The term “heart failure” sounds as if the heart has already failed. This can increase a person’s anxiety especially in the aging population that is a targeted community for this disease assuming that the failure is equivalent to death. Heart failure is actually the decline in the hearts ability to sufficiently pump oxygenated blood to the rest of the body. Many people can live with heart failure and are able to manage it through lifestyle changes, prescribed medication compliance, and regular physician scheduled follow-up visits.
Heart failure is the clinical syndrome that results from the progressive process of remodeling, in which mechanical and biochemical forces alter the size, shape, and function of the ventricle’s ability to pump enough oxygenated blood to meet the metabolic demands of the body (Lippincott). So, heart failure does not mean that the heart has stopped working. It means that the heart’s pumping power is weaker than normal thus blood moving through the heart and body is slower and the pressure in the heart increases. The result is that heart cannot pump enough oxygen and nutrients to meet body’s needs.
The chambers of the heart respond by stretching to hold more blood to pump through the body and eventually that causes the heart muscle walls to weaken and decrease the strength of contractility. Heart failure can be caused by a number of preexisting conditions. Typically, these conditions cause wear and tear that lead to heart failure. The primary cause of heart failure is coronary artery disease resulting from atherosclerosis. There is an increase of plaque lining the arteries that supply oxygen to the heart.
These arteries become narrowed by cholesterol and fatty deposits that build up therefore obstructing blood flow to such a monumental organ. Other causes include past myocardial infarctions, hypertension, abnormal heart valves and heart muscle disease which includes dilated cardiomyopathy, hypertrophic cardiomyopathy, or inflammation myocarditis, congenital heart disease, sever lung disease, diabetes, and sleep apnea. There is a greater risk of heart failure occurring with more than one of these preexisting conditions. Heart failure is divided into two subdivisions to further diagnose and differentiate the disease.
The two types of heart failure include left sided and right sided. Left sided failure is due to the weakened myocardium of the left atrium and ventricle. The left side is unable to sufficiently pump the oxygenated blood out of the aorta to distribute to the rest of the body. So, the blood backs up into the pulmonary veins and capillaries and causes congestions in the lungs. Common signs and symptoms patients present with are shortness of breath, adventitious lung sounds (crackles and wheezes), pulmonary edema, dyspnea on exertion, orthopnea, tachycardia, audible S3 sounds, and dry cough or frothy pink tinged sputum.
These are more evident upon sleeping because the body lays in a horizontal position and the extra fluid in the lungs spreads throughout creating mild to severe respiratory symptoms. Also, the patient may experience restlessness, fatigue, weakness and confusion due to the lack of oxygen circulating to the brain. Right sided failure is most commonly caused by left-sided heart failure. When the left ventricle fails, there is an increase in volume and pressure of blood. The right side of the heart is responsible for taking the deoxygenated blood from the body and delivering it to the lungs.
If the right side of the heart is weakened, the blood gets backed up in the circulatory system causing peripheral edema as seen by swelling in the legs and ankles which may first be noticeable with weight gain. If it goes untreated, more severe symptoms present themselves such as ascites (interstitial fluid accumulating in the abdomen), Jugular Vein Distention, and enlarged organs such as the liver and spleen. The excess volume accumulating in the circulatory system causes a fluctuation in blood pressure and activity intolerance (which can occur in both left and right sided heart failure).
It is important to ensure a correct diagnosis is made so that any reversible causes can be addressed, and treatment and patient education started. To diagnose heart failure, a detailed history and clinical examination are needed (cite Butler ). As symptoms and signs are often non-specific and could be related to other conditions, objective evidence is also required. Echocardiography is considered the gold-standard diagnostic test as it provides information on the cardiac structure, degree of dysfunction within the myocardium and, therefore, the underlying cause.
Heart Failure can also be diagnosed with an EKG, chest X-ray, complete blood count and measuring of the hearts elasticity (BNP). Treatment includes both the use of medications and lifestyle changes. Medications prescribed are diuretics (“water pills” for fluid retention) , Beta blockers (slow the heart rate and increase pumping action of the heart), ACE inhibitors (increase blood flow) , Angiotensin II receptor blockers (ARB), and statins (to lower cholesterol). Patients must be equal partners when it comes to medications through diligent compliance to ensure the desired outcome and a better quality of life.
With compliance of medications, patients must also incorporate healthy lifestyle changes such as a healthy diet, regular exercise, and if applicable, smoking cessation. Managing a healthy diet promotes weight control and helps manage the patient’s blood pressure and cholesterol levels. If the patient is a diabetic, these changes can also positively impact blood glucose management within a normal, healthy range. As the patient, there are simple guidelines that can be followed to keep you on track to success. Daily weight in the morning before breakfast is an easy way to monitor weight gain. Report to your primary doctor of 2.
2 pounds or more in 1 day, or more than 5 pounds gained in one week. Check for swelling of the feet, ankles, and legs and report any changes in appearance to your doctor upon the next scheduled visit. . Follow medication as prescribed. For changes in your diet, include fruits and vegetables, high protein, low fat sources such as fish at least twice a week, fiber-rich whole grains, sodium of less than 1500 mg a day, and no more than 450 calories of sugar-sweetened beverages a week (AHA). Slowly increase your exercise regimen to at least 20 minutes, three times a week, with rest periods as needed.
Healthy People 2020, a report that establishes national goals to improve the countries overall health, states “Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events”. New health care system promotes the prevention of disease before it gets worse or before any symptoms develop into disease by providing wellness programs to public which was not done here in this country until a few years ago.
Affordable heal care program now mandate starting from October 1st, 2012, government will not reimburse the hospital if patient with cardiovascular disease would return to hospital within 30 days with the same cause. So it is imperative that patient education is the key to pass beyond this core measure and everyone must participate in it especially nurses. Patients need to call 911 when having these symptoms: when struggling to breathe or severe SOB while resting, or having chest pain, or experiencing confusion or restlessness. This is an emergency situation that patients should be alert about.