Heart Failure Care and Support
By DR ARFA
Heart failure means that the heart is unable to pump blood around the body properly. It usually happens because the heart has become too weak or stiff. It's sometimes called congestive heart failure, although this name is not widely used now. Heart failure does not mean your heart has stopped working.
Symptoms:
•Fatigue and weakness.
•Swelling in the legs, ankles and feet.
•Rapid or irregular heartbeat.
•Reduced ability to exercise.
•Persistent cough or wheezing with white or pink blood-tinged mucus.
•Fatigue and weakness.
•Swelling in the legs, ankles and feet.
•Rapid or irregular heartbeat.
•Reduced ability to exercise.
•Persistent cough or wheezing with white or pink blood-tinged mucus.
Types:
•Right heart failure
•Left heart failure
•Right heart failure
•Left heart failure
Stages
Stage A
Stage A is considered pre-heart failure. It means you’re at high risk of developing heart failure because you have a family history of heart failure or you have one or more of these medical conditions:
Hypertension.
Diabetes.
Coronary artery disease.
Metabolic syndrome.
History of alcohol abuse.
History of rheumatic fever.
Family history of cardiomyopathy.
History of taking drugs that can damage your heart muscle, such as some cancer drugs.
Diabetes.
Coronary artery disease.
Metabolic syndrome.
History of alcohol abuse.
History of rheumatic fever.
Family history of cardiomyopathy.
History of taking drugs that can damage your heart muscle, such as some cancer drugs.
Stage B
Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but you’ve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. (See "Diagnosis" section for more about ejection fraction.) This category includes people who have heart failure and reduced EF (HF-rEF) due to any cause.
Stage C
People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.
Stage D and reduced EF
People who have Stage D HF-rEF have advanced symptoms that don’t get better with treatment. This is the final stage of heart failure.
Causes, Treatment & Prevention
Causes:
Coronary artery disease.
Heart attack.
Cardiomyopathy.
Heart issues present at birth (congenital heart disease).
Diabetes.
High blood pressure (hypertension). This is a common cause in people assigned female at birth.
Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
Kidney disease.
Having obesity.
Heart attack.
Cardiomyopathy.
Heart issues present at birth (congenital heart disease).
Diabetes.
High blood pressure (hypertension). This is a common cause in people assigned female at birth.
Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
Kidney disease.
Having obesity.
INVESTIGATIONS:
Blood tests.
NT-pro B-type Natriuretic Peptide (BNP) blood test.
Cardiac Catheterization.
Chest X-ray.
Echocardiogram (echo).
Magnetic resonance imaging (MRI).
Electrocardiogram (EKG or ECG).
Multigated Acquisition Scan (MUGA scan).
Stress test.
NT-pro B-type Natriuretic Peptide (BNP) blood test.
Cardiac Catheterization.
Chest X-ray.
Echocardiogram (echo).
Magnetic resonance imaging (MRI).
Electrocardiogram (EKG or ECG).
Multigated Acquisition Scan (MUGA scan).
Stress test.
Management:
Position: Sit up with legs dependent and get patient comfortable.
Give High flow O2 target SaO2 > 94-98 % unless COPD then 28%
Nitrates: GTN spray or GTN tablet S/L if SBP > 110 mmHg. IV nitrates may help e.g. GTN Infusion may be considered
Opiates: Chest pain or APO: Give slowly over several minutes Morphine 5-10 mg IV or Diamorphine 2.5-5 mg IV Metoclopramide 10 mg IV (Avoid cyclizine)
Furosemide 50-100 mg stat IV which venodilates and causes diuresis
Salbutamol 5mg Neb if significant wheeze and bronchospasm. It may worsen tachycardia.
Fast AF: Digoxin loading for Fast AF can help
CPAP may help to reduce oedema and improve oxygenation if respiratory failure and exhausted : take senior advice and mechanical ventilation and IPPV may be needed
Inotropes may be considered
Mechanical assist/Balloon pump
Give High flow O2 target SaO2 > 94-98 % unless COPD then 28%
Nitrates: GTN spray or GTN tablet S/L if SBP > 110 mmHg. IV nitrates may help e.g. GTN Infusion may be considered
Opiates: Chest pain or APO: Give slowly over several minutes Morphine 5-10 mg IV or Diamorphine 2.5-5 mg IV Metoclopramide 10 mg IV (Avoid cyclizine)
Furosemide 50-100 mg stat IV which venodilates and causes diuresis
Salbutamol 5mg Neb if significant wheeze and bronchospasm. It may worsen tachycardia.
