Risk Factors for Congestive Heart Failure
Discuss about the Epidemiology of heart failure with ejection fraction.
Most important risk factors of congestive heart failure include older age, high levels of cholesterol, diabetes mellitus, high blood pressure and active smoking. Other risk factors include lack of physical activity, family history, obesity and alcohol consumption. Hypertensive female are four times more prone to congestive heart failure as compared to the non-hypertensive female. Hypertension is responsible for the occurrence of congestive heart failure in approximately 60 % female and 40 % male. However, it is evident that hypertension is more evident in males as compared to females in all age groups. High levels of low-density lipoproteins and low levels of high density lipoproteins are also responsible for the occurrence of congestive heart failure. It is evident that smoking is responsible for approximately 36 % cases and obesity is responsible for the approximately 20 % cases of the congestive heart failure. Consumption of high amount of saturated fat is also responsible for the occurrence of congestive heart failure. Increased levels of B-type natriuretic peptides are also responsible for the occurrence of congestive heart failure (Mahmood and Wang, 2013).
Other cardiovascular conditions like coronary artery disease and heart attack, faulty heart valves, cardiomyopathy, myocarditis, congenital heart defects and heart arrhythmias are the cause of congestive heart failure. Other cardiovascular risk factors responsible for the occurrence of congestive heart failure include coronary artery disease, heart attack, congenital heart defects, irregular heartbeats and valvular heart disease. Sleep apnoea and viral infection are also responsible for congestive heart failure. Consumption of medications like antidiabetic medications (rosiglitazone and pioglitazone), nonsteroidal anti-inflammatory drugs (NSAIDs), certain anaesthetics, anti-arrhythmic medications, antihypertensive and anticancer are responsible for the occurrence of congestive heart failure. Approximately 2 % and 5 % of persons in the age group 40 to 59 years and 60 to 69 years experiences congestive heart failure respectively. Approximately 50 % of the patients diagnosed with congestive heart failure die within five years after diagnosis. Approximately 6 to 9 times more sudden death can occur in congestive heart failure patients as compared to the normal patients. Family members of Mrs McKenzie should take responsibility to avoid exposure of risk factors to her. Family members should monitor eating and medication consumption in her. Family members should maintain positive communication with her because it is evident that it can be helpful in maintaining adoption and maintenance of health behaviours. Family members should focus on care of Mrs McKenzie rather than worrying about her diseased condition because worrying about patient condition can lead to inaction in care of patient (Dhingra et al., 2014; Raman, 2016).
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Symptom |
Pathophysiology |
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Dyspnea |
Reduced cardiac can lead to impaired supply of blood to the skeletal muscle. It leads to the augmented left ventricular filling pressure to maintain optimum cardiac output. It can lead to reduced pulmonary diffusion and consequently interstitial edema which results in the breathlessness. Raised diastolic pressure results in the increased expenditure of myocardial energy. It leads to ventricle remodelling, raised myocardial oxygen demand and myocardial ischemia. Mrs McKenzie is also experiencing breathlessness (Güder et al., 2014). |
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Swollen ankle |
Swollen ankle indicates increased swelling in the leg or ankle. It mainly occurs due to the increased fluid accumulation in the body. This build-up of fluid occurs in the body due to decreased blood flow out of the heart. Release of atrial natriuretic peptide and B-type natriuretic peptide can lead to the vasodilation and reduced ventricular felling pressure which reduces cardiac preload and afterload. It leads to the back flow of blood to the heart through the veins. Mrs McKenzie also exhibited signs of swollen ankle (Moe, 2013). |
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Dizziness |
Dizziness can occur in patients of congestive heart failure mainly due to reduced supply of blood to the brain. Reduction in the blood supply to brain can occur when there is heart rate or rhythm is abnormal. In such case, heart would be unable to pump adequate amount of blood due to block in the blood flow which can occur due to narrowing of the valve. In Mrs McKenzie also, mild dizziness was observed (Kovács et al., 2014). |
