Wednesday, April 20, 2011

Heart failure treatments may reverse failure with right medication and life style changes


TREATMENT OF HEART FAILURE .

Heart failure can occur in people of all ages, even in small children (especially those who are born with a heart defect). But it is much more common in the elderly because older people are more likely to have diseases that damage muscle and heart valves. Thus the age-related changes in the heart tends to make the heart pump less efficiently. Heart failure develops in approximately 1100 people. The suffering will probably become more frequent because people are living longer and because some countries have certain risk factors for heart disease (such as smoking, hypertension and a diet high in fat) affects more people.

Heart failure does not mean the heart has stopped. This means that the heart can not follow the work needed to pump blood adequately all parts of the body (the workload). However, this definition is a bit simplistic. Heart failure is extremely complex and there is no simple definition can encompass its multiple causes, aspects, forms and consequences.

Heart failure is a chronic disease requiring lifelong treatment. But with treatment, signs and symptoms of heart failure can improve heart and sometimes strong. Doctors sometimes can correct heart failure by treating the underlying cause. Example. Repair of a heart valve or controlling a rapid heart rate may reverse heart failure, but for most people, treatment of heart failure involves a balance between the right medication and in some cases, the devices that help the heart beat and contract properly.


LIFE STYLE CHANGES .


  • Encouraged to stop smoking and support with smoking cessation.

  • To tell and good nutrition and to provide assistance to reduce weight in obese patients. Cachexic patients (weight loss over 6 months  in the past, a stable weight) should be evaluated by a dietician. Suggest a patient to avoid foods with high salt content and is not salt food.

  • Salt intake should not exceed 2-3 g / day. Whereas a moderate sodium restriction severe CCF, make sure the low salt alternatives are not much use, because they can be very rich in potassium, which can be a problem in patients with ACE inhibitors or spironolactone.

  • Tell patients with severe hyponatremia with CCF in particular, to limit their fluid intake sensibly. Avoid excessive dryness - especially in elderly patients with high-dose diuretics.

  • Patients can help monitor their water retention by themselves regularly weighing. If a sudden, unexpected weight gain of 2 kg in 3 days, should seek advice.

  • Some patients may benefit from the possibility of varying the dose of diuretic based on weight steadily. Self-weighing complement the ongoing monitoring of weight in the offices of general practitioners, hospital outpatient and inpatient services.

  • Alcohol may act as a negative inotropic and blood pressure increases the risk of arrhythmia. Limit alcohol consumption to 10-20 grams / day (equivalent to 1-2 glasses of wine) or advise for or against, if the consumption of alcohol induced cardiomyopathy.


  • Encourage aerobic exercise, preferably in a supervised cardiac rehabilitation program for patients with heart failure up to and including NYHA class III, which has proven beneficial effects.


  • Air transport is not limited in stable patients (and perhaps preferable to other means of transportation for long trips), but the long-haul flights increase the risk of peripheral edema and deep vein thrombosis. Travel to high altitude and hot and humid to be very discouraged in symptomatic patients who can not adapt easily.


  • There are no specific restrictions on sexual activity, although there is a slight risk of decompensation including NHYA class III-IV.

  • Inform patients that symptoms such as breathlessness, palpitations, angina, it is unlikely unless the sexual experience similar symptoms of moderate physical activity (such as climbing two flights of stairs in a reasonable time).

  • Sexual activity does not always cause symptoms, if included, after sleep, and minimal impact on partners most of the physical work. The most challenging times will have sex with a new partner after a hot bath or a full stomach. Sexual problems are common in patients with heart failure linked to heart disease at the same time, side effects of treatment (eg, beta-blockers) and psychological factors. risks of pregnancy, heart failure due to aggravation of blood volume and cardiac output, and many of its drugs are contraindicated during pregnancy.

  • Potentially fertile women with heart failure should be obtained before the birth of advice, so that information about reproductive choice.

  • Depression is very common in heart failure, occurring in at least one in five patients and significantly higher in patients with advanced illness. Screening and treatment should be considered in patients with symptoms.

