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| treatment of congestive heart failure |
Congestive
heart failure means “unable to the proper functioning of heart due to various
causes”. Mainly this all causes reduced cardiac output and decreases blood flow
in the body. When blood flow decrease, doesn’t meet their actual requirement of the body.
First of
all understand the treatment of congestive heart failure, understand basic
introduction, symptoms, causes, and other details of CHF.
Basically,
mainly two types of congestive heart failure.
Systolic
dysfunction ➞ abnormality in heart systole.
Diastolic
dysfunction ➞ abnormality in heart diastole.
Heart
failure causes are mainly affecting the left ventricle of the heart.
If
contraction of heart muscle (myocardium) decreases, leads to decrease cardiac
output. If cardiac output decreases, do not proper blood flow in the body, and
finally, the body does not meet their oxygen, salt, and nutrient requirement.
(if you
understand cardiac output and stroke volume relation visit this article. Cardiac output)
Why
congestive?
Congestive means “accumulation of blood or fluid in the body”. In CHF, reabsorption
of salt and water increase leads to increase fluid in body. So, retention of
salt and water in the body and produce a toxic effect in our body.
Various causes
of CHF include myocardium ischemic, myocardium infraction, hypertension,
coronary artery etc.
Various symptoms
seen in CHF patients include Chest pain, shortness of breath, jugular vein
distention, fluid retention, rapid weight gain, ankle inflammation, irregular
heartbeat and weakness. (if you learn CHF pathophysiology in details visit
this article CHF pathophysiology)
In the USA, approximately
50 lakhs new cases diagnosed each year. It is shown in younger, elder, and child.
But, Most of the cases shown in elder patients. But, in minor stages (starting
phase) consult your consultant or doctor. If proper medication and treatment have taken don’t worry its curable.
(Don’t take
any medication and treatment of your own decision. Self-medication is dangerous.
If you suffering any disease consult your health consultant or doctor. Here, I
will provide some details for information and boost your knowledge, not our
motive to promote self-medication)
So, let’s
start congestive heart failure treatment
Treatment of congestive heart failure
Here, I
will discuss three types of treatment that cure CHF
➣ Congestive
heart failure Treatment through medication
➣ Congestive
heart failure treatment through heart devices
➣ Congestive
heart failure treatment through surgeries
Medication
therapy beneficial for minor heart failure conditions or first stage condition.
If a problem arises and converts major heart failure to treat with some heart
devices. If condition extreme critical to required replacement of heart, valve,
artery, etc via surgery.
➣ Congestive heart failure Treatment through medication
To minor
congestive heart failure is treated with some medication. The various medication
available in the market that cures congestive heart failure. But, why medication
required. what’s our motive to take this medication.
Let’s
discuss it
Our main
motive to cure congestive heart failure by the following mechanism,
✔️ If
contraction of heart muscle decrease, its increase.
✔️ If increase
blood pressure (hypertension), decrease it.
✔️ If salt and
water retention to our body, restrict to it.
✔️ If cardiac
output and stroke volume reduced, just increase it. (normal level)
✔️ If blood
flow decreases, increase the flow of blood.
✔️ If heart the rate increase, decrease it. (in normal condition)
following
this all condition rises in CHF. Here, some following medication that cures this
condition with different medications.
Let’s
understand congestive heart failure medication in detail.
➙ ACE
inhibitors drugss
➙ Beta
blocker drugs
➙ Diuretic
drugs
➙ Cardiac
glycoside drugs
Above all
type of medication is beneficial in CHF condition. Most of the cases ACE
inhibitors are used in CHF condition. Here, I will discuss step by step each
class in detail.
⇨ ACE inhibitors drugs
Example
of ACE inhibitors,
Captopril (Vasotec)
Lisinopril (Zestril)
Fosinopril (Monopril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Rimipril (Altace)
Trandolapril (Mavik)
Aim of ACE inhibitors is to reduce
hypertension and venous constriction. Let’s see how?
ACE
inhibitors are one of the most useable drugs in the treatment of congestive heart
failure.
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| CHF treatment |
As per this the image in CHF condition, kidney release renin. Renin and angiotensin both
stimulate the angiotensin 1. After with the use of angiotensin-converting
enzyme angiotensin 1 converted angiotensin 2.
Angiotensin
2 are responsible for increase venous constriction. Also, increase blood
pressure (hypertension). these drugs are relaxed the venous tone and reduced
blood pressure.
When ACE
inhibitor drugs are given it inhibits the angiotensin-converting enzyme and relaxes
the contraction of venous tone. These drugs decrease preload and afterload.