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Tachycardia |
Life-threatening ventricular arrhythmias can occur in patients with heart failure. Ventricular dilatation, myocardial hypertrophy, and myocardial fibrosis are mainly responsible for the occurrence of arrhythmias. Exposure of myocytes to the ventricular dilatation, myocardial hypertrophy, and myocardial fibrosis are responsible for arrhythmias (Ellis and Josephson, 2013). |
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Lack of appetite and nausea |
Lack of appetite and nausea can occur in patients with congestive heart failure mainly due to less supply of blood to the gastrointestinal tract. Nausea can occur mainly due to irritation of the nerve endings in the gastrointestinal tract. These nerve endings stimulate centres in the brain which induces nausea and vomiting (Kemp and Conte, 2012). |
Angiotensin-converting-enzyme inhibitor (ACE inhibitor) can be used as the first line therapy for the congestive heart failure. ACE inhibitors exhibits its effect by inhibiting angiotensin-converting enzyme which is a prominent component of renin–angiotensin- aldosterone (RAAS) system. RAAS system is responsible for the hypertension. ACE inhibitors halt conversion of Angiotensin I (ATI) to Angiotensin II (ATII) . It leads to lowered arteriolar resistance, augmented venous capacity, reduced cardiac output and volume, lowered resistance in blood vessels and increased excretion of sodium in the urine. Benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril are the examples of the ACE inhibitors. ACE inhibitors can relax blood vessels and reduce blood volume which can be helpful in lowering blood pressure and reducing oxygen demand from the heart (Sayer and Bhat, 2014; Valika and Gheorghiade, 2013).
Cardiovascular conditions that lead to heart failure
Beta blockers can be useful in managing heart arrhythmias which can be helpful in reducing second chance of heart attack. Beta blockers are competitive antagonists which acts on receptor sites of endogenous catecholamines like epinephrine (adrenaline) and norepinephrine (noradrenaline). Beta blockers block action of catecholamine of the sympathetic nervous system. Few of the beta blockers act on all the β-adrenergic receptors while others act on the specific β-adrenergic receptors like β1, β2 and β3 receptors. Beta blockers useful in the congestive heart failure specifically act on the β1 receptors because β1-adrenergic receptors specifically present in the heart. Bisoprolol, carvedilol, and sustained-release metoprolol are the examples of beta blockers useful in the congestive heart failure. Beta blockers reduce heart rate. Beta blockers also exhibit its action on renin–angiotensin system by reducing secretion of renin. By reducing renin secretion, beta blockers lower extracellular volume and consequently reduces heart oxygen demand. In hear failure , there is increased sympathetic activity due to increased catecholamines which lead to the increased oxygen demand, secretion of inflammatory mediators and inappropriate myocyte remodelling. It leads to the reduced efficiency of cardiac contraction and reduced ejection fraction. Beta blockers restores normal physiological functions by countering augmented sympathetic activity (Bavishi et al., 2015; Buchhorn and McConnell, 2014).
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Intervention |
Rationale |
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Cardiovascular intervention |
Auscultate apical pulse, monitor heart rate and heart beat rhythm. Heart sound should be noted. Peripheral pulses should be palpated. Blood pressure should be monitored. Amount of urine output and concentration of urine should be noted. Make sure that patient is continuing with the consumption of medications like furosemide and enalpril. |
Patient is associated with bradycardia. Patients with congestive heart failure are associated with dysrhythmias like premature atrial contractions (PACs), paroxysmal atrial tachycardia (PAT), PVCs, multifocal atrial tachycardia (MAT), and atrial fibrillation (AF). Due to impaired pumping action, S1 and S2 sounds might be weak. Murmurs might be evident due to valvular incompetence. Reduced cardiac output can be evident in the abnormal pulses like radial, popliteal, dorsalis pedis, and post tibial pulses. In the initial period, there might be occurrence of hypertension due to increased systemic vascular resistance (SVR). Due to reduced cardiac output, there might be reduced urine output due to retention of sodium and water. Diuretics can be helpful in improving condition of patient by reducing preload, maintaining normal cardiac output and reducing congestive symptoms. ACE inhibitors can be useful in congestive heart failure patients by reducing ventricular filling pressure and increasing cardiac output (Paul and Hice, 2014; Currie, et al., 2015). |
