Congestive Heart Failure - Research Paper Example

? Running Head: CONGESTIVE HEART FAILURE Congestive Heart Failure School Globally, congestive heart failure (CHF) affects more than 22 million people. Before, this life-threatening disease could only be treated with medication, changes in lifestyle, and heart surgery. On the other hand, not all patients, especially those with more serious indications, find relief from these possible treatment practices (Cardiac Resynchronization Therapy, n.d.). Treatment of heart failure may include medication, such as, angiotensin converting enzyme (ACE) inhibitors that lessen the pressure in the blood vessels; beta blockers that reduce the heart’s tendency to beat faster; and antiarrhythmia medications that keep the rhythm regular and prevent sudden cardiac death. In some cases, patients with heart failure may need implantation of mechanical devices, such as pacemakers and cardioverter defibrillators or ICDs (Saxon et al, 2009). This paper will discuss the different pharmacological treatments and procedural interventions for the treatment of congestive heart failure. Risks and complications associated with each approach will likewise be discussed. What is Congestive Heart Failure? Congestive heart failure is a disorder that causes pulmonary vascular obstruction and decreased cardiac input. In layman’s terms, it is a condition in which the heart cannot pump sufficient oxygenated blood to meet the needs of the other organs of the body. CHF causes pumping malfunctions of the heart in either the left or right side. In some cases, both sides are impaired. Malfunction of the heart’s pumping ability may cause blood to collect in areas of the body, such as the lungs, liver, kidneys, gastrointestinal tract, arms and legs, causing oxygen and nutrition losses. These losses decrease the organs’ capacity to work efficiently (Berger, 2009). What Causes Congestive Heart Failure? Congestive heart failure may result from underlying heart problems, such as coronary artery disease; untreated high blood pressure (hypertension); heart muscle disease (cardiomyopathy); congenital heart disease; damaged heart valves, specifically the aortic and mitral; viral infections of the heart valve and heart muscles; and arrhythmias. Other factors that can strain and weaken the heart are anemia, hemorrhage, diabetes, hyperthyroidism, kidney or liver failure, longstanding alcoholism and drug abuse, mainly cocaine and amphetamines. Severe vitamin deficiencies could rarely cause a heart weakening (Soufer, 1992). Modifications in Behavior and Lifestyle The most important approach to the treatment of CHF is a change in the behavior and lifestyle of the patient. Regular exercise could be helpful in the maintenance of overall bodily functions, quality of life, and survival. Further vital precautionary steps include the following: maintaining a normal blood pressure, smoking restrictions, moderation in alcohol intake, and abstinence from cocaine and other prohibited drugs; cautious diet; weight control and low Sodium diet (Soufer, 1992). Pharmacological Treatment and Possible Side Effects Pharmacological treatments are aimed at stopping the progression of the disease, thus, diminishing symptoms and complications, and preventing hospital admissions and mortality. Several treatments have been effective in reducing some or all of these, however, each approach has possible side effects, hence, cautious observation is necessary to capitalize on benefits and lessen unpleasant consequences (Management of Chronic Heart Failure, 2007). Diuretics, also called “water pills,” facilitate easy pumping of the heart because they reduce the water and sodium in the body. Removal of excess fluid likewise lowers blood pressure since there is less blood volume for the heart to pump, and there is minimal force used by the blood vessels. Excess fluid reduction lowers or gets rid of edema or swelling in the ankles, feet or abdomen (Management of Chronic Heart Failure, 2007). Several diuretics cause potassium loss. Potassium, an essential body component that regulates correct functions of the muscles, is particularly important for the heart muscle. Extremely high or low potassium levels may cause irregular heartbeats. However, not all diuretics can cause the body to lose too much potassium (Understanding Congestive Heart Failure, 1995). Diuretic doses should be individualized to decrease retention of fluid without over-treating which may consequentially lead to dehydration or renal failure (Management of Chronic Heart Failure, 2007). Digitalis or Digoxin reduces the speed of the heart and pulse and reinforces the