Live Well Wednesday

Defining Heart Failure

PJ THP_2550_pp.JPGAt Compass Community Health Care Center we are dedicated to providing the best health care possible. We are listening to our patients, families, and community with their health concerns and questions. Watch for #LiveWellWednesday posts each Wednesday evening, which focus on giving you the information and tips you need to understand current health care concerns and topics.

Today’s topic is Defining Heart Failure, by Paul (PJ) Adkins, Compass Community Health Care Center Family Nurse Practitioner.

In honor of February being Heart Health Month, we will be highlighting heart health issues and topics all this month during our #LiveWellWednesday posts. Be sure to check back each Wednesday in February for more information from Compass Community Health Care Center Family Nurse Practitioner, Paul Adkins.

Heart failure is a very common condition that we routinely see in primary care.  Today’s article will define the symptoms, causes, and treatment options involved in heart failure.  Common symptoms of heart failure include shortness of breath with exertion, weight gain, lower extremity swelling, abdominal swelling, inability to lie completely flat without getting short of breath, fatigue, and sometimes a chronic dry cough.  These symptoms of heart failure can be caused by a multitude of clinical problems.  Some of the problems that can result in heart failure commonly include ischemia or blockage from coronary artery disease, heart attacks, viruses resulting in viral cardiomyopathy, stress of pregnancy in some cases, valve disorders, certain chemotherapy agents, untreated hypertension,  severe untreated sleep apnea, prolonged stress (broken heart syndrome), and sepsis or shock.  Any insult that renders the left ventricle to become weaker can result in heart failure.  The importance of taking care of yourself is in your heart’s best interest.

The left ventricle is essentially the main pumping chamber of the heart.  The left ventricle’s squeezing  function is measured through an ultrasound called an echocardiogram to assess the ejection fraction.  A normal ejection fraction should be greater than 55%, so a reduced ejection fraction indicates a weak pump.  Systolic heart failure is defined as an ejection fraction less than 55%.  The left ventricle can also become enlarged (dilated) and stiff resulting in diastolic dysfunction and diastolic heart failure. In patients with diastolic dysfunction, the left ventricle has decreased or impaired relaxation abilities.  The impaired relaxation can result in a decrease of blood filling.  The left ventricle can only pump what it fills up with, so a decrease in filling means a decrease in the amount of blood pumped with each squeeze.  Congestive heart failure refers to being “congested” with fluid overload which is a common in severe systolic heart failure.

Treatment options for heart failure commonly begin with low salt diet as salt causes people to retain water, fluid restrictions or fluid balance, heart healthy diet, exercise, adequate sleep and taking medications as scheduled.  Weighing yourself everyday is also important as gaining more than 3 pounds a day or more than 5 pounds in a week can be a sign of fluid overload.  Inability to lie flat without becoming increasingly short of breath and lower extremity swelling are also indicates of fluid overload.  ACE inhibitors like Lisinopril and angiotension receptor blockers like losartan are commonly used to help treat heart failure. Beta blocker medications are also commonly used.  These medicines help the heart squeeze and relax.  In some cases, maintaining medication therapy can improve a person’s ejection fraction over time and that can be reassessed with an ultrasound.  Diuretics or water pills like Lasix or aldactone are often used for patients who are fluid overloaded.  A balance of the correct salt intake, such as less than 4gm of sodium a day is important.  Adherence to medication therapy is equally important and monitoring your symptoms should not be overlooked.

Patients with advanced heart failure often require inotropic agents via IV to help improve their hearts pumping function.  These medications include dobutamine and milrinone.  Recurrent admissions to the hospital and IV Lasix or bumex is often used to assist with getting the excess fluid off.  Kidney function and electrolytes like potassium and magnesium have to be monitored closely when patients are on aggressive diuretic medications.  Ultrafiltration is a process that is also sometimes used to remove salt and water.  This process is similar to dialysis, but does not require a permanent dialysis catheter.  Left ventricular assist devices (LVADS) or heart transplants are the last resort options in those with end stage heart failure.
For additional information on this topic check out the American Heart Association at www.heart.org or to schedule an appointment with one of our providers, please contact our office 740-355-7102.                  #LiveWellWednesday #CompassCares

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