Also, increase stroke volume and cardiac output of the heart.
ACE
inhibitors are mostly beneficial to increase ejection blood flow. it indicates
used with diuretics, B – blocker,
digoxin, and aldosterone.
Other
agents angiotensin receptor blockers are also beneficial for venous
constriction. These agents block the angiotensin receptor to bind the venous
muscle and block the contraction of the blood vessels.
Also,
angiotensin 2 are responsible for the secretion of aldosterone from the adrenal gland.
These aldosterone increases the salt and water retention in the body and
ultimately increases blood pressure. ACE inhibitor drugs inhibit aldosterone
and decrease blood pressure.
Some adverse
effect produced include postural hypotension, hyperkalemia, renal
insufficiency, angioedema, and dry cough.
Drugs
do not take with ACE inhibitors drugs,
➞ ACE
inhibitors with thiazide diuretics additionally decrease blood pressure.
➞ Such NSAIDs
drugs (naproxen, ibuprofen, and aspirin) reduce ACE inhibitor effect on blood
pressure. (because retention of water and salt)
➞ ACE
inhibitors taken with potassium-sparing diuretics leads to potassium buildup
and imbalance in heart rhythm.
Warning.
ACE inhibitor drugs
and angiotensin receptor blockers doesn’t use in pregnancy. Because generate
teratogenic effect and harmful for the fetus.
⇨ Diuretics drugs
Example of
diuretics
Thiazide diuretics.
Hydrochlorothiazide (hydrodiuril)
Chlorthalidone (hygroton)
Metolazone (zaroxolyn)
Indapamide (lozol)
Chlorothiazide (diuril)
Loop diuretics.
Bumetanide (bumex)
Torsemide (demadex)
Furosemide (Lasix)
Potassium-sparing diuretics.
Amiloride (midamor)
Triamterene (dyrenium)
Eplerenone (aldoctone)
Spironolactone (Aldactone)
Aim of Diuretics
drugs is to
decrease pulmonary and peripheral edema. Let’s see how?
In CHF
condition, pulmonary and peripheral edema are produced. These diuretics
drugs decrease the reabsorption of venous tubules. When reabsorption decrease
leads to increase excretion of urine and relieves both types of edema.
increase
elimination of salt and water leads to decrease blood pressure and venous
pressure. So, this medication also
relieves hypertension.
Diuretics
are decrease the volume overload symptoms and preload.
Adverse
effect of diuretic include weakness or tiredness, loss of appetite, nausea & vomiting,
dehydration, confusion, restlessness and etc.
Drugs
do not take with a diuretic,
➞ Diuretic
given with some ACE inhibitors, anxiolytic, hypnotics, beta-blocker. Cause low
blood pressure.
➞ Also,
diuretic given with some NSAIDs drugs include naproxen, ibuprofen and aspirin
causes a liver toxicity.
⇨ Beta blocker
Example of
beta-blocker,
Acebutolol (Sectral)
Metoprolol (Lopressor)
Nadolol (Corgard)
Bisoprolol (Zebeta)
Atenolol (Tenormin)
Esmolol (Brevibloc)
Aim of Beta-blocker is to
increase systolic function and relieve myocardial hypertrophy (size of heart
muscle). Let’s seen how?
Generally, CHF has produced two types of dysfunction. Systolic and diastolic. systolic
dysfunction means Heart doesn’t properly systole. And that’s why to reduce the cardiac
output of the heart. So, beta-blocker increases systolic function and again balanced
heart rhythmicity as well as its cardiac output.
If
sometimes cardiac muscle (myocardium) produce hypertrophy. In
hypertrophy, condition heart doesn’t work properly (contraction and relaxation).
So, beta-blocker drugs normalize hypertrophy of myocardium. This condition
called remodeling of muscle.
In fear
and fight condition, heart rate increases. It’s one of the important causes
of congestive heart failure. If heart rate increase, less blood filling time
provide for the heart. If blood felling time less, reduced blood flow. So, Beta-blocker drugs normalized heart rate and
increase blood flow.
Also, beta
blocker inhibits the release of renin in blood. As understand in ACE inhibitor
drug renin are one of the important parts in salt & water retention. So,
beta-blocker is directly inhibiting the renin release.
Adverse
effect of
beta-blocker include tiredness, dizziness, slow heart rate, don’t proper sleep,
inflammation in legs.
Drugs
do not take with beta-blocker,
➞ Beta
blocker with arrhythmic medication (amiodarone), decrease heart rate, and blood pressure.
➞ Beta
blocker with antipsychotics drugs (thioridazine), causes blood pressure.