heart’s pumping action. As each heartbeat is stronger, more blood is circulated in the entire body. There is less possibility for excess blood to pump back into the lungs when the heart’s pumping action is strengthened. Digitalis should never be substituted with any other brand not prescribed by a physician. Some side effects are appetite loss, diarrhea, low energy, headaches, nausea and vomiting, vision trouble, and weakened muscles (Understanding Congestive Heart Failure, 1995). Angiotensin converting enzyme (ACE) inhibitors are vasodilators that dilate or open up peripheral arteries, thus, relaxing the blood vessels and helping the heart pump easily. Along with diuretics and digitalis, ACE inhibitors help the body in the elimination of excess fluid and sodium, and improve the heart’s pumping ability. This drug helps control high blood pressure, decreases some or all CHF symptoms, reduces the need for hospitalization and raises survival (Understanding Congestive Heart Failure, 1995). ACE inhibitors, however, could cause blood pressure to go down, which may cause angina, dizziness, tremors, loss of consciousness, or chest pain. When taking this drug, intake of alcohol, caffeine, cof­fee, cola, and tea, should be moderated (Understanding Congestive Heart Failure, 1995). Moreover, CHF pharmacological treatment includes calcium-channel blockers, which enlarge blood vessels; beta blockers, which slow the heart (in cases when heartbeats are too fast); and drugs that correct abnormalities of heartbeat. These medications are usually effective when taken with diuretics, digitalis, and ACE inhibitors (Soufer, 1992). Interventional Procedures and Possible Complications Cardiologists may suggest mechanical device implantation of single or dual chamber pacemaker to help regulate the heart’s normal rate; a biventricular pacemaker or cardiac resynchronization therapy (CRT) to help both sides of the heart in simultaneously synchronizing contractions and improving pumping capacity; and an implantable cardioverter-defibrillator (ICD) that detects when the heart is beating rapidly and converts the fast rhythm to a normal rhythm (Berger, 2009). Pacemakers Generally, a pacemaker’s purpose is to monitor and ensure efficient rate of heartbeats in CHF patients. It uses indiscernible electrical impulses to stimulate the beating of the heart. Nearly all pacemakers are equipped with two electrode wires leading to the left and right ventricles. Pacemakers can be externally programmed by a cardiologist to adjust the most favorable pacing modes for individual patients, improving synchronization of both upper and lower heart chambers (Cardiac Resynchronization Therapy, n.d.). Types of Pacemakers A single-chamber pacemaker has only one lead that is positioned into either the atrium or the ventricle. It delivers electrical impulses to and from the atrium when placed in the atrium and transmits impulses to and from the ventricle when positioned in the ventricle. The cardiologist chooses the position of the single lead, depending on the basis and characteristics of the slow heart rate (Pacemaker – Electronic Device for the Heart Condition, 2010). A dual chamber pacemaker has two leads, one to the right atrium and one to the right ventricle. It mimics the heart’s natural pacing activities. A dual chamber pacemaker is more advanced than a single chamber pacemaker is. Electrical signals are transmitted to and from both the right ventricle and the right atrium, allowing simultaneous harmonized pacing and contractions of the atrium and ventricle, thus, restoring and maintaining a regular heartbeat (Pacemaker – Electronic Device for the Heart Condition, 2010). Dual Chamber versus Single Chamber Ventricular Pacemakers Pacemakers send electrical impulses to one or more chambers of the heart. These impulses help the heart to contract in a normal rhythm. A single chamber pacemaker has one lead that paces only one of the heart’s pumping chambers. A dual chamber pacemaker paces both pumping chambers of the heart. Although more costly, a dual chamber pacemaker is more effective than a single chamber pacemaker because it gives a more natural synchronization to the heart by sustaining atrioventricular and sinus node synchronization. Patients with dual chamber devices have lower risk of fatalities, stroke and hospitalization. These patients have better survival and enhanced quality of life. On the other hand, a big percentage of CHF patients today receive only the single chamber pacing (Dretzke et al, 2004). Possible Complications of Pacemaker Implantation The safety and reliability of pacemaker implantations are ensured only when