Heart Failure (HF)

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

Heart failure develops when there is an abnormality to the cardiac structure that lead to impairment of ventricular filling and ejection of blood to the body (7). Thus, the cardiac output does not meet the body’s oxygen demand.

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).

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,

Mr. Javier Escobar, U.S Army Veteran, 50-year-old Latino male and divorced claiming to “not having anyone in his life due to Combat Post Traumatic Stress Disorder”. Mr. Escobar is a newly patient diagnosed with Congestive Heart Failure (CHF). Patient claims to smoke 1 pack of cigarettes a day, also the consumption of 1 bottle (750mls) per night of alcohol. Congestive Heart Failure is due to Chronic high blood pressure that puts great stress on the heart muscle. The muscle of the heart weakens and fails to push the normal amount of blood around the body leading to Congestive Heart Failure. There are multiple symptoms that could by identified before heart failure such as anxiety, restlessness, cyanotic (blue

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.

Heart failure (HF) is defined as a multifaceted clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. In HF, the heart may not provide tissues with adequate blood for metabolic needs, and cardiac-related elevation of pulmonary or systemic venous pressures may result in organ congestion1. In the United States, HF is increasing in incidence with about 5.1 million people suffering from HF and half of people who develop HF die within 5years 2. Over 75% of existing and new cases occurred in individuals over 65 years of age, < 1% in individuals below 60 years, nearly 10% in those over 80 years of age. HF costs the

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).

Heart failure is a long-term (chronic) condition in which the heart cannot pump enough blood through the body. When this happens, parts of the body do not get the blood and oxygen needed for them to function properly.

(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

Congestive heart failure (CHF) is a condition where the heart is unable to efficiently pump blood to supply the body with adequate blood flow and it can cause fluid to build up in the lungs. There are several disease processes and risk factors that predispose an individual to this condition. CHF can be chronic or acute and life threatening, and most of these patients are in the older adult population. Some symptoms of CHF include fatigue, shortness of breath, edema, and diminished exercise capacity. There are several medical management techniques for this condition including lifestyle modifications, medications and surgical intervention. Below, I will summarize two articles on two different medical treatments for CHF.

One of the main causes of mortality and morbidity is congestive heart failure (CHF). The major causes of CHF are coronary artery disease and hypertension. Other risk factors are occurrence of left ventricular hypertrophy (LVH), valvular heart disease, diabetes, smoking, obesity and dyslipidemia [46, 47]. Diabetes mellitus as an anticipated factor of CHF was explained in some studies [44, 47]. Diabetes is considered as a risk factor for CHF but yet, its relationship with CHF has not been completely understood [47, 48]. Alterations of left ventricular function and structure that are associated with diabetes mellitus or diminished glucose regulation have been described in recent studies [42, 49]. It has been reported that insulin resistance

“In the United States alone, 5.8 million Americans have been diagnosed with heart failure” (Mancini & Colombo, 2015, p. 2542). Heart failure is a condition where the heart does not pump as efficiently; therefore, it does not meet the needs of the body. There is a growing number of heart failure patients each year. “More than 300,000 deaths per year are attributed to heart failure, and the annual cost to manage these patients is close to $40 billion” (Mancini & Colombo, 2015, p. 2542). Since the heart failure population is steadily growing in size the progress of therapies and management is continuing to evolve. The greatest improvements have been surgery related. The two major surgical approaches involve heart transplants or receiving a ventricular assist device (Mancini & Colombo, 2015). There are much discussion in regardless to receiving a heart transplant versus a ventricular assist device, destination therapy, as well as future advances in ventricular assist devices.

Congestive heart failure (CHF) is a disorder of the cardiovascular system that occurs when the heart cannot sufficiently pump blood to meet the body’s metabolic and oxygen needs. Insufficient contractility of the heart will cause intravascular and interstitial volume overload and poor tissue perfusion. CHF is classified according to the side of the heart affected. The onset of CHF increases with age, as over the age of 50, 1% will develop CHF and 10% over the age of 80. An individual with CHF will experience a reduced exercise tolerance, quality of life and shortened life span and the prognosis depends on underlying cause and the individual’s response to treatment.

After the occurrence of a heart attack, patients are typically put on pharmacological agents to help improve the heart’s now compromised condition and prevent the occurrence of another infarction. The two main categories of drugs used for this purpose are ACE inhibitors and ß- blockers. As previously stated, ACE is an enzyme that converts angiotensin I into angiotensin II. This can be problematic in the failing heart because of the effects of angiotensin II, specifically vasoconstriction and enhanced sympathetic activity (Jackson, et al., 2000). By inhibiting this enzyme, the constricted blood vessels are relaxed and blood pressure is lowered. This allows the heart to return to pumping