Chronic Heart Failure: Etiology, Clinical Manifestations, Diagnosis, Treatment Essay.

Discuss about the  Chronic heart failure. 

Chronic heart failure is also known as the congestive heart failure is the ongoing incapability of the heart to push or pump sufficient blood throughout the body to make sure enough oxygen is supplied to each part of the body. This condition can be caused by different risk factors like old age, increased blood pressure, diabetes, and being obese (Stout et al., 2016). The symptoms associated with this condition include chest pain, cough, swelling of the ankles and legs, tiredness, constipation, weakness, loss of appetite, nausea, and shortness of breathing. This Adverse health condition impacts the inferior chambers of the heart called the left and right ventricles. CHF occurs when the heart is unable to cope with the changing oxygen demands of oxygen of the body (Klip et al., 2013).

Congestive heart failure assessed at least 300,000 population of Australia currently undergo Congestive heart failure (CHF) and about 30,000 fresh cases are identified each year. Between, 1996-1997, nearly 41,000 hospitalizations were reported for congestive heart failure as a principal diagnosis (Sahle, Owen, Mutowo, Krum, & Reid, 2016). There are presently 26 million heart failure patients globally. Particularly in the US, the prevalence of these health conditions is more than 5.2 million. In this particular assessment report the etiology, clinical manifestations, diagnosis, and treatment for CHF will be discussed (Zarrinkoub, et al., 2013).

It can be concluded that this particular health conditions is a global health issue.

Etiology & Pathophysiology

Causes

In this particular section, the pathophysiology and etiology will be discussed. Chronic heart failures are caused by the combination of different health condition including coronary heart disease, heart attack, and cardiomyopathy, conditions that overwork the heart such as valve disorder, diabetes, kidney disorder, and hypertension.

Risk factors

The risk factors associated with this health condition include diabetes type two, obesity, excessive smoking, anemia, hypo and hyperthyroidism, myocarditis, heart arrhythmias, atrial fibrillation, lupus, amyloidosis, emphysema, excessive alcohol consumption, and viral contamination of the heart muscles (Borlaug, 2014). 

Chronic Heart failure is the final outcome of dissimilar pathophysiological courses in which there is damage to the heart that include loss or diminishing of working myocardial cells. Mechanisms of Compensatory neuro-hormone are triggered in order to uphold satisfactory cardiac function and the tissue perfusion. Instigation of the sympathetic nervous system upsurges heart rate and contractility of the cardiac system, while triggering of the system called renin-angiotensin-aldosterone raises reabsorption of sodium and water withholding. Although these reactions are primarily beneficial, continued overstimulation of both sympathetic nervous scheme and renin-angiotensin-aldosterone structure outcomes in maladaptive circulatory remodelling. The discharge of natriuretic peptides counters the vasoconstriction impacts of the sympathetic nervous organization and renin-angiotensin-aldosterone scheme (Piepoli, & Crisafulli, 2014).

In the diastolic type of congestive heart failure, the ventricle turns into less compliant or harder, this damages ventricular filling. This damage results in abridged ventricular acquiescence, which further causes insufficient left ventricular filling. Due to this, left atrial stress increases and the augmented pressure are frequently communicated to the pulmonary scheme, results in pulmonary jamming and dyspnoea. During Systolic congestive heart failure loss of inherent contractility occurs inside the ventricle. Indications are linked to a reduction in cardiac output and the consequence of a changed load on a deteriorating ventricle. In this situation, the ventricle becomes incapable to contract and eject the blood supply. The outcome is an abridged ejection fraction, a distended left ventricle and the remodelling of the heart chamber. The procedure of remodelling encourages a transformed ventricular figure which further misrepresents the bicuspid valve instigating regurgitation and augmented volume burden in the deteriorating ventricle. This overfilling subsidizes promote to the remodelling course and illness progression (Borlaug, 2014).

Causes

Chronic Heart failure is the main health issues in developed nations with increased occurrence and prevalence in the aged populace. Hospitalizations due to heart failure augmented 159% in last decade notwithstanding the improvements in the management of the illness. Two-thirds of individuals with chronic heart failure are favoured for completely by their primary care doctor rather than being involved in the heart failure clinics and reintegration or rehabilitation programs focused in handling the disease (Liu, & Eisen, 2014).

