Heart Failure

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Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of care for both individuals, assuming symptoms necessitate treatment. Include realistic lifestyle changes that would be appropriate in your plan of care and evidence-based pharmcotherapy.

About 1 in 3 or 68 million U.S. adults have high blood pressure (CDC, 2012). Of those with hypertension only 50% have it under control. Risk factors associated with this disease are congestive heart failure, heart disease, stroke, and kidney disease (CDC, 2012). The patients at the clinic in this scenario presented with hypertension and two different types of heart failure, systolic and diastolic. The difference between the diseases and treatments used to manage them will be discussed further with particular focus on ACE inhibitors, ARBs, and diuretics.

Heart failure is a condition that occurs when the heart’s ability to pump has become compromised and can no longer properly meet the body’s oxygen demands (Lehne, 2010). This failure in the heart’s ability as a pump may be due to multiple causes and is divided up into two main categories: systolic and diastolic heart failure. Systole and diastole are two different phases of heart contraction. Systole is the portion of the cardiac cycle when the ventricles are contracting; blood is pushed through the semilunar valves out into systemic circulation, from the left ventricle, or into pulmonary circulation, from the right ventricle (Bailey, 2012). Also during this time, the atria are in a period of “relaxation”, or filling. During atrial relaxation, the AV (atrioventricular) valves are closed. Diastole occurs when ventricles are in a period of filling. The semilunar valves are closed to prevent blood from going into circulation. The atria are contracting, pushing the blood through the AV valves into the ventricles. The beginnings of heart failure occur when the heart is unable to pump the entire blood volume out into circulation or if it is unable to fill the ventricle completely (Lehne, 2010). Heart failure plagues nearly 5 million Americans and is the most common inpatient diagnosis in hospitals today (Emory, 2012). More than half of those with heart failure will die within 5 years of diagnosis. Specifically in patients that are 60 years of age and older, it is the cause of 1/5 of all hospitalizations and is evident in 5% of this demographic (Emory, 2012). It is estimated to cost the United States $120 billion annually and is on the rise (CDC, 2012). Although the effects of heart failure are permanent, advances in pharmacological treatments and cardiac therapies have led to bettering outcomes and longer years of life with individuals diagnosed. Before we begin talking about specific types of heart failure, let’s look at factors that lead to heart failure. The main causes of heart failure are chronic hypertension and myocardial infarction. Chronic hypertension is caused by increased pressure in the arteries of the body that will subsequently cause the heart to work harder to pump against. An MI can lead to necrosis of myocardial tissue that causes that portion of the heart to become weak and unable to pump efficiently (Mayo Clinic, 2011). Other causes of heart failure include damaged heart valves, arrhythmias, coronary artery disease...
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