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Treatment of heart failure medications
Treatment of heart failure surgery




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Wednesday, April 13, 2011

Left side heart failure -Signs and symptoms - Risk factors - Diagnostic investigations - Treatment - Prognosis



LEFT SIDE HEART FAILURE .

Versus left heart failure is a condition in which the left side of the heart loses its ability to pump blood efficiently, which does not meet the requirements of the body . Heart failure may affect the right side, left side or both sides of the heart. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body. Because the ability to pump blood from the left side of the heart decreases, the rest of the body does not receive enough oxygen especially when exercising. This leads to fatigue. Furthermore, the pressure in the veins of the lung increases, which can cause a buildup of fluid in the lungs. This results in shortness of breath and pulmonary edema.

The heart’s pumping action moves oxygen-rich blood from the lungs into the left atrium and left ventricle, which propel them to the body. The left ventricle supplies most of the heart's pumping power is larger than the other rooms and essential for normal operation. On the left side or the left ventricle (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.

There are two types of faces of the left heart failure. Drug treatments are different for the two types. systolic heart failure: The left ventricle loses its ability to contract normally. The heart can not pump with enough force to pump enough blood into circulation. diastolic heart failure: The left ventricle loses its ability to relax normally (because the muscle has hardened). The heart can not properly fill with blood during the rest period between each time.

There are about 707 000 people with heart failure in UK . You have the possibility of heart failure increases dramatically with age. Only one patient in every 100 children under 65 years suffer from heart failure, but the figure rises to six and seven of every 100 persons between 75 and 84, and up to 22,100 over 85 Heart failure is slightly more common in males and females. Heart failure is usually a chronic disease. A chronic disease that lasts a long time, the rest of the life of the person affected. The term chronic means the time is not like a serious condition. The treatment of heart failure aims to reduce symptoms and prolong life.


SIGN AND SYMPTOMS OF LEFT SIDED HEART FAILURE .

SYMPTOMS .

Standard rear of the left ventricle causes congestion of pulmonary vessels, and therefore the symptoms are primarily respiratory in nature. standard background check can be subdivided into the left atrium, left ventricle or both at the circuit on the left. The patient has dyspnea (breathlessness) on exertion (dyspnea) and in severe cases, dyspnea at rest. The increased dyspnea orthopnea flat called, is produced. It is often measured in number of pillows to lie down comfortably, and in severe cases, the patient may resort to sleeping while sitting. Another symptom of heart failure is paroxysmal nocturnal dyspnea, also known as " cardiac asthma "  a sudden night attack of severe breathlessness, usually several hours before bedtime. Fatigueability easily and exercise intolerance are also common symptoms associated with respiratory distress.
Compromise left ventricular function post may cause systemic symptoms of poor circulation such as dizziness, confusion, and cool extremities at rest.

SIGNS .

Common respiratory symptoms are tachypnea (increased breathing) and more work to breathe (non-specific signs of respiratory distress). Rales or crackles, heard first on the basis of the lung, and severe if the entire lung fields suggests the development of pulmonary edema (fluid in the alveoli). Severe cyanosis indicating hypoxemia, it is too late to sign very difficult to pulmonary edema. Other signs of left ventricular function is affected by the tip of the side to beat (what happens when the heart is great), and gallop (Increased heart rate) can be heard as a sign of blood flow, or increase the intra-cardiac pressure . heart murmurs may indicate valvular heart disease, the cause (eg aortic stenosis) or below (for example, mitral regurgitation) and heart failure.

RISK FACTORS .

Risk factors for heart failure in the left that you can not control age, male gender, African American ethnicity, disease of the heart valves and family history of diseases that damage the heart muscle, cardiomyopathy () . Risk factors that can be controlled are chronic alcohol abuse, obesity, high cholesterol (CHD), diabetes, smoking, thyroid disease and high blood pressure (hypertension).

DIAGNOSTIC INVESTIGATIONS .

