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Causes of Congestive Heart Failure

Question:

Discuss about the Congestive Cardiopoietic Regenerative Therapy.

Congestive heart failure is a very common cardiac disorder that mainly targets the middle aged and above patient population. On a more elaborative note, it can be mentioned that this disease is a chronic progressive condition that only alters the pumping capability of the heart due to excess fluid build up facilitated by deficient oxygen rich blood supply (Tissot, da Cruz & Miyamoto, 2014). Elaborating on the different causes of the disease it can be mentioned that there are a variety of different health conditions that can lead to the occurrence congestive heart failure such as coronary arterial diseases, hypertension, valve deterioration and damaged or weakened heart. Exploring further, in case of the coronary arterial diseases, there is generally cholesterol deposition that blocks the most vital arteries narrowing them down further (Bartunek et al., 2016). This restricts the flow of blood and leads to deficiency of oxygen rich blood reaching the heart. Another very common cause to congestive heart failure is the hypertension which increases the vulnerability of any patient suffering from congestive heart failure as well. It has to be mentioned in this context that for hypertensive patients, the blockages are much more aggravated in vital arteries leading to more probability of the patient going through congestive heart failure. Other causes include impaired valve condition that do not open or close correctly and weakened o pre damaged heart due to past history of cardiovascular disorders. In this case the patient had went through a past history of myocardial infarction which can have damaged her cardiovascular apparatus, along with that Sharon had also went through a sinus bradycardia which must have contributed to irreversible damage to the coronary muscles and arteries leading to the congestive heart failure (Crowley et al., 2017).

Considering the incidence of congestive heart failure, it can be stated that this diseases carries the burden of 30% of the total mortality in Australia and affects one Australian in every 12 minutes. There are various risk factors associated with the disease, first and foremost, tobacco usage and alcohol addiction can be considered as one of the most common ones. Along with that, a few health conditions can also increase the risk of congestive heart failure effectively such as obesity, diabetes, insomnia, congenital coronary abnormalities, etc. Although, with respect to the case study, the common risk factors to this scenario, can be the hypertension and previous history of myocardial infarction and sinus bradycardia (Hall, Levant & DeFrances, 2012). The impact of congestive heart failure is extreme and it imposes a significant set of restriction and it can be a huge psychological burden on the patient; even the family members suffer to see their loved one going through the complexities of this disease management.

Signs and symptoms

Patho-physiology

Shortness of breath

It is one of the most frequently observed and reported signs of congestive heart failure. The medical terminology for this symptom is Dyspnoea, and it accompanies acute breathlessness occurring randomly and persistently. The underlying pathophysilogy behind this symptom is associated with the leakage of blood into the longs of the patient due to the excessive blood back up in the pulmonary veins as the heart is unable to keep up with the demand of oxygenated blood of the body (Martindale et al., 2016).

Swollen ankles or localized oedema

The direct reason behind the occurrence of swollen ankles in the cardiac disorders or in congestive heart failures is the excess fluid back in the body tissues. The reduced or slowed down blood flow through the heart causes blood back up in the veins which in turn leads to fluid back up in the tissues. The reduced blood flowing through the body also affects the water retention capability of the body and leads to reduced water and sodium disposal in the body. This is how fluid retention is aggravated in different parts of the body including feet, ankles, legs, and abdomen (Mathew et al., 2018).

Fatigue and dizziness

Another very common symptom of congestive heart failure can be the persistent feeling of tiredness or fatigue all throughout the day. The pathophysiology behind this is the inability of the heart to pump enough blood to meet the needs of the rest of the body. The lack of enough blood flow to brain and vital organs of the body results into the blood being diverted from the less vital organs of the body like the muscles in the limb causing extreme muscular fatigue (Norhammar et al., 2017).

Rapid and irregular heart rate

Heart palpitations can be defined as a very common consequence of congestive heart disease and is a very common sign or symptom of such disorders. In congestive heart failures, the loss of pumping capacity is compensated by the heart by pumping faster (Cho et al., 2015).

Cold hands

The last sign or symptom that congestive heart failure is associated with is the cold hand and feet which is mainly facilitated by the de to the lack of warm oxygenated blood flowing throughout the body. The end points or peripheral regions of the body receive the least amount of warm blood and hence the hands and feet remain cold for the most part of the day (Di Biase et al., 2016).

