Pathophysiology of Congestive Heart Failure - Term Paper Example

Congestive Heart Failure Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Table of Contents Table of Contents 2 Pathophysiology of Congestive Heart Failure 3 Causes of Congestive Heart Failure 5 Tobacco and diabetic 5 Diet and nutritional factors 5 Activity and exercise 6 Environmental factors 6 How to manage the health condition 7 Bibliography 9 Pathophysiology of Congestive Heart Failure Heart failure is the inability of the myocardium to circulate blood at a rate that is commendable to maintain the need of the metabolizing tissues. It is worth noting that the heart failure is caused by a defect in myocardial contraction although not always (Jessup & Brozena 2003). From a pathophysiology point of view, it implies a complex interplay of myocardial and non myocardial events that combine to give rise to to a clinical syndrome which is characterized by hypertrophy, dilatation, and increased intra-cardiac pressures, reduced cardiac output and dilapidated functional reserve. The notable changes of etiology shows a decline in systolic function, which means that there is an increase in diastolic dimension, continual remodeling of the myocardial architecture which tries to cover the deteriorating ejection fraction while contributing to its decreasing clinical course (Lloyd-Jones 2001). Together with the primary contractile disturbances, there is another activity that activates the secondary or non-myocardial systems. These secondary systems are rennin-angiotensin, sympathetic neural and atrial hormonal, which are obligated to fluid retention, peripheral edema and an increase in peripheral resistance with tremendous depression of the cardiac output in addition to peripheral blood flow impairment (Kenchaiah, Narula & Vasan 2004). Even if the spectrum of disease entities that make the etiological basis of congestive heart failure (CHF) are many,. The loss of myocardial cells and the pathological changes in surrounding the unaffected cardiac tissues which define the function and eventual development of symptoms play a very big role (Vasan & Levy 2000). This therefore entails that CHF ventricular dysfunction is blamed for the majority of cases which is as a result of systolic dysfunction, hypertension which is also referred to as diastolic and systolic dysfunction or even both. Degenerative valve disease, idiopathic cardiomyopathy and alcoholic cardiomyopathy are the major causes of the same. Heart failure is very common in elderly patients who have angina, hypertension, diabetes and chronic lung disease which are referred to as multiple comorbid conditions. Additionally, some comorbidities like renal dysfunction are multifactorial for instance decreased perfusion or volume depletion form orders of breathing and cachexia, while other like anemia, depression, form overdiuresis are also cause but are not clearly understood (Lloyd-Jones 2001). CHF shows that there is an inability of the heart to maintain commendable oxygen delivery and a systemic response attempting to compensate for the inadequacy. What determines the cardiac out put are the heart rate and stroke. The stroke volume is determined by the volume that enters the left ventricle, contractility, the free flow from the left ventricle. These are very important in determining the pathophysiologic consequences of heart failure and in determining any treatment to be administered. Consequently, understanding the cardiopulmonary interaction is also vital in understanding heart failure. In other words, the heart which acts like a dynamic pump is dependent on what is pumped in and what is pumped against. This being the case, the preload is marked by the volume that the pump is given to send, the contractility, and the after load determines what is working against. It is also worth noting that, with the acute decompensation, the pulmonary capillary may give in to the increased pressure and release the fluid, protein and even the red blood cells to the alveoli (Lloyd-Jones 2001). The lungs the will cough to send out te fluid in the alveoli. This concludes the fact that, chronic heart attack failure can result in interstitial fibrosis and a restrictive lung disease. Causes of Congestive Heart Failure Tobacco and diabetic Tobacco causes endothelial injury and stimulates the inflammatory process within the cardio vascular system and there smoking it is one cause of CHF. The damaged endothelium causes an increase in vasoconstriction, which in then affects the properties of platelet adhesion, systemstic inflammation and dyslipidemia. In all this process, there is then a call an increase in oxygen demand and decrease it demand supply to the myocardium. Diabetic also play a role in the effects of CHF(Wheeler 2003). This is attributed to the fact that, it causes an elevation of blood glucose levels and limits the control of diabetes. This in the long run causes an exacerbation of the endothelial injury and inflammation in the whole of vascular system. Diet and nutritional factors Diet and nutritional factors have a very high correlation with the prevalence of CHF. For instance lower diert folate and Vitamin b12, lower serum Vutamin D concentration and increased serum inflammatory biomakrjer levele cause high levels of CHF (Zittermann, Schleithoff & Koerfer, 2005). This therefore mean that there is a close link between micro nutrients and the role they polay ion the pathogenesis of CHF (Lip, 2001). In other words, their scarcity in an individual increases the occurrence of the disease. Folate and Vitamin B12 regulate the homocysteine metabolism, vitamin D downregukates nuclear factos-kB activity, interferon-y and tumor necrosis factor- causes less inflammation. On the other hand, diets with high levels of vitamin D will mean that