Heart failure the left side is usually diagnosed by a series of tests from blood and urine analysis, cholesterol and lipid levels checked, blood sugar, blood red rate albumin, and thyroid function. A heart stress test measures the blood pressure and oxygen consumption during exercise. An electrocardiogram (EKG, ECG) is used to check for heart problems caused by a muscle or an electrical problem. Echocardiography uses ultrasound to test the cardiac imaging of heart, when he is beaten. Imaging techniques such as radionuclide ventriculography and magnetic resonance imaging (MRI) to visualize the damage in and around the heart.

TREATMENT .

Treatment involves taking medication for the underlying disease causes heart failure and high blood pressure and regulate heart rate, increased muscle strength and heart to treat fluid accumulation. If necessary, patients may have to make lifestyle changes permanent, eliminating bad habits such as alcoholism, overeating, lack of exercise and smoking. Surgery or catheterization may be needed to unblock the arteries. Patients with weak hearts may need an implantable defibrillator.


PROGNOSIS .

Heart failure is a serious disease that can cause premature death. How well a person does depends on the cause of heart failure, and age of the person and his ability to tolerate exercise. In many cases it is unlikely that the heart will fully recover. But many forms of heart failure is well controlled with medication and the disease may remain stable for many years with only occasional flare-ups of symptoms.




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Test for heart diseases - nuclear stress test - Gated blood pool scan - Cardiac catheter study - Left ventriculogram - Pacemakers



INVESTIGATIONS FOR HEART DISEASES 


NUCLEAR STRESS TEST 

A nuclear stress test helps doctors see images of the heart while at rest and shortly after you've practiced. The test can give information about the size of your heart chambers such as the heart is pumping blood, and if the heart muscle is damaged or dead. Nuclear testing stress may provide information on the arteries and if they can be narrowed or blocked because of coronary artery disease. This test is the same as the stress test, with the exception of doctors will give a small amount of radioactive substance just before the end of the year part of the test. This radioactive substance is not harmful to your body or your organs.
The results of the nuclear test stress can show doctors if the heart does not work properly when you are at rest, exercise, or both. If the test shows that blood flow is normal while you are at rest but not during a normal year, because doctors know that your blood flow to the heart is not adequate during times of stress. The heart normally pumps more blood during periods of physical exertion. If test results are not normal during both parts of the test (rest and exercise), a part of your heart is permanently deprived of blood or scar. If doctors can not see the radioactive substance in a part of your heart, it probably means that the portion of heart muscle is dead, either due to a previous heart attack, or because the coronary arteries supplying blood to the region of the heart are blocked.

GATED BLOOD POOL SCAN 


A door Blood Pool Scan is a test radioisotope dye that shows how blood flows in your heart at rest, exercise, or both. The test can tell doctors about the heart to pump blood and if it works harder to compensate for one or more blocked arteries. This test is also very useful for finding your ejection fraction, which is the percentage of blood that is pumped from the heart's lower chambers (the ventricles) with each heartbeat. The review also called analysis of several units closed or MUGA. Research and analysis uses a radioactive substance is injected into the bloodstream. The radioactive "tags", or "tags" red blood cells in the blood. This substance is safe and will not affect your blood or organs. Then doctors use a gamma camera to take pictures of your heart that the "label" red blood cells to circulate.



CARDIAC CATHETER STUDY


Also known as coronary angiography (angiogram), this is a test to evaluate coronary arteries and heart muscle. And the gold standard that all other tests to look at blood flow in cardiac assessment. Further developed and refined several decades, cardiac catheterization is running fine, flexible wires groin artery tube, or the elbow to the heart. It requires only local anesthesia to numb the skin for increasing the artery section. The tube is passed into the heart, where color is injected visible coronary and cardiac muscle. Images (angiograms) are conducted using the X-ray machines to help.


LEFT VENTRICULOGRAM WITH NORMAL LV FUNCTION 


Cardiologist to determine if the coronary arteries are filled and to what extent. This knowledge is important to plan the best treatment for patients with coronary artery disease (atherosclerosis), ranging from regular medications with angioplasty + / - stent insertion of coronary bypass surgery. In addition to the pressure measurements in a valve disease be evaluated process takes only 10-20 minutes in most cases. However, as we are dealing with the heart, patients are kept in the hospital a few hours after the procedure before being allowed home. Patients are not to eat or drink anything for 2-4 hours before surgery. You should take your usual medications with a sip of water, but in general you are advised to withdraw diuretics (water pills) that day. Diabetics are advised individuals, particularly those who took metformin or insulin that patients taking warfarin.