Risk Factors Associated with Congestive Heart Failure

For any cardiovascular disorders the most abundantly opted medication is the beta blockers. This class of drugs are extremely potent and they provide immediate relief to the patients defying the fatal consequences of the patient effectively. It has to be mentioned in this context that there has been a time in the past when the beta blockers were not the first choice of medication for congestive heart failures, however nowadays, a medication plan for the congestive heart failure is not complete without beta blockers (Cho et al., 2015). The mechanism of action of the beta blockers is complex, these agents can slow down the progression of systolic heart failure effectively by slowing down the heart rate and allowing the left ventricle to access higher blood flow and fill more completely. As the left ventricle is the main pumping chamber of the heart this function has a significant impact on slowing down the heart rate and evading the mortality dangers for the patient. Along with that it has to be mentioned as well that the beta blockers can also widen the blood vessels allowing higher blood passage through the veins and arteries. Hence, Beta blockers can be the first choice of medication for the patients, such as carvedilol, extended-release metoprolol, and bisoprolol (Raimondi et al., 2016).

It has to be understood that the patient had been suffering from extreme breathing troubles or shortness of breath. The most important reason behind the shortness of breath and breathing troubles is the increased fluid back up in the body. The second class of drugs that can be extremely beneficial for the patient can be the diuretics. The aldosterone receptor antagonists are potent potassium sparring diuretics that can helps by stimulating the kidneys to dispose more water and sodium which reduces the fluid back up completely and relieves the pulmonary burden and swelling as well (Di Biase et al., 2016). Hence, medication ACE inhibitors like the amiloride and triamterene can be used to manage the patient as well.

This case study represents the case of a Sharon Mackenzie who had been presented to the emergency department with the symptoms of shortness of breath, swollen ankles, mild nausea and dizziness. The patient had past patient history of myocardial infarction at the age of 65and had been going thorough random and frequent episodes of shortness of breath for the last 7 days as well. It has to be mentioned in this context that her signs and symptoms were aggravated whenever she was undergoing any physical exertion. According to the diagnostic assessment that the patient had been undergone the most possible health disorder diagnosed had been congestive heart failure. The emergency care plan for her can be as follows:

Nursing care priority

Nursing outcome

Intervention

Rationale

Shortness of breath

The ineffective breathing pattern of the patient will subside and the patient will be relieved from the dyspnoea.

   Monitoring and assessment of the respiratory ratio of the patient along with the vital signs to assess the immediate care priorities.

Critically analyse the breathing pattern for dyspnoea such as the nasal flaring, pursed lip breathing and prolonged expiration involving excessive respiratory muscle usage (Fry et al., 2017).

Administer airway clearance and external oxygen therapy to the patient.

Administration of potassium sparring diuretics such as the ACE inhibitors to relieve the patient from the pulmonary burden due to fluid back up (Yu et al., 2015)

The thorough assessment will help reveal the exact breathing troubles that Sharon was dealing with and will be able to design accurate and precise acre plan.

The airway clearance and the external oxygen therapy will be beneficial to increase the respiratory rate the oxygen saturation.

Increased renal functions will revive the swelling and breathing troubles of the patient (Yu et al., 2015).

High heart rate and decreased cardiac output

The heart rate of the patient will return to normal levels and the cardiac output of the patient will also increase.

Auscultation of the apical pulse and assessment of heart rate and rhythm.

Administration of beta blockers to dilate the blood vessels and slow down the heart rate (Norhammar et al., 2014).

Palpating peripheral pulse to revive diminished radial, popliteal, dorsalis pedis, and post tibial pulses.

It will provide insight regarding the exact cardiac function will help in customizing the care plan according to the emergency care needs.

Slowing down the heart rate and vasodilatation will be helpful in avoiding fatalities due to decreased cardiac output (Di Biase et al., 2016).

As the impact of decreased cardiac output can be reflected upon the peripheral pulses, palpating will help revive them (Martindale et al., 2016)

hypertension

The blood pressure of the patient will revert back to normal

Monitor the blood pressure of the patient and assessment of the systolic pressure imbalance.

