Heart Failure Treatment, Patient Education And Life Style Changes
Diagnostic test results:-
»Electrocardiogram (ECG): May be ordinary or could demonstrate various anomalies including intense ST-T-wave changes from myocardial ischemia, atrial fibrillation, bradycardia, and left ventricular hypertrophy.
»Serum Creatinine: May be augmentation inferable from hypoperfusion. Past renal brokenness can add to volume over-load.
»Complete blood count:
»Chest x-ray: Valuable to decide whether heart disappointment because of diminished oxygen-conveying limit.
»Echocardiogram: Used to survey LV size, valve work, pericardial emanation, divider movement variations from the norm, and discharge part.
»Bed rest decreases metabolic needs, which reduces cardiac workload.
»Reduced workload, in turn, reduces pulse rate and dyspnea.
»Bed rest also helps decrease excess fluid volume by promoting diuresis.
»Physical activity should be encouraged to avoid physical deconditioning and exercise intolerance.
»The risk of venous stasis increases with bed rest and can result in thromboembolism. Antiembolism stockings help minimize this risk, as do passive or active leg exercises, when the patient’s condition permits.
Treatment goals:- HF requires a two-pronged therapeutic approach, the overall goals of which are the following:
»To expel or alleviate the hidden causes or hazard factors;- for instance, by disposing of ingestion of specific medications or different substances that can create or worsen HF or by adjusting a frail disorder, which can build heart requests
»To diminish the indications and improve siphon work by
»reducing metabolic demands through rest, relaxation, and pharmaceutical controls;
»Decreasing fluid volume excess through dietary and pharmaceutical controls;
»administering a combination of diuretics, angiotensin-converting enzyme inhibitors (ACEIs), β-adrenergic blockers, and ARBs.
Angiotensin-converting Enzyme (ACE):–
All ACEIs that have been studied in the treatment of HF have shown benefit. The selection of agent and dose should be based on currently available large-scale studies in which target doses of ACE’s Scaptopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Perindopril (Aceon), Ramipril (Altace), and Trandolapril (Mavik) are different from those used to treat hypertension.
Angiotensin-II Receptor blocker:-
(Avapro), Losartan ,Azilsartan (Edarbi), Eprosartan (Teveten), Irbesartan (Cozaar), Olmesartan (Benicar), Valsartan (Diovan), Telmisartan (Micardis), and initial studies on several of the agents have shown potential benefits for treating HF.
Β-Adrenergic blocking agents:-
Bisoprolol (Zebeta), Metoprolol (Toprol XL), Carvedilol (Coreg).
Chlorothiazide (Diuril), Hydrochlorothiazide (Microzide), Chlorthalidone (Various), and Indapamide (Various).
Furosemide (Lasix),Ethacrynic acid (Edecrin), Bumetanide (Various),
Torsemide (Demadex) and have become the preferred diuretics.
Aldosterone antagonists:- Spironolactone (Aldactone)
Vasodilators:- These agents include
Nitroprusside (Nitropress), Nitroglycerin (Various), Nesiritide (Natrecor).
Digitalis glycosides:- Digitalis, specifically
Digoxin (Lanoxin), continues to play a role in the treatment of HF, but ongoing evaluations have altered its place in the long-term management of HF.
Precautions and monitoring effects:-
»Decreased potassium levels favor digoxin binding to cardiac cells and increase its effect, thus increasing the likelihood of digitalis toxicity.
»This antagonism is particularly significant for the HF patient who is receiving a diuretic . Conversely, increased potassium levels decrease digoxin binding and decrease its effect. This is likely in patients taking potassium or an ACEI or ARB (which increase potassium reabsorption).
»Calcium ions act synergistically with digoxin, and increased levels increase the force of myocardial contraction. At excessive levels, arrhythmias and systolic standstill can develop.
»Magnesium levels are inversely related to digoxin activity. As magnesium levels decrease, the predisposition to toxicity increases.
USED IN THE TREATMENT OF HEART FAILURE (HF) –EXAMPLES
Image source: Heart failure Treatment drugs.
»Consuming small but frequent meals (four to six daily) that are low in calories and residue provide nourishment without unduly increasing metabolic demands.
»Moderate sodium restriction along with daily measurements of weight help maximize the lowest and safest doses of diuretics, a primary tool in reducing central volume in HF.
»Renal function should be evaluated to assess sodium conservation if severe sodium restriction is contemplated.
»Moderate sodium restriction (2 to 4 g of dietary sodium/day) can be achieved with relative ease by limiting the addition of salt during cooking and at the table.
»The patient should be advised about medications and common products that contain sodium and cautioned about their use (e.g., antacids, sodium bicarbonate or baking soda, commercial diet food products, water softeners).
»Patients should be made aware of the importance of taking their medications exactly as prescribed and should be advised to watch for signs of toxicity.
»Patients should be educated on the need for lifestyle modifications that will have a positive effect on reducing HF development and reducing HF symptoms, including daily weight monitoring, fluid management, sodium restriction, early intervention if symptoms appear, compliance with the treatment plan, modification of alcohol intake, exercise, and stress reduction.
»The patient should understand the need for regular checkups and be able to recognize symptoms that require immediate physician notification—for example, an unusually irregular pulse rate, palpitations, shortness of breath, swollen ankles, visual disturbances, or weight gain.
»The patient needs to be educated about drugs such as calcium-channel blockers; NSAIDs, which may cause a problem in HF by retaining fluid; and sodium.
»In addition, the patient needs to be informed of the potential dangers of use of over-the-counter medications that might also predispose him or her to HF symptoms and loss of symptom control.
»A thorough review of all should be carried out as frequently as possible to ensure compliance with the treatment regimen.
Life Style Changes:-
»Controlling high blood pressure, high cholesterol and active.
»Maintaining a healthy weight.
»Staying physical activity.
»Reducing and managing stress.
»Eat low fat food and low sodium food.
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