PACEMAKERS

Permanent pacemakers were very sophisticated devices that are implanted to treat various heart rhythm disorders. Originally they were only able to treat slow heart rhythms, but the modern generation pacemakers, help regulate heartbeat and preventing irregular rhythms too. Pacemakers have also been developed to help the muscles weakened heart pump more efficiently.

The pacemaker is composed of a metal box (generator), which contains the battery and circuit for interpreting changes in heart rate. The pacemaker is implanted under local anesthesia under the skin of the anterior chest wall (just below the collarbone). It is connected to one or more tracks that are swept under the direction of X-ray in a vein in the chest at the bottom so that the end of the track (s) is in a chamber of the heart in particular. The pacemaker senses the heart's electrical rhythm and generate the electrical impulses that pass along the track (s) to make the heart beat regularly when the heart is unduly delayed. Pacemakers are effective treatments for outages and other anomalies very safe heart rate. The aim is to restore the patient to a normal life.








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Test for heart diseases - Transesophageal ehocardiography - Exercise stress test - Holter monitoring



INVESTIGATIONS FOR HEART DISEASES




TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Like standard echocardiography, using transesophageal echocardiography (TEE) sound waves to produce an image of the heart and see how it works. But unlike standard echocardiography, the sound waves are transmitted through a tube-shaped device placed in the mouth and forwarded the esophagus (gullet). This test can show doctors detailed the size, shape and movement of your heart muscle and the condition of your aorta, the largest blood vessel supplying your body. It can also show how the heart valves are working and how blood flows through your heart. TEE also provides the physician about your arteries. This test is often used when doctors can not get a clear picture of your heart by echocardiography standard.

Transesophageal ultrasound uses sound waves frequency (called ultrasound) that can provide a moving picture of your heart. The standard test is echocardiography, except that the images of the heart comes from inside the esophagus rather than the chest wall. They sent sound waves through the body of a device called a transducer, which is attached to a pipe and put the esophagus. Sound waves bounce off the heart and return to the transducer as echoes. They reflect converted into images on a television screen to produce an image of your heart and aorta.


EXERCISE STRESS TEST OR STRESS ECHOCARDIOGRAPHY

A stress test is a common test that doctors diagnose coronary artery disease. The test helps doctors see how the heart functions during exercise. You can also hear a stress test is called the test of exercise tolerance, stress tests, EKG or treadmill tests. A stress test can also use echocardiography (called a stress echo), or dyes, radioisotopes are injected into the blood (called nuclear stress test). When these tests are complete, the doctors say more about the structure and blood flow in the heart.

During a stress test, you will wear small metal discs called electrodes. The electrodes are connected to son called son, who are connected to a computer with a television screen that records the heart's electrical activity (ECG). This screen can also display images from a stress echocardiography and stress nuclear testing. Seeing this video, doctors can detect your pulse while you exercise. Sometimes a patient is too ill to perform. In these cases, the patients receiving a drug that has the same effect on the body, as if they had exercised.

Do not eat or drink four hours before the test, in particular the elements That contain caffeine, which can be found in coffee, tea, soft drinks, chocolate and some pain relievers in-the-counter. Also make sure you ask your doctor about medicines, and if end up before the test. During the test, you will be asked to walk on the treadmill. Every two or three minutes by a doctor or technician who adds speed and angle of the treadmill that makes you feel like you are walking uphill. The doctor or technician who wishes to renew the models ECG and blood pressure, which doctors can your heart not getting enough oxygen. Other symptoms of coronary heart disease are chest pain or unusual shortness of breath when exercising.