there is negative endocrine regulation of the rennin-angiotensin-aldosterone system which is associated with regulation of the blood pressure and thus CHF is curbed. Much intake of sodium in the diet only makes the cases worse. This is due to the fact that, somebody and act like a sponge which hold extra water in the in the long run gives more work to the heart. This being the case canned food and smoked meet, fish or even vegetables are high in sodium and therefore should be avoided at all cost. Fruits and vegetables are the only option rather than snack foods. Activity and exercise Exercises are very vital in lowering anxiety and stress and also help to control weight, blood pressure and blood sugar which are commonly associated with an increase in CHF. In actual facts patients with CHF always complain of breathlessness and fatigue (Lloyd-Jones 2001). To asses their exercise limitation, incremental exercise testing with metabolic gas exchange to get the peak oxygen consumption is used. Patients with CHF may also have impaired aspiratory muscle strength and endurance. This calls for the seated positions which require diaphragmatic effort during exercises due to the increased pressure of abdominal contents. It is also worth noting that, exercises that require holding one’s breath are not recommended and also not after meals or when it is too hot it humid (Wheeler 2003). Environmental factors Genetics and environment risk factors have a part to play in the mobility of CHF. Due to the current social burden, which has even been increased by recession, many CHF cases have been reports and this can be associated to stress and depression suffered by many patients. Factors like shortage of resources of provided quality healthcare, not having enough healthcare providers directly affects the prevalence of CHF (Lloyd-Jones 2001). Additionally, low levels of knowledge of the disease in the community are also a factor that increases the same disease. How to manage the health condition In many instances, patients require readmission due to reasons like age, gender, presence of co-existing condition such coronary artery disease or diabetes and poor inpatient care. But in many instances, non compliance with the medication and diet is blamed of the same when it is possible to have enough and accurate information to keep patients out of hospitals (Wheeler 2003). Medical management is enough to prevent the distressing exacerbations of symptoms such as breathlessness and edema. It is also worth noting that CHF is a chronic illness which is progressive and therefore should be managed consistently on a day to day basis. This therefore calls for patients to adhere to all the medications, dietary restriction and a good balance of activities and rest. This they can do on their own for they are the best managers of themselves. CHF patients must have a working knowledge of the facets of the illness that require their participation. Symptoms such as shortness of breath, fatigue and peripheral edema are associated with heart failure but these are just common ones. Patients must be aware that, these are also factors towards the same (Hibbard 2003). Patients must have remote physiological monitoring which they can use to take note of very important signs and other parameters; which will tell them whether they need immediate medication or not. Or even a need to see a medical practitioner. Moreover, there is no one who monitors the kind of diet they take. Information on the nutrients to take and what not to take will mean that they will take only the recommended foods and hence manage the disease.. However, this calls for discipline on the part of the patients (Wheeler 2003). All patients must be placed on a low sodium diet with the amount of salt being solely dependent of the severity of the heart failure. In may instances, the intake should be between 2-3g sodium every day. Those with refractory symptoms should have strict restriction on the same. 48 fluids ounces per day are sufficient for the patients however; it is worth noting that, as for those with hyponatraemia or diuretic therapy might have a change of the restriction (Wheeler 2003). This ay trigger sensation of thirst and measures about how to quench their thirst is recommended like the sue of mints or lozenges. In all instances, the patient must exercise regularly and lightly. This is due to the fact that, exercises will keep the cardiac system healthy and functional to minimize any consequence of CHF. In any case exercises reduces neurohomornal activation, improve endothelial function and skeletal muscle physiology (Wheeler 2003). In addition to this drugs should be taken consistently. They include diuretics, digoxin, angiotensin converting enzyme (ACE) inhibitor, spironolactone and beta blocker just to mention but afew. Bibliography Hibbard, J. H. (2003). Engaging health care consumers to improve the quality of care. Medical Care, 41(1), , I61-I70. Jessup M, Brozena S. (2003). Heart failure. N Engl J Med 348 , 18. Kenchaiah S, Narula J, Vasan RS. . (2004). Risk factors for heart failure. Med Clin North Am; 88 : , 1145-72. Lloyd-Jones D., M. (2001). The risk of congestive heart failure: sobering lessons from the Framingham Heart Study. . Curr Cardiol Rep; 3(3):1 , 84-190. P, L. (2001). Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications. Endocr. Rev. , 22: 477–501. Vasan RS & Levy D. ( 2000). Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 101 : , 2118-21. Wheeler, J. R. (2003). Can a disease self-management program reduce health care costs? The case of older women with heart disease. Medical Care, 41(6) , 706-715. Zittermann A, Schleithoff SS, Koerfer R. (2005). Vitamin D insufficiency in congestive heart failure: Why and what to do about it? . Heart Fail. Rev , 11: 25–33. Read More