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.




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.








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 



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.










Test for heart diseases- Chest X-ray - Electrocardiography or ECG - Exercise electrocardiography - Doppler ultrasound

INVESTIGATIONS  FOR HEART DISEASE .


There are lot of diagnostic tests and procedures currently available to help doctors determine if you have heart disease or vascular disease. If you already have the disease, helping doctors to determine the progress of the disease. Most studies also show images of heart, but only a doctor can say what they show. Some tests are more reliable than others, but only a doctor could tell you where to take based on your symptoms and medical history.

CHEST X - RAY .

Radiation of the chest radiograph in the body means even if the level is minimal. A pregnant woman should take special measures of protection and the fetus. The chest radiograph provides inforamtion on the Size and configuration of the heart and great vessels and lung fields and blood vessels. It is a routine procedure of investigation of radiation exposure very low heart.


ELECTROCARDIOGRAPHY OR ECG .

This test is most common, which virtually all patients who saw a doctor for a heart. heart's electrical activity is recorded at various points in the chest and printed on what is called a twelve lead ECG. A variety of changes you can see that reflected a wide range of heart problems, however, the issue may be quite normal, although there is underlying heart disease.

An electrocardiogram records the electrical activity of a patient's heart. An ECG may be performed to diagnose an acute myocardial infarction (heart attack) and / or detect an abnormal heart rhythm of a patient or pace. The ECG can also provide information on the problems of circulation of blood and oxygen to the heart muscle. Electrodes are placed on the chest and attached to a monitor. The ECG technician will get the best possible reading and files a copy for your doctor to interpret. The technicians are experienced in ECG interpretation for the physician can be notified immediately if there are severe abnormalities or acute changes in the ECG.

For your heart, an electrical pulse is sent from the sinoatrial (SA node), located into your heart. SA node helps your heart keep a steady rhythm. Electrocardiogram can follow the path of the electric power that is sent from the SA node and your heart. This allows the doctor to know if you have a problem which can cause your heart beat unevenly. Small metal discs called electrodes placed on the skin. The electrodes are used to pick up electrical impulses in the heart. The pulses are recorded, allowing doctors a recording of the heart's electrical activity.


EXERCISE ELECTROCARDIOGRAPHY .

This assay is commonly used to discover if the patient has significant coronary artery disease. Twelve ECG apply and are labeled in use until the patient's symptoms, it seems the end, & says the doctor, or changes in ECG. The test can also assess the risk of further difficulties when patients have had a heart attack and assess the degree of certainty, heart failure or breathlessness. Even if the test can not completely exclude heart disease, normal fitness test is unlikely to occur in patients with severe underlying diseases, coronary artery disease.


DOPPLER ULTRASOUND .

Doppler is a test that uses sound waves to examine blood flow to the heart. This test can also help the doctor to see if your heart valves are blocked or leaking blood. Ultrasound can also be abnormal tissues (such as tumors or blood clot) and measure the size of certain organs. Doppler ultrasound uses sound waves at high densities, which are through the body. Sound waves transmitted through a wand-like device called a transducer. When the sensor in the skin tissues of the body, particularly blood, absorb sound waves. The absorption of sound waves from the echoes that are sent to the transducer and converted to a television.

No special preparation is required before an echocardiogram. During the test, you will lie on an examining table. A gel will be put on your thick skin on the area to examine. The gel may be cold, but it does not harm the skin. An ultrasound technician then place the transducer on the skin. The transducer sends and receives sound waves at high frequency. Sound waves to the transducer as echoes that are converted into images on a television screen. These images are recorded and given to a radiologist for reading. An ultrasound takes about 45 minutes to complete. You should have any discomfort, but you can be asked to hold their breath several times during the test. The ultrasound test is a very safe and there are no harmful side effects. In fact the amount of energy used in the sample is so small that it can not cause damage to body tissues ..... Read more


LOOP RECORDER
ELECTROPHYSIOLOGY STUDY
ECHOCARDIOGRAPHY
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
EXERCISE STRESS TEST OR STRESS ECHOCARDIOGRAPHY
HOLTER MONITORING
NUCLEAR STRESS TEST  
GATED BLOOD POOL SCAN
CARDIAC CATHETER STUDY
LEFT VENTRICULOGRAM WITH NORMAL LV FUNCTION
PACEMAKERS




Heart failure treatments - Medications and surgery and heart transplant can help people to live longer and feel better

TREATMENT OF HEART FAILURE .