➞ Beta
blocker with clonidine increase blood pressure.
⇨ Cardiac glycoside drugs
Example of
cardiac glycoside,
Digoxin
Digitalis
Dobutamine
Aim of Cardiac
glycoside is to
increase cardiac muscle contractility. Let’s see how?
Cardiac
glycoside is responsible for increase cytoplasmic intracellular calcium ion in cells.
It inhibits the Na+ – K+ channel. When Na+ – K+
channel block, decrease efflux of sodium and calcium ion. Accumulate calcium
level in the cytoplasmic level.
If calcium
ion increase inside the cell. it’s responsible for increase cardiac muscle
contraction and increase stroke volume. Also, Cardiac muscle contraction leads
to an increase the cardiac output of the heart.
Its mostly
indicate in only left ventricle systolic function. And it's not indicated in
diastolic and right-sided heart failure.
Various cardiac
glycoside is used in the treatment of congestive heart failure but, a cardiac
glycoside is dose-dependent. If doses of cardiac glycoside slightly
increase it’s very toxic and dangerous for our health.
Adverse effect of cardiac glycoside include tachycardiac,
decrease intracellular potassium ion, anorexia, headache, confusion, blur
vision, nausea, and vomiting.
Drugs
do not take with cardiac glycoside,
➞ Quinidine
and verapamil is taken with cardiac glycoside increase digoxin toxicity.
➞ Antacid and
neomycin are decreasing the absorption of digoxin.
➞ Rifampicin
and phenobarbitone is increasing the metabolism of digoxin.
➣ Congestive heart failure treatment through heart devices
Various
type of heart failure devices are available in the market, here discuss most
popular devices
➙ Implantable
cardioverter defibrillator (ICD)
➙ Cardiac
resynchronization therapy (CRT)
➙ Left ventricular
assist devices (LVAD)
This all
devices not used in mild congestive heart failure condition. These are used in
severe conditions or irregular heartbeat conditions. The main motive of these
devices if our heart rate increases or decrease sometimes, these devices
generate a pulse and regulate it.
Let’s
discuss details in
⇨ Implantable cardiovascular defibrillator (ICD)
it’s
battery-powered devices. This device is placed under the chest & abdominal skin,
Below the collarbone. ICD install through blood vessels. It eliminates via
open chest surgery.
ICD tract
the heartbeat and regulate it
If heart
rate increase ➞ sends signals to decrease it. (defibrillator shock)
If heart
rate decrease ➞ sends signals to increase it. (pacemaker signal)
This device
tract abnormality of heart rate, detect and deliver an electric shock to restore
condition.
Which
condition patients go for ICD. Ventricular tachycardiac, sudden heart attack, sudden cardiac arrest,
long QT & Brugada syndrome.
Benefits
of ICD. prevent the
ventricular tachycardiac or fibrillation. It also prevents sudden cardiac
arrest in severe congestive heart failure.
Before
patients going to ICD, your doctor restore some causes like infarction,
ischemia, irregular blood flow, and imbalance of electrolyte in the body.
view animation of ICD treatment - click here
⇨ cardiac resynchronization therapy (CRT)
As per heart.Org CRT is a half-dollar sized pacemaker. It’s
implanted below the collarbone. Leads (3 wires) are connected devices to monitor
and detect the heart rhythm.
ICD is mostly
beneficial who have heart failure with arrhythmic. It regulates the heartbeat
and rhythmicity of the heart via an electric signal.
Which
condition patients go for CRT. CRT not for any mild congestive heart failure patients. Usually, it is only for the left and the right chamber of the heart does not work properly. If this condition not correct with medication.
Your doctor going for ICD.
Benefits
of CRT. It’s
improve blood flow of heart as well as the efficacy of the heart. It prevents some heart failure causes like shortness of breath, cardiac arrest, etc.
Before
patients go for CRT, your doctor check your blood test, another medical history,
age for best and safe treatment
view animation of CRT treatment - click here
⇨ Left ventricle assist device (LVAD)
Also called
“bridge to transplant”
As per discuss,
ventricles are the most valuable part of the heart. Ventricle pumping the blood through-out
body. If the heart can’t work properly. This device implanted just the upper part of
the abdomen. LVAD is pumping blood like a battery device.
LVAD is tube
like structure that pulls the blood from ventricle to aorta.
Which
condition patient goes for LVAD. if the heart’s pumping ability sometimes declines to some reason. In this
condition, the LVAD device maintains the pumping ability of the heart.
Mostly,
LVAD was available in the heart transplant center. If LVAD implanted patients also
discharged from the hospital and wait to heart donor available.