It can be concluded that CHF occurs due to damage to myocardial cells, increase in reabsorption of sodium and water withholding, insufficient ventricular filling, and deterioration of ventricles. This particular health issues increases hospitalizations in last few years.

Clinical manifestations 

In this particular pat clinical manifestations of CHF will be discussed.

The following are possible symptoms of heart failure:

Congested lungs: Build-up of fluid in the lungs area and result in breathing issues even when relaxing and chiefly when lying down.

Retention of Fluid: as a smaller amount of blood is being driven to the renal part; it can result in water retention. This may cause swelling in the ankles, legs, and stomach. It can likewise increase weight and urination (Ponikowski, Voors, Anker, Bueno, Cleland, Coats, & Jessup, 2016).

Fatigue and dizziness: as less blood is getting the body organs, it may result in a sense of weakness.

Irregular and rapid heartbeats: heart may pump more rapidly in order to overcome the deficiency of blood being driven to the body (Better health, 2018).

Manifestations of CHF include congested lungs, retention of fluid, dizziness, and irregular heartbeat,

Diagnosis process 

In this part the diagnosis process of CHF will be discussed

Echocardiogram

This test is considered as the most useful test to diagnose CHF.  It basically provides the objective examination of the cardiac structure and the working and assures the diagnosis of systolic LV malfunctioning

ECG

It can particularly add or assures the information related to the causes of CHF. The alternations detected on ECG are not precise to heart failure; therefore an abnormal ECG cannot replace the echocardiography (Ramírez, Orini, Mincholé, Monasterio, Cygankiewicz, e Luna, & Pueyo, 2017).

Chest X-ray

This test helps the physician to examine the exact conditions of the lungs and heart. The specific malfunctioning can rule out the CHF as the explanation for the individual’s symptoms and signs. Cardiomegaly, the pulmonary venous alterations and the intestinal oedema of the lung areas help the examinations of the chronic heart failure 

Blood tests

As mild anaemia is common in the CHF, therefore, this test is important to diagnose any indications of Anaemia. It can also diagnose abnormal blood cells and contaminations. It can also detect the BNP levels, which is a hormone that elevates heart failure.     

Thyroid functions test; these tests are conducted to diagnose hypo and hyperthyroidism. These tests indicate the thyroid dysfunction is recognised as the likely cause of CHD.

Stress tests

This test measures the wellbeing of the heart by identifying how it reacts to the exertion. The physician may ask the patient to walk on the treadmill with the attached ECG machine or the drug can also be administered intravenously that triggers the heart similar to work out or exercise. Sometimes this test might be performed while the patient wearing the mask that calculates the ability of the heart and lungs to intake O₂ and exhalation of CO₂ (Ahmad, et al., 2014).

Risk Factors

The diagnosis process or CHF includes using ECG, chest X ray, blood tests, and stress tests.  

In this section some of the treatment options will be discussed.

ACE inhibitors: ACE or angiotensin-converting enzyme inhibitors widen the narrowed blood vessels to enhance the blood flow. Some of the ACE inhibitors include benazepril, captopril, enalapril fosinopril, lisinopril, quinapril, ramipril, and perindopril. Some of the side effects can be caused by these drugs such as low blood pressure, a build-up of potassium in the loped, abnormal heart rhythms, and water and sodium retention (Abete, Testa, Della-Morte, Gargiulo, Galizia, De Santis, & Cacciatore, 2013).

Beta blockers: these drugs are helpful in reducing the blood pressure and decrease the rapid heart rhythm. Some of the beta blockers include acebutolol, atenolol, bisoprolol, carteolol, esmolol, metoprolol, nadolol, nebicolol, and propranolol. The side effect includes increased cardiovascular impacts like low blood pressure and reduced heart rate (Abete et al., 2013).