MEDICATIONS .

Doctors usually treat heart failure with a combination of drugs. Depending on your symptoms, you may take one or more of these drugs. 

These include :

Angiotensin converting enzyme (ACE). These medicines help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve circulation and reduce the workload of the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).

Angiotensin II receptor blockers (ARBs). These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many advantages such as ACE inhibitors. They can be an alternative for people who can not tolerate ACE inhibitors.

Digoxin (Lanoxin). This drug, also known as digitalis, more power to muscle contractions of the heart. It also tends to slow the heart rate. Digoxin reduces symptoms of heart failure and improve your ability to live in condition. 

Beta-blockers .This class of drugs slows the heart rate and lowers blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These drugs also reduce the number of cardiac arrhythmias. Beta-blockers can reduce symptoms and symptoms of heart failure and improve cardiac function.


Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid in your body. Commonly prescribed diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix). The drugs also decrease fluid in the lungs, so you can breathe more easily. Because diuretics cause loss of potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you take a diuretic, your doctor should monitor levels of potassium and magnesium in the blood by regular blood tests.

Aldosterone antagonists. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They are primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and can help people with severe heart failure live longer. Unlike some other diuretics, spironolactone can raise blood potassium to dangerous levels, talk to your doctor if increased potassium is a problem.

You will probably have to take two or more medications to treat heart failure. Your doctor may prescribe medication for the heart as others - such as nitrates for chest pain, a statin cholesterol-lowering drugs or anticoagulants to help prevent blood clots - drugs with cardiac failure.

SURGERY .

In some cases, heart failure can be treated with surgery, such as valve replacement or repair, coronary bypass surgery or transplantation.

Coronary artery bypass graft (CABG or "cabbage") or angioplasty to prevent and treat heart failure caused by blocked arteries. During bypass surgery, blood vessels taken from another part of the body -- usually the leg -- are used to link the open parts of a blocked artery around the blockage.
In angioplasty, a thin flexible tube, called a catheter is inserted through a small incision in the groin or neck vein. A procedure, a balloon catheter has reached the middle of the blocked blood vessel. When the balloon is filled, jam packed material back against the artery walls. A metal device, called a stent can be inserted through the catheter, a permanent barrier to act as a plate packed. In the second procedure, the tools available through the catheter to remove plaque.

Fixation, pacemakers and other devices, such as artificial heart valves .

Repair congenital heart defects.

Surgical treatment of heart failure itself, include:
Heart transplantation - Although the heart may be the best option for patients with more severe types of heart failure, this treatment is only available for a limited number of people for lack of hearts donors. Recent developments may make an artificial heart transplant option in the future.

Left Ventricular Assist Devices (LVAD) - can be implanted in the chest to increase your heart pumping action. Until recently, LVADs require that the patient is connected to a large hospital-console waiting for a transplant. Miniature battery-powered LVAD units, however, many patients can leave hospital. The devices can be used for primary treatment or as a bridge between a heart transplant in adults.

Heart  Reconstruction - The electrical signals that cause the heart to contract around the spiral. Ideally, the heart is elliptical, like a soccer ball, for it is easier to receive the electrical signals that trigger the heartbeat. In heart failure, the heart becomes more spherical and becomes more like a basketball, which is more " unique " wiring diagram and makes the heart less efficient. A number of surgical procedures are promising for the study of this problem by reconstructing parts of the heart to restore its shape.



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Treatment of heart failure 
Lifestyle changes