Systolic Heart Failure: A Case Study

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.

Patient A.S. is 87-year-old female with a diagnosis of Acute onset chronic systolic heart failure, Afib, CHF, and hypothyroidism. She has a past medical history of Hypertension, diabetes mellitus, CAD (Stent 2001). The patient was admitted to Lutheran Augustana Center on January 4, 2016 and was evaluated for therapy on January 5, 2016. Her current medications include Albuterol and Ipratropium via nebulizer to address shortness of breath. A combination of drugs to treat the symptoms of congestive heart failure and other comorbid diagnosis include: Eliquis, Furosemide, hydralazine, and metoprolol. Other medications include Synthroid to treat hypothyroidism, Tradjenta for hyperglycemia, and Zocor for hyperlipidemia. The patient also presented with skin problems. She has bilateral ecchymosis in her lower extremities and abdomen. Lotrisone lotion was prescribed for atopic dermatitis. Edema was also present in her lower extremities.

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

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.

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).

50 mg once daily, swallowed whole with water. Not to be crushed, cut, dissolved or chewed, as this will modify the timed-release mechanism, reducing efficiency and causing adverse effects.

Case Study 2 involves a geriatric patient, Mr. P., who is having difficulty managing his congestive heart failure (CHF) and cardiomyopathy (GCU, 2013). For one to find the best way to help him, one must have an understanding of his disease processes. This paper will briefly describe congestive heart failure and cardiomyopathy. It will look at the nurse’s approach to care and define a treatment plan. The treatment plan will include methods for educating Mr. P. and his wife. Furthermore, a teaching plan will be included with language the patient and the wife will understand.

The goals of treatment for heart failure are determined by the rapidity of onset and severity of the heart failure and directed towards relieving the symptoms, improving the quality of life, and reducing or eliminating the risk factors (Grossman & Porth, 2014). There are

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

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

Reduction of heart failure has been looked at in a number of ways, some with reduction of

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

I should have educated about healthy diet and daily 30 minutes of aerobic exercises. I should have encouraged to increase fruits, vegetables, reduce salt intake, low fat/cholesterol diet, serving sizes and avoiding canned and fast food. Also, I should have educated about maintaining proper intake of dietary potassium, calcium and magnesium (Madhur, 2014). I should have educated about the increase bBP with decongestants. Regular aerobic exercises can be walking, using bicycles and climbing stairs. Effectiveness of lowering BP increases when diet and lifestyle modification are combined together (Cash, 2015). Also, I should have mentioned about not exceeding 2 drinks of alcohol per day and smoking cessation (Weber et al., 2014). This is because most of the patient with high BP have other cardiovascular risk factors such as diabetes, hyperlipidemia, tobacco use and inactivity. Hence, while treating HTN, we must address all these risk factors and take preventive measures (Dunphy et al., 2015). I should have educated on relaxation techniques and lowering stress level (Cash, 2015). Diuretics, ARB, ACE and calcium channel blocker are the first line therapy for the HTN (Hernandez-Vila,

The causes of acute HF should be promptly recognized, treated, and monitored to determine if the heart failure is reversible. The commonly cause of acute onset of left HF heart failure is acute myocardial ischemia in conjunction with the underlying coronary disease. Treatment include oxygen, nitrates, and morphine administration to improve myocardial oxygenation and help relieve coronary spasm while lowering preload through systemic venodilation. Diuretics are firtst line therapy in reducing preload while intravenous inotropic drugs, such as dobutamine and milrinone, increase contractility and also help raise the blood pressure in hypotensive patients. In some people, calcium-sensitizing inotropic drugs such as levosimendan have been effective in treatment of acute HF. Other treatments that can be used include ACE inhibitors which reduce preload and afterload, and intravenous beta-blockers which reduce myocardial demand. However, these treatments must be used with caution in hypotensive individuals. Intravenous administration of nesiritide (recombinant BNP) also improves preload and contractility. Individuals with severe systolic failure due to myocardial ischemia may benefit from acute coronary bypass or

Decreasing sodium and calorie intake may be recommended; Avoid natural licorice; Pyridoxine supplementation of 100-200 mg may fix peripheral neuropathy side effect of