Fast AF: Digoxin loading for Fast AF can help
CPAP may help to reduce oedema and improve oxygenation if respiratory failure and exhausted : take senior advice and mechanical ventilation and IPPV may be needed
Inotropes may be considered
Mechanical assist/Balloon pump
Treatment:
•Loop Diuretics
•ACE inhibitors
•Angiotensin II receptor blockers
•Beta blockers
•Digoxin
•Hydralazine and Nitrates:
•Anticoagulation
For end stage:
•Cardiac resynchronization therapy
•LV assist devices
•Heart Transplant
Prevention:
Staying at a healthy weight.
Eating foods that are good for your heart.
Exercising regularly.
Managing your stress.
Stopping the use of tobacco products.
Not drinking alcohol.
Not using recreational drugs.
Taking care of other medical conditions you have that can increase your risk.
Eating foods that are good for your heart.
Exercising regularly.
Managing your stress.
Stopping the use of tobacco products.
Not drinking alcohol.
Not using recreational drugs.
Taking care of other medical conditions you have that can increase your risk.
By DR MOHSIN
Heart failure is a condition in which the heart becomes unable to pump enough blood to meet the body's needs. It can affect people of all ages, but is more common in older adults. Heart failure can be caused by a variety of underlying conditions, including high blood pressure, coronary artery disease, heart valve disease, and other heart conditions. In this article, we will discuss the symptoms, causes, diagnosis, and treatment of heart failure.
Symptoms
The symptoms of heart failure can vary depending on the severity of the condition. Some common symptoms include:
- Shortness of breath: This is often the first symptom of heart failure. You may feel like you can't catch your breath, even when resting.
- Fatigue: You may feel tired all the time, even after sleeping.
- Swelling: You may notice swelling in your legs, ankles, or feet. This is due to fluid buildup caused by the heart's inability to pump blood effectively.
- Rapid or irregular heartbeat: You may feel like your heart is racing or fluttering.
- Difficulty exercising: You may find it hard to perform physical activities that you were once able to do without difficulty.
- Persistent cough or wheezing with pink or white blood-tinged phlegm
- Loss of appetite and nausea
- Confusion or impaired thinking
- Sudden weight gain due to fluid retention
Causes
Heart failure can be caused by a variety of underlying conditions that damage the heart muscle, making it weaker and less efficient at pumping blood. Some common causes of heart failure include:
- Coronary artery disease: This is a condition in which the arteries that supply blood to the heart become narrowed or blocked, reducing blood flow to the heart muscle.
- High blood pressure: Over time, high blood pressure can damage the heart muscle and lead to heart failure.
- Heart valve disease: Problems with the heart valves can cause the heart to work harder to pump blood, leading to heart failure.
- Cardiomyopathy: This is a disease of the heart muscle that can cause the heart to become enlarged or stiff, making it less efficient at pumping blood.
- Congenital heart defects: Some people are born with heart defects that can cause heart failure later in life.
- Heart attack: This occurs when the blood supply to the heart is blocked, leading to damage to the heart muscle.
Diagnosis
If you are experiencing symptoms of heart failure, your doctor will perform a physical exam and ask about your medical history. They may also order several tests to help diagnose heart failure, including:
- Echocardiogram: This test uses sound waves to create images of your heart, allowing your doctor to see how well your heart is pumping blood.
- Electrocardiogram (ECG): This test records the electrical activity of your heart, helping your doctor identify any abnormalities.
- Chest X-ray: This test can help your doctor see if your heart is enlarged or if there is fluid buildup in your lungs.
- Blood tests: Your doctor may order blood tests to check for certain markers of heart failure, such as B-type natriuretic peptide (BNP).
- Cardiac catheterization: This is an invasive test that involves inserting a catheter into your heart to measure the pressure and blood flow in your heart.
Treatment
The treatment for heart failure depends on the underlying cause and the severity of the condition. Some common treatments include:
- Medications: There are several medications that can help improve heart function and reduce symptoms of heart failure, including ACE inhibitors, beta-blockers, and diuretics.
- Lifestyle changes: Making changes to your diet and exercise habits can help improve your heart health and reduce your risk of heart failure.
- Surgery: In some cases, surgery may be necessary to repair or replace damaged heart valves, or to bypass blocked arteries.
- Implantable devices: Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) can help regulate heart rhythm and prevent sudden cardiac arrest.
- Heart transplant: In severe cases of heart failure, a heart transplant may be necessary to replace the damaged heart with a healthy one.
Prevention
The following measures can be taken to prevent heart failure:
- Manage your blood pressure: This includes taking medication as prescribed, maintaining a healthy weight, and reducing salt intake.
- Control your cholesterol levels: This includes maintaining a healthy weight, eating a healthy diet, and exercising regularly.
- Stop smoking: Smoking is a major risk factor for heart disease and can increase your risk