Use of Ramipril and Carvedilol Combination Therapy in Heart Failure

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

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,

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 defined as a serious heart condition that prevents the heart from providing adequate blood flow to other parts of the body, causing a buildup of fluids in organs such as the lungs and kidneys (Heart Disease and Congestive Heart Failure). This heart condition affects approximately 670,000 people a year and is one of the leading causes of death for older people (Heart Disease and Congestive Heart Failure). Congestive heart failure, a chronic heart condition, manifests itself by causing fatigue, shortness of breath and edema; consequently, the treatments are basic and there remains no cure.

Congestive heart hailure, also known as CHF or heart failure, affects the lives of 5 million Americans each year with 550,000 new cases diagnosed yearly. (Emory healthcare, 2013) CHF is a medical condition in which the heart has become weak and cannot pump enough blood to meet the need for oxygen rich blood required by the vital organs of the body, less blood is pumped out of the heart to the organs and tissues in the body and pressure in the heart increases, it does not mean the heart has stopped working. (Murphy, 2013) Once the heart has become weakened by conditions such as hypertension, abnormal heart

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

Congestive heart failure (CHF) is a condition caused by the weakening of the heart and the cardiovascular system. It develops when the heart is not able to pump enough blood. Some causes of CHF would include, narrowed arteries that supply blood to the heart muscle – coronary artery disease, past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle’s normal work, high blood pressure, heart valve disease, primary disease of the heart muscle itself, called cardiomyopathy.

Beta-2 Adrenergic Agonists Are Substrates and Inhibitors; Albuterol is a beta-adrenergic agonist called also sympathomimetic. It mimics the effect of sympathetic nervous systems.

Congestive Heart Failure (CHF) is a chronic dysfunction of the heart’s ability to effectively pump blood throughout the body. Left-sided heart failure is the most common and there are two main types: systolic and diastolic. In simple terms, diastolic heart failure occurs when the left ventricle still pumps effectively, but doesn’t move as much blood as it should due to a filling problem. Systolic heart failure, on the other hand, occurs when the left ventricle does not pump as forcefully as it should, and therefore less blood makes it into circulation per contraction. Researchers and physicians alike are moving away from the classifications of systolic and diastolic as problems with one can produce abnormalities with the other. Instead, they are moving to classifying heart failure as having normal or impaired left ventricular ejection fraction. Impaired ejection fraction (<40%) would be

(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.

Almost every one in the United States knows a person suffering from congestive heart failure. This disease has manifested its way into the lives of so many—the statistics are astounding. According to the National Heart, Lung and Blood Institute, nearly 5 million people are affected and it is the main reason for hospital admission in older adults over the age of 65. This is a great cause for concern. In order to reduce the morbidity and control this epidemic, we must first understand the risks and causes of this condition. It is of the upmost importance to first understand the risks and causes of this condition. Education plays a key role in order to recognize the clinical manifestations and necessary actions to best treat

As the population ages heart failure is expected to increase exceptionally. About twenty-two percent of men and forty-four percent of women will develop heart failure within six years of having a heart attack. “Thirty years ago patients would have died from their heart attacks!” (Couzens)