Diuretics: diuretics are the drugs that decrease the body’s fluid intake as CHF can stimulate the body to retain extra liquid than it should. The doctor may prescribe medications like thiazide diuretics (helps in widening to the blood vessels and remove the extra fluid), loop diuretics (triggers kidneys to generate more urine to remove additional fluid), and potassium-sparing diuretics (helps in get rid of sodium and liquid). The side effects of these drugs include headaches, dizziness, thirst, very low levels of potassium in the blood, an increase of blood sugar (Ramírez, et al., 2017).

Non-pharmaceutical management of CHF might be as essential as the drug therapies a patient might develop physical deconditioning. Some of the non-pharmaceutical interventions include;

Physical activity

Most of the physician now recommends regular exercises for the individual having CHF. The physical activities have been proven to enhance the functional ability, sign and symptoms, and neuro-hormonal malfunctioning. Some of the exercises that must be included in patient's interventions programs are normal walking, bicycling, light weight lifting, and stretching workouts. The patient should be educated about the type of physical exercise they are recommended to perform every day (Hetland, et al., 2013).

Nutrition

Nutritional approaches might also be beneficial for the patient with CHF. The intake of saturated fat should be restricted for the patient with CH. Among the CHD patient constipation id common due to gastrointestinal hypoperfusion, therefore high fibre food should be included in their routine diet. Fluid overload is caused due to the excessive dietary sodium is the main cause of preventable hospitalizations (Ponikowski et al., 2016), therefore reducing the dietary sodium in the diet might be beneficial clinical and haemodynamic impacts specifically when mixed with the diuretics (Slawson, Fitzgerald, & Morgan, 2013).  

Fluid management

Fluid management is the key approach in order to achieve the health goals already set for a particular patient. The patient must be advised that a steady gain of weight with time may indicate that they are retaining a high amount of fluid.  If the patient gained more than 2 kg of weight in two days, they must talk to their physician or expert. Little to moderate intake of alcohol might improve the prognosis in the individual with left ventricle dysfunction is actually controversial. Intake of high caffeine might exacerbate issues related to arrhythmia, upsurge the BP and heart rate (Philipson, Ekman, Forslund, Swedberg, & Schaufelberger, 2013).

Clinical Manifestations

Smoking

Smoking or chewing tobacco should be stopped as it can reduce the oxygen availability in the blood, provokes the vasoconstriction, and impacts the respiratory and endothelial performance or functioning (Bos-Touwen et al., 2015).

Health promotion

There is a number of health programs are conducted by the Australian government to increase the awareness of this health condition among the people. Different services providers like heart foundation, Australian indigenous Healthinfonet, World Heart Foundation, RHD action, Reach, her heart, and Ministry of health are working continuously to reduce the prevalence of this health issues by funding research companies, making people conscious about the risk factors of the chronic heart failure and other heart condition. The health promotion programs conducted are working in different societies and states of Australia to enhance the lifestyle and reducing the causing factor of CHD (Chen et al., 2016).

It can be concluded that by using some of the treatment options including pharmacological treatment, non-pharmacological treatment, nutrition, fluid management, and stop smoking can be beneficial in CHF. A different health promotions programme has been implemented by different organisations like AIH, WHF, and ministry of health. 

Conclusion

Chronic or congestive heart failure is basically the current incapability of the human blood to drive or pump enough blood to different parts of the body. Risk factors associated with this health condition include being obese, old age, increased BP, diabetes, and other heart condition. Nearly 300000 people of Australian presently suffering from this health issue, and 26 million people are affected worldwide. It occurs due to the dysfunctioning of myocardial cells. The diastolic CHF caused when ventricles become stiffed and due to the pulmonary blocking and dyspnoea. In systolic CHF occurs due to the reduced cardiac output and deteriorating ventricles. CHF is the worldwide issue which increases the hospitalization cases by 159 per cent. The symptoms associated with CHF include congested lungs, dizziness, and retention of fluid, fatigue, quick and irregular heartbeats. The diagnosis methods can be prescribed by a physician for this health includes ECG, echocardiogram, chest X-Ray, blood tests (complete CBC and infection), thyroid function test, and Stress tests. The treatment methods applied for this problem is two types; pharmaceutical and non-pharmaceuticals. The pharmaceutical management o CHF includes ACE inhibitor, beta blockers, and diuretics.  The non-pharmaceutical treatment includes applying recommended physical activities, diet rich in fibre, less dietary sodium, management of fluid intake, and stopping smoking. Health promotion also plays a major role in the elimination of this health. There is the number if health promotions have been implemented by the Australian government to enhance the knowledge and awareness about the preventive measures, treatment option and risk factors that can cause this health. Some of the health promotion services providers available in Australia are Reach, Heart Foundation, and the Ministry of health 

