between the blood volume exiting the left ventricle over the volume filling the left ventricle. A higher ejection fraction (EF) indicates better strength and contractility of the heart. Recent guidelines from the American and European society of echocardiography have defined an abnormal LVEF as any EF <40-55%.