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Respiratory intervention |
Assess respiratory rate every four hour. ABG levels should be assessed. Breathing pattern should be observed. Encourage and demonstrate deep breathing. It comprises of slow inhalation, end respiration holds and passive exhalation. Spirometer should be used. Diaphragmatic breathing should be promoted. Patient should be educated about lip breathing, abdominal breathing, relaxation technique and planned daily activities to avoid fatigue. Respiratory medications and oxygen should be provided after doctors’ instructions. Nurse should give company to the patient during acute episodes of respiratory distress. Patient should be encouraged to take rest for maximum amount of time. Patient should be encouraged to take small quantity of meals in frequent durations. Nutritional status of the patient in the form of weight, electrolyte level and haemoglobin level should be evaluated. |
Average respiratory rate for adults is 10 – 20 bpm. If deviation from it can be detected as abnormal. Detection of breathing pattern can be helpful in identifying abnormal respiratory system. It would helpful in monitoring oxygenation and ventilation pattern. ABG analysis comprise of pH, PaCO2, HCO3 and PaO2. It would be helpful in determining hypoxia and acidosis. It would be helpful in understanding underlying disease condition and respiratory function. It would be helpful in the deep respiration and increasing oxygen level. Extended expiration can be helpful in preventing air trapping. It would be helpful in relaxing muscles and improving oxygenation. It would be helpful in improving ventilation. Bronchodilator medications would be helpful in bronchodilation and in opening the airway passage. It would be helpful in reducing anxiety and reducing oxygen demand by the patient. Strenuous activity would worsen breathlessness in the patient. It would be helpful in reducing burden on the diaphragm. Malnutrition can adversely affect respiratory mass and strength. It can lead to respiratory failure (Rogers and Bush, 2015; Suter et al., 2012). |
References:
Bavishi, C., Chatterjee, S., Ather, S., et al. (2015). Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis. Heart Failure Reviews, 20(2), 193-201.
Buchhorn, R., and McConnell, M.E. (2014). Beta blockers in childhood heart failure – why not? International Journal of Cardiology, 175(1), 211-2.
Currie, K., Strachan, P.H., Spaling, M., et al. (2015). The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives. European Journal of Cardiovascular Nursing, 14(6), 525-35.
Dhingra, A., Garg, A., Kaur, S., Chopra, S., et al. (2014). Epidemiology of heart failure with preserved ejection fraction. Current Heart Failure Reports, 11(4), 354-65.
Ellis, E.R., and Josephson, M.E. (2013). Heart failure and tachycardia-induced cardiomyopathy. Current Heart Failure Reports, 10(4), 296-306.
Güde, G., Brenner, S., Störk, S., Hoes, A., and Rutten, H. Chronic obstructive pulmonary disease in heart failure: accurate diagnosis and treatment. European Journal of Heart Failure, 16(12), 1273-82.
Kemp, C.D., and Conte, J.V. (2012). The pathophysiology of heart failure. Cardiovascular Pathology, 21(5), 365-71.
Kovács, Á., Papp, Z., and Nagy, L. (2014). Causes and pathophysiology of heart failure with preserved ejection fraction. Heart Failure Clinics, 10(3), 389-98.
Mahmood, S. S., and Wang, T. J. (2013). The epidemiology of congestive heart failure: the Framingham Heart Study perspective. Global Heart, 8(1), 77–82.
Moe, G. (2016). Heart failure with multiple comorbidities. Current Opinion in Cardiology, 31(2), 209-16.
Paul, S., and Hice, A. (2014). Role of the acute care nurse in managing patients with heart failure using evidence-based care. Critical Care Nursing Q, 37(4), 357-76.
Raman, J. (2016). Management of Heart Failure. Springer.
Rogers, C., and Bush, N. (2015). Heart Failure: Pathophysiology, Diagnosis, Medical Treatment Guidelines, and Nursing Management. Nursing Clinics of North America, 50(4), 787-99.
Sayer, G., and Bhat, G. (2014). The renin-angiotensin-aldosterone system and heart failure. Cardiology Clinics, 32(1), 21-32.
Suter, P.M., Gorski, L.A., Hennessey, B., and Suter, W.N. (2012). Best practices for heart failure: a focused review. Home Healthcare Nurse, 30(7), 394-405.
Valika, A.A., and Gheorghiade, M. (2013). Ace inhibitor therapy for heart failure in patients with impaired renal function: a review of the literature. Heart Failure Reviews, 18(2), 135-40.
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