➣ Congestive heart failure treatment through surgeries
Surgery is
not use for all heart failure patients. If your doctor has shown correctness causes
that develop heart failure. Then, your doctor goes for heart surgery. During
this, all surgery patients connect to a heart-lung machine to supply proper
blood and oxygen to the brain and body.
Here, I
will discuss the most popular heart surgery.
➙ Heart
transplantation
➙ Angioplasty
➙ Coronary artery
Bypass
➙Valve
replacement
Let’s
discuss in details
⇨ Heart transplantation surgery
Heart
transplantation is not used infrequently. Approx 2500 heart transplant per
year. The ratio of transplantation is very rare.
Which
condition heart transplantation required? If a patient's heart failure can’t cure with
medicine, devices, and any condition or both type of heart chamber severely
defective. In this condition heart transplantation is the last option.
How it
works in the body? In the heart transplantation condition, your surgeon replaced disease or defective
heart with a healthy heart (patients who declare brain dead). Not any kind of
heart replace with any kind of heart. It takes a lot of time to find a perfect
heart for patients. Before transplant heart, Your doctor matched tissue and
other body condition and then after transfer the heart.
During the
transplantation, your body connects with the heart-lung machine. Which provide same
function of the heart. Then, the surgeon removed the diseased heart, transplant a healthy
heart, and reconnect the blood vessel.
During
transplantation gave some immunosuppression drugs to suppress immunity otherwise the body doesn’t accept foreign organs and reject it.
After the
heart transplantation, your doctor regularly checks your blood reports, ECG,
artery condition, etc. to check everything is fine. As per the ratio, 90 % of people
survive more than one year.
⇨ Angioplasty surgery (percutaneous coronary intervention)
Which
condition angioplasty required? If heart failure develops due to blockage of the coronary artery and prevents
the blood supply to the heart. And it’s not cured with medication. This time
angioplasty is most beneficial.
Angioplasty
remove the blockage and resolve the heart failure conditions. To again normalize
blood supply to the heart.
How it
works in the body? Generally, angioplasty performs in a catheterization lab. A small tube-like catheter with a tiny deflated tube is
placed in the artery via the groin. It pushed in the artery, at the blockage this tube
inflated and removed the blockage. After completion of process tube-like structure
removed from the body.
Also, stent
implanted in body to consistently open your blood vessel.
Sometimes
it’s slightly risky for patients (damage the artery). But it increases the patient's condition very well.
view animation of angioplasty treatment - click here
⇨ Coronary artery bypass surgery
Which
condition bypass required? If any type of cause damage to the coronary artery, develop congestive heart
failure and angiography doesn’t beneficial. In this condition bypass required.
How it
works in the body? In bypass surgery surgeon removed healthy
blood vessels form the other part of your body (most cases are taken in chest or
leg) and then surgically attached to the disease blood vessels. After attachment,
blood flow through around the blockage section and sufficient blood provide as
per normal condition
Bypass is
helpful in if coronary artery damage due to any condition bypass surgery bypass
the blood via another blood vessel.
Some the precaution was taken after bypass like not taken fat and cholesterol food. Because
these substances make a plaque or clot in the artery. Also, the surgeon recommended
doing some exercise to increase the strength of the myocardium.
view animation of bypass treatment - click here
⇨ Valve replacement
Which
condition valve replacement required? if sometimes heart failure develops due to some
disease and defective valve. In this condition, valve replacement is required.
Heart valve
are regulated by the pumping of blood flow. if valve doesn’t work properly. In
this condition valve problems cause congestive heart failure. In valve problem
first step to correct it via treatment. If not cure with treatment then the second
option is valve replacement surgery.
Different
type of valve is available, like
Mechanical
valve ➞ made by metal and plastic
Human valve ➞ made by human and animal tissue
How it
works in the body? first, the patient connects with a heart-lung machine for oxygen and blood circulation. Then, the surgeon removed the bad and defected valve and placed a new valve in the heart. After
replacement, the heart works fine.
After
replacement your doctor has given some anti-clotting medicine to prevent the clot
formation in a new valve.
Most of the
cases of valve replacement surgery are a success.
view animation of valve replacement treatment - click here
Again, I a humble request to you any kind of medicine don’t take of your own decision.
Sometimes self-medication is very dangerous to our health. If you suffering any
health problem appoint your physician and doctor.
Conclusion:
in this article, I will discuss the treatment of congestive heart failure,
medication of CHF, heart devices, surgery. This article for just boost your
knowledge. If you like our article, comment out.