performed by a certified cardiologist or electro-physiologist. The mortality levels attributable to direct complications of pacemaker implantation are below 1 in 10,000 patients. Complications may comprise hemorrhage, bruising, and site infection. Accidental entry of air in between the lung and chest wall, puncture of the heart, stroke, cardiac arrest, and injury to blood vessels are also possible complications. Because of its modern sophistication, dual-chamber pacemakers are highly at risk to problems of abnormal racing of the heart. The leads are more susceptible to failure. Several patients may need only a single chamber pacemaker implantation (Pacemaker – Electronic Device for the Heart Condition, 2010). Cardiac Resynchronization Therapy Cardiac resynchronization therapy (CRT) is a modern and beneficial therapy that can alleviate CHF indications by developing better synchronization of the heart’s contractions. CRT device corrects the timing of the heart’s contraction, thereby, keeping CHF patients from irregular heart patterns (Cardiac Resynchronization Therapy, n.d.). Almost half of CHF patients have arrhythmia, an irregular heartbeat. Patients suffering from arrhythmia are the best candidates for cardiac resynchronization therapy. Through the leads and into the heart muscle, small amounts of electrical energy are delivered. This energy causes the heart’s lower chambers to beat in harmony. When synchronization is achieved, sufficient amount of oxygenated blood is distributed throughout the body (Cardiac Resynchronization Therapy, n.d.). CRT device has 2 or 3 leads or wires; one lead is implanted through a vein in the right atrium; one in the right ventricle and one into the coronary sinus vein to pace the left ventricle. The device generates electrical impulses that navigate from the wires to the heart muscle. These impulses cause the right and left ventricles to pump in synchrony. The two-way pacing of the CRT device is also called “bi-ventricular pacing”. Overall, CRT improves cardiac function (Cardiac Resynchronization Therapy, n.d.). Complications with Cardiac Resynchronization Therapy Implantation A considerable number of CRT implantation fails to work due to incorrect positioning of the leads in the left ventricle of the heart. Other complications comprise trauma of coronary vein, collapsed lungs, injury to diaphragmatic nerve, and site infection (Mc Alister et al, 2007). In a study performed by Finlay Mc Alister and his associates, “Cardiac Resynchronization Therapy for Patients with Left Ventricular Systolic Dysfunction: A Systematic Review,” out of the 6123 patients who underwent CRT implantation, 7% of all implantations were unsuccessful; 0.3% died during surgery; 5% had device malfunction; 2% were hospitalized due to site infection; and 7% had lead problems (Mc Alister et al, 2007). In a research done by Kostas Perisinakis and his associates, “Fluoroscopically Guided Implantation of Modern Cardiac Resynchronization Devices: Radiation Burden to the Patient and Associated Risks,” it was found out that there are no marked indications of skin injuries caused by radiation from fluoroscopy after implantation of fluoroscopically-guided cardiac resynchronization device unless improperly implanted. With young patients, risk of cancer from radiation should be studied (Perisinakis et al, 2005). Implantable Cardioverter Defibrillator An implantable cardioverter defibrillator is used in patients susceptible to persistent, ventricular tachycardia or fibrillation. The ICD is attached to wires placed on the heart’s surface or inside the heart, to detect cardiac pacing and to correct it by sending electric impulses. The wires are connected to a “pulse generator” and inserted in a pouch under the chest skin. ICDs are usually slightly bigger than a wallet, constantly monitoring heart rate and heart rhythms, sending electric impulses whenever the ICD detects an abnormal activity of the heart. Many modern ICDs are smaller and can conveniently be inserted through blood vessels, thereby, reducing the necessity for an open-heart surgery (Implantable Cardioverter Defibrillator, 2010). Implantable cardioverter defibrillators reduce occurrences of cardiac arrest in CHF patients, and constant ventricular tachycardia or fibrillation. Research is now being conducted as to the effectiveness of ICDs in guarding sudden death to high-risk patients suffering from severe ventricular arrhythmia (Implantable Cardioverter Defibrillator, 2010). Risks of Having Implantable Cardioverter Defibrillator Inappropriate firings of electrical shocks are the most observed problem of patients with ICD