Administration of medication like the thiazide diuretics and the calcium channel blockers as well (Martindale et al., 2016).

Diligently monitoring the blood pressure of the patient in the hands and thighs.

This monitoring will be beneficial for the patient so that any minute change in the vital sign can be addressed properly.

This medication will help in reducing the systolic pressure of Sharon.

The progress of the patients and response to the medication will be helpful to carry forward the nursing care planning (Mathew et al;., 2018).

Nausea and dizziness

The patient will be relieved from the nausea and dizziness and fatigue.

Provide the patient with the opportunity to be comfortable in a calm environment.

Increase the fluid uptake of the patient and put her in a high energy high antioxidant diet.

Encourage a therapeutic relationship with the patient and ask her take the recovery position (Norhammar et al., 2017)

It will relax the patient and will help in reviving the energy of the patient (Mathew et al;., 2018).

It will help the patient find the necessary nutrition to remain energized (Crowley et al., 2017).

This intervention will relax her and will help in reducing the anxiety and fatigue (Vijayakrishnan et al., 2014).

Medications Used in Congestive Heart Failure Treatment

References:

Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C. (2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART?1) trial design. European journal of heart failure, 18(2), 160-168.

Cho, M. J., Lim, R. K., Jung, M. K., Park, K. H., Kim, H. Y., Kim, Y. M., & Lee, H. D. (2015). Effects of beta-blockers for congestive heart failure in pediatric and congenital heart disease patients: a meta-analysis of published studies.

Crowley, M. J., Diamantidis, C. J., McDuffie, J. R., Cameron, C. B., Stanifer, J. W., Mock, C. K., ... & Williams, J. W. (2017). Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease: a systematic review. Annals of internal medicine, 166(3), 191-200.

Di Biase, L., Mohanty, P., Mohanty, S., Santangeli, P., Trivedi, C., Lakkireddy, D., ... & Casella, M. (2016). Ablation vs. amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device management : results from the AATAC multicenter randomized trial. Circulation, CIRCULATIONAHA-115.

Fry, N., Liu, C., Garcia, A., Galougahi, G. K., Hamilton, E., Harris, J., ... & Rasmussen, H. (2017). From Bench-Based PhD Project to First-in-Man Use of β3 Adrenergic Agonist in Patients with Treatment-Resistant Decompensated Congestive Heart Failure. Heart, Lung and Circulation, 26, S134.

Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalization for congestive heart failure: United States, 2000–2010. age, 65(23), 29.

Martindale, J. L., Wakai, A., Collins, S. P., Levy, P. D., Diercks, D., Hiestand, B. C., ... & Sinert, R. (2016). Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta?analysis. Academic Emergency Medicine, 23(3), 223-242.

Mathew, J., Hunsberger, S., Fleg, J., Mc Sherry, F., Williford, W., & Yusuf, S. (2018). Incidence, predictive factors and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure. Journal of the American College of Cardiology, 31(Supplement 1), 218.

Norhammar, A., Johansson, I., Thrainsdottir, I. S., & Rydén, L. (2017). Congestive heart failure. Textbook of Diabetes, 659-672.

Raimondi, S., Botteri, E., Munzone, E., Cipolla, C., Rotmensz, N., DeCensi, A., & Gandini, S. (2016). Use of beta?blockers, angiotensin?converting enzyme inhibitors and angiotensin receptor blockers and breast cancer survival: Systematic review and meta?analysis. International journal of cancer, 139(1), 212-219.

Tissot, C., da Cruz, E. M., & Miyamoto, S. D. (2014). Congestive Heart Failure. In Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care (pp. 2045-2062). Springer London.

Vijayakrishnan, R., Steinhubl, S. R., Ng, K., Sun, J., Byrd, R. J., Daar, Z., ... & Stewart, W. F. (2014). Prevalence of heart failure signs and symptoms in a large primary care population identified through the use of text and data mining of the electronic health record. Journal of cardiac failure, 20(7), 459-464

Yu, O. H. Y., Filion, K. B., Azoulay, L., Patenaude, V., Majdan, A., & Suissa, S. (2015). Incretin-based drugs and the risk of congestive heart failure. Diabetes Care, 38(2), 277-284.

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