References 

Abete, P., Testa, G., Della-Morte, D., Gargiulo, G., Galizia, G., De Santis, D., & Cacciatore, F. (2013). Treatment for chronic heart failure in the elderly: current practice and problems. Heart failure reviews, 18(4), 529-551.

Better health (2018). Congestive heart failure (CHF). Retrieved from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congestive-heart-failure-chf

Diagnosis Process

Philipson, H., Ekman, I., Forslund, H. B., Swedberg, K., & Schaufelberger, M. (2013). Salt and fluid restriction is effective in patients with chronic heart failure. European journal of heart failure, 15(11), 1304-1310. 

Ahmad, T., Fiuzat, M., Neely, B., Neely, M. L., Pencina, M. J., Kraus, W. E., & Adams, K. F. (2014). Biomarkers of myocardial stress and fibrosis as predictors of mode of death in patients with chronic heart failure. JACC: Heart Failure, 2(3), 260-268.

Stout, K. K., Broberg, C. S., Book, W. M., Cecchin, F., Chen, J. M., Dimopoulos, K., & Kuvin, J. T. (2016). Chronic heart failure in congenital heart disease: a scientific statement from the American Heart Association. Circulation, 133(8), 770-801.

Borlaug, B. A. (2014). The pathophysiology of heart failure with preserved ejection fraction. Nature Reviews Cardiology, 11(9), 507. 

Chen, A. M., Yehle, K. S., Albert, N. M., Ferraro, K. F., Mason, H. L., Murawski, M. M., & Plake, K. S. (2014). Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Research in Social and Administrative Pharmacy, 10(2), 378-386.

Klip, I. T., Comin-Colet, J., Voors, A. A., Ponikowski, P., Enjuanes, C., Banasiak, W., & van Veldhuisen, D. J. (2013). Iron deficiency in chronic heart failure: an international pooled analysis. American heart journal, 165(4), 575-582. 

Liu, L., & Eisen, H. J. (2014). Epidemiology of heart failure and scope of the problem. Cardiology clinics, 32(1), 1-8.

Hetland, A., Haugaa, K. H., Olseng, M., Gjesdal, O., Ross, S., Saberniak, J., & Edvardsen, T. (2013). Three-month treatment with adaptive servoventilation improves cardiac function and physical activity in patients with chronic heart failure and cheyne-stokes respiration: a prospective randomized controlled trial. Cardiology, 126(2), 81-90.

Bos-Touwen, I., Schuurmans, M., Monninkhof, E. M., Korpershoek, Y., Spruit-Bentvelzen, L., Ertugrul-van der Graaf, I., & Trappenburg, J. (2015). Patient and disease characteristics associated with activation for self-management in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study. PloS one, 10(5), e0126400.

Piepoli, M. F., & Crisafulli, A. (2014). Pathophysiology of human heart failure: importance of skeletal muscle myopathy and reflexes. Experimental physiology, 99(4), 609-615.

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.

Ramírez, J., Orini, M., Mincholé, A., Monasterio, V., Cygankiewicz, I., de Luna, A. B., & Pueyo, E. (2017). Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model. PloS one, 12(10), e0186152. 

Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of heart failure in Australia: a systematic review. BMC cardiovascular disorders, 16(1), 32.

Slawson, D. L., Fitzgerald, N., & Morgan, K. T. (2013). Position of the Academy of Nutrition and Dietetics: the role of nutrition in health promotion and chronic disease prevention. Journal of the Academy of Nutrition and Dietetics, 113(7), 972-979.

Zarrinkoub, R., Wettermark, B., Wändell, P., Mejhert, M., Szulkin, R., Ljunggren, G., & Kahan, T. (2013). The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. European journal of heart failure, 15(9), 995-1002.