implantation. Arrhythmias due to excessive physical activity or a perforated wire, and the patient’s neglect of regular medicine intake can also cause unnecessary pulses (Risks of Implantable Cardioverter Defibrillator, n.d.). Young patients who have ICDs have a higher risk of receiving needless pulses or shocks because children exert more physical energy than adults do. Unnecessary shocks can cause heart injury and abnormal heartbeat. If this happens, the cardiologist can reset the ICD program and give proper medication to stop these unnecessary shocks from recurring (Risks of Implantable Cardioverter Defibrillator, n.d.). The procedure of ICD implantation poses some risks to patients. These risks include site infection where the ICD was implanted; injury to the vein where ICD leads are attached; bleeding around the heart; allergic reaction to the anesthesia used during the procedure; swelling, bruising and bleeding at implantation site; and blood-leak through the heart valve where ICD was implanted. Patients with ICDs have higher risk for congestive heart failure, heart attack, and post-operative stroke (Risks of Implantable Cardioverter Defibrillator, n.d.). There are also possible serious dangers associated with the improper functioning of the ICD device once it is in place. Malfunction of the ICD may hinder the device’s primary function of correcting abnormal heart rhythms. In that case, only a certified and qualified cardiologist can reprogram or replace the ICD (Risks of Implantable Cardioverter Defibrillator, n.d.). Conclusion Latest studies imply that supplementary pharmacological treatments may not be safe or effective. Regardless of improvements in this kind of treatment aimed at treating congestive heart failure, an escalating number of patients with severe symptoms experience alarmingly high morbidity and mortality. To ensure that the heart pumps enough oxygenated blood throughout the rest of the body, some CHF patients may need the use of mechanical devices. Cardiac transplantation is an alternative for those patients suffering from severe heart failure. However, because of organ donor unavailability, there is a possibility that patients will die before getting a donor. The lengthy wait and the heart donor shortage necessitate the search for alternative solutions to sustain patients with heart failure. Moreover, other major organs such as the kidney and liver may be permanently injured before the patient has cardiac transplantation. Therefore, there is a strong reason and necessity for use of mechanical devices as a substitute to cardiac transplantation (Mancini and Burkhoff, 2005). Although pacemakers and cardioverter defibrillators are lifesaving, they are not long-term solutions. Moreover, there are reported complications associated with the use of these mechanical devices either during or after the implantation. These complications may be caused by unsuccessful implantation, device malfunction, site infection and lead problems. Complications of electronic device implantation increase as the level of device sophistication increases. Proper education of patients and their families, health providers, and the public will facilitate protection of patients with implanted electronic devices from complications and risks (Mancini and Burkhoff, 2005). References Berger, A. (2009). Heart Failure. Medline Plus Medical Encyclopedia. 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Cardiac Resynchronization Therapy for Patients with Left Ventricular Systolic Dysfunction: A Systematic Review. Journal of American Medical Association, 297, 22. Pacemaker – Electronic Device for the Heart Condition (2010). Medicine net. Retrieved February 19, 2012 from http://www.medicine.net.com Perisinakis, K. et al. (2005). Fluoroscopically Guided Implantation of Modern Cardiac Resynchronization Devices: Radiation Burden to the Patient and Associated Risks. Journal of the American College of Cardiology, 46, 2335. Risks of Implantable Cardioverter Defibrillators (n.d.). National Institute of Health. Retrieved February 19, 2012 from http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_risks.html Saxon, L. A. et al. (2009). Cardiac Resynchronization Therapy in Heart Failure. Up to Date. Retrieved February 19, 2012 from http://www.uptodate.com/home/content/topic.do?topicKey=hrt Soufer, R. (1992). Heart Failure. In B.L. Zaret, M. Moser, & L.S. Cohen (Eds.), Yale University School of Medicine Heart Book. (pp. 177-184). New York: Hearst Books. Understanding Congestive Heart Failure (1995). Patient Education. Retrieved February 20, 2012 from http://www.cc.nih.gov/ccc/patient_education/pepubs/chf.pdf Read More