Heart failure (HF) is a complex clinical pathological syndrome characterised by symptom of shortness of breath , fatigue and the sign of rales on chest ascultation and peripheral pitting oedema also termed as sign of congestion. It is caused by the structural and functional diffect of the heart(1) . It is initally characterised by the dysfunction of the levt ventricle which lead to impairing the filling functin of the ventricles or unable to produce enough contractility of the left ventricle to maintain the cardiac output to meet the demand of the peripheira tissue (2). HF is the major globle public health problen causing cardiovascular morbidity and motality with socio-economic burden. (3) HF is more common in the elder population, …show more content…
Špinar J, Hradec J, Špinarová L, Vítovec J. Summary of the 2016 ESC Guidelines on the diagnosis and treatment of acute and chronic heart failure. Prepared by the Czech Society of Cardiology. Cor Vasa. 2016;58(5):e530–68.
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Souza FC, Baptista TM, Marques EB, Barros RBM, Scaramello CBV. Omeprazole does not modulate pharmacokinetic of digoxin in patients with heart failure. Vol. 179, International Journal of Cardiology. 2015.
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Epinephrine can be added to NE if needed to maintain acceptable BP, or substituted if necessary. Vasopressin (0.03 units/min) can be used as an adjunct to increase MAP,or to lower NE dose; it should not be used as a single agent. Dopamine can be used as an alternative to NE, but only in patients meeting criteria due to risk of arrhythmias; low dose dopamine not to be used for renal protection. Phenylephrine not recommended in most cases; can be utilized if NE leads to serious arrhythmias, CO is known to be high yet BP continues to be low, or as salvage therapy when MAP target is not achieved by other means. An arterial cath should be placed ASAP in patients who require vasopressors. Inotropes can be added to vasopressors or used alone, with a doubatmine trial of up to 20 mcg/kg/min as an option if myocardial dysfunction is suspected by elevated cardiac filling pressures and low CO, or if hypoperfusion is still evident although intravascular volume and MAP are at goal. Bicarbonate should not be used in patients with pH greater than or equal to
HCG which tells the body that it has produced to much ooestrogen. The body counteracts
This systematic review conducted by Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M, (2012) sourced twenty-five trials, and the overall number of people of the collective trials included was 5,942. Interventions were classified and assessed using the following headings.-
(14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51.
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Congestive Heart Failure is when the heart's pumping power is weaker than normal. It does not mean the heart has stopped working. The blood moves through the heart and body at a slower rate, and pressure in the heart increases. This means; the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. This only keeps the blood moving for a short while. The heart muscle walls weaken and are unable to pump as strongly. This makes the kidneys respond by causing the body to retain fluid and sodium. When the body builds up with fluids, it becomes congested. Many conditions can cause heart failure, and they are Coronary artery disease, Heart attack, Cardiomyopathy, and conditions that overwork the heart.
Today, cardiovascular disease is “the number one killer in the United States and the developed world” (Sapolsky, 2004, p. 41). Coronary heart disease (CHD) is the most common form of cardiovascular disease, and is responsible for claiming an unreasonable amount of lives every year. CHD can begin to accumulate in young adults, but is prominently found in both men and women in their later adult lives. As a result of CHD, men typically experience heart attacks, whereas women present with chest pains, known as angina (Matthews, 2005).
“Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen” (American Heart Association, 2012, para 3). What this basically means is that the body is functioning in a way that the heart cannot keep up with. Although heart failure can be acute and occur suddenly, it usually develops over time and is a long-term or chronic condition. There are two different types of heart failure, left-sided and right-sided, and they can be caused by other diseases such as diabetes, coronary heart disease, or high blood pressure (National Institutes of Health, 2012). In most cases, both sides of the heart are affected simultaneously.
One of the leading causes of death in the United States is heart disease. “Approximately every 29 seconds one American will have a heart attack, and once a minute one American will die from a heart attack” (Ford-Martin and Odle, 915). According to the Gale Encyclopedia of Alternative Medicine men over the age of 45 and women over the age of 55 are considered at risk for heart disease. Heart disease is a major cause of death. It is beneficial to individuals who seek to prevent heart disease to recognize the risks leading to heart attacks as they are one of the primary indications of developing heart disease; especially those that fall into the at risk age groups. These risks consist of some that cannot be changed such as heredity risks, or those that can change such as smoking habits. It is very important to know these specific risks for prevention and to understand the symptoms of heart attacks, such as sweating or the feeling of weakness so if these or other symptoms occur people are aware. Finally heart disease treatment is of vital importance if you experience a heart attack so you can learn how to prevent another one from occurring.
...blood and increase the absorption and concentration of digoxin in the blood. This may reduce the effectiveness of ketoconazole or increase digoxin toxicity. Through unknown mechanisms, omeprazole may increase blood levels of saquinavir and reduce blood levels of nelfinavir and atazanavir, drugs that are used for treating patients with infection caused by the human immunodeficiency virus (HIV). Omeprazole can be contraindicated in patient with hepatic impairment thus doctors are advised not to prescribe more than 20mg daily of omeprazole for such patients. [1] [3] [4]
Digoxin (Lanoxin) 250 mcg daily: In heart failure, increases contractility by inhibiting sodium/potassium ATPase pump in myocardial cells promoting calcium influx via sodium –calcium exchange pump ("Digoxin," 2015, p. 6).
“Pharmacokinetics (PK) and pharmacodynamics (PD) can be seen as two sides of the same coin. PK and PD have a definite relationship, assessing how much drug gets to the site of action and then what that action is. Both activities are essential in the complete investigation of the interaction between the drug and body, and play significant roles in both drug development and their continual use in the clinical setting (Institute Of Clinical Research, Clinical Pharmacology Special Interest Group, Pharmacokinetics vs. Pharmacodynamics).”
Dilated cardiomyopathy accounts for approximately 15% of heart failure cases in the under 75s (“Chronic Heart Failure”). Patients with Dilated cardiomyopathy are usually unaware of the disease until they experience the signs and symptoms of heart failure or they develop an arrhythmia.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
Swan, S.H., F. Liu, J.W. Overstreet, C. Brazil, and N.E. Skakkebaek. "Growth Hormones Fed to