HOLTER MONITORING

Holter gives physicians a constant reading of your heart rate and rhythm over a period of 24 hours (or more). The Holter monitor can record heart rate and rhythm when you feel chest pain or symptoms of an irregular heartbeat (arrhythmia called). Your doctor can then look at when you noticed the symptoms. Reading this printout will give your doctor an idea of the nature of your heart problem.

Holter monitoring is a storage device. The display is a strap that is worn over the shoulder or around waist. Holter monitoring is battery operated and regularly a lot of cartridge you use the audio cassette. The display is called the 5-7 wires. Lead sheets for setting called electrodes, which is worn on the breast. These electrodes are very sensitive and can pick up electrical impulses to the heart. The pulses are recorded by Holter monitor and provide medical records 24 hours of the electrical activity of the heart.

Holter monitoring is a painless test. You need to go to medical office to install the screen. It's a good idea to take a bath before going to the doctor's office, because when the Holter monitor is installed, you can not do it wet in the shower and bathtub. The nurses clean the areas of alcohol and then insert the electrodes is resistance. Men, the nurses may have little beard chest area. Gel electrodes attached to skin. Sometimes the electrode and lead wire is recorded to prevent them from moving the chest. You can use a Holter monitor for at least 12-24 hours. When you wear the monitor, you are asked to keep records of daily life: what you did and now. This helps the doctor know what you were doing at times that the readings are abnormal. Otherwise you can make a typical operation, except for those who can benefit from Holter monitor wet.After 24 hours (or more), you return to your doctor about removing the electrodes. This may cause some discomfort, as if you had a bandage torn 



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Test for heart diseases - Loop recorder - Electrophysiology study - Echocardiography


INVESTIGATIONS  FOR HEART DISEASE 

LOOP RECORDER 

This record is extensive and a Holter monitor recorded 14-28 days. For disposable electrodes attached chest. The data recorded in a loop of two minutes and the event is recorded for the last two minutes when the button is pressed event. This test is excellent for patients whose symptoms are very short or as a free consciousness that one time tracking pushed past two minutes saved.


ELECTROPHYSIOLOGY STUDY 

Electrophysiology (EPS) studies use cardiac catheterization techniques to study patients with irregular heartbeats (arrhythmias call). Electrophysiology shows how the heart reacts to controlled electrical signals. These signals can help doctors determine where to start cardiac arrhythmia, and that the drugs will stop. Electrophysiology can also help doctors know which other catheter techniques could be used to terminate arrhythmias.
Electrophysiology uses electrical signals to help doctors know what type of arrhythmia you have and what can be done to prevent or control. Doctors performed a heart catheterization procedure in which a long tube, thin (called a catheter) is placed in a leg artery and threaded up to his heart. This catheter could be used to send electrical signals to the heart. Stimulate the heart to cause arrhythmia, doctors can record where in the heart, from its inception. In some cases, you may be given medication to induce an arrhythmia. Some medications can also be given through the catheter to see who will stop the arrhythmia.
Do not eat or drink anything after midnight on the evening before the test. Tell your doctor that the drugs you are taking, so he can decide to stop before the test. It can also be useful if you move the medicine is the procedure so doctors know exactly what you are using and how much. Probably blood tests, ECG, chest radiograph and taken before the procedure.


ECHOCARDIOGRAPHY 

Echocardiography uses sound waves to produce an image of the heart and see how it works. Depending on the type of echocardiography test they use, doctors can learn about the size, shape and movement of your heart muscle. This test can also show how the heart valves are working and how blood flows in your heart. Echocardiography can also give doctors information about your arteries. 
Echocardiography uses sound waves frequency (called ultrasound) that can provide a moving picture of your heart. Sound waves transmitted through the body of a wand like device called a transducer. Sound waves bounce off the heart and return to the transducer as echoes. They reflect converted into images on a television screen to produce images of your heart.

Dimensional echocardiography and M-mode ultrasound beam is aimed at heart. Doctors use the ultrasound M-mode to see only the left (or primary pumping chamber) of your heart. echocardiography gives a broader movement of your heart. dimensional echocardiography is one of the most important tools for diagnosing doctors. Doppler echocardiography measures the blood flow in the arteries and the model shows the flow through the heart.










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