Congestive Heart Failure (CHF) is a condition in which the pumping action of the heart is insufficient for delivering a rich supply of blood through the body. It can be caused by diseases that weaken or harden the myocardium (heart muscle) or conditions that require a higher demand of oxygen-rich blood that is beyond the heart’s capability (Kulick, D. MD, FACC, FSCAI). When the heart loses its ability to pump, the rest of the body functions will be compromised, as the cells and tissues won’t be receiving enough oxygen and nutrients from the blood. People who have this condition must be enrolled into treatments and lifestyle modifications in order for them to adapt and retain the strength their bodies still have. Below is the list of such practices involved in the care of a person with congestive heart failure.
Maintaining an Upright Position
The erect position, whether standing or sitting, lessens the pressure on the heart, as it can unload more blood faster compared to when in a supine position. The downward flow of the blood also spares the pumping organ from the effort of having to stress itself more into letting blood reach the peripheries, such as the toes and fingers. Keeping an upright position is encouraged because it allows maximum lung expansion too, therefore permitting more oxygen molecules to enter, reach the alveoli (functional site of gas exchange) and be brought into the blood circulation.
There are various medicines used to treat congestive heart failure, one of which is Digoxin (Lanoxin). Digoxin is given to patients to stimulate their heart muscles to produce more forceful contractions. Nitrates are also administered, although they are given in lesser doses. They are vasodilators, which mean they widen (dilate) blood vessels to allow more room for blood to flow and reach the myocardium. Nitrates also help in relaxing the veins. When there is less deoxygenated blood returning to the heart from the different parts of the body, such as the arms and legs, the heart’s workload is minimized (Texas Heart Institute, 2010).
Anti-hypertensive drugs, such as beta-blockers and ACE-inhibitors are, also given to relieve pressure from the blood vessels.
Aminophyllines are typically given to patients with breathing problems such as asthma. Since, in the case of congestive heart failure, the patient’s oxygen supply is diminished by the poor heart muscle contraction, coupled with a heart filled with so much blood, there are possibilities that it already compresses the area allotted for lung expansion. Aminophyllines are given to dilate the bronchioles (airway passages in the lungs) to accommodate more oxygen flow.
Fluid and Sodium Restriction
Sodium, by nature, attracts water. When there is an increased amount of sodium in the blood, the more it will bind itself with water molecules. This phenomenon is verified with hypertensive patients who eat too much salty foods. The volume of the blood increases as more sodium molecules are present in the body’s system, consequently adding to the already heightened amount that’s congesting the heart. As a way of preventing further complications, adhering to a diet with decreased sodium and fluid consumption is strongly advised.
Diuretics (Lasix) are also part of the treatment regimen. They are used to prevent or alleviate fluid retention in the body. They promote the flow of fluids to the kidneys as well.
In cardiac physiology, afterload is the pressure that the chamber of the heart has to exert in order to contract and eject the blood out. In the case of congestive heart failure, this has to be decreased to limit the neurohormonal cascade. This is achieved through a plan of collaborative interventions, which entails administration of nonpharmacologic options such as bilevel positive airway pressure (BiPAP) and mechanical ventilation for critically ill patients in combination with pharmacologic agents. These include arterial and venous vasodilators, inotropic drugs (increase muscle contractility for short-term), diuretics, morphine (a strong pain killer), and natriuretics (promote sodium excretion). (Sutter, M. MD and Diercks, D. MD, FACEP)
Arterial Blood Gases are important, because they determine the level of acidity or alkalinity of the blood. Results are respiratory acidosis, respiratory alkalosis, metabolic acidosis and metabolic alkalosis, to which will also be characterized if they are “fully compensated”, “partially compensated” or not at all. This test also gives the medical team the idea if the person’s compensatory mechanisms are working. Ideally, if the patient is acidotic in one system, either in respiratory or metabolic, the other system should be alkalotic. This will be classified as “fully compensated” if the blood pH returns to normal. If it is not, then it is only “partially compensated”. But if both systems are acidotic or both are alkalotic, there is no compensation here, and the pH will always have an abnormal value.
Potassium levels are computed because they play a major role in muscle contractility. Basically, potassium is advised to promote muscle contraction, to ensure the effectiveness of the pumping action of the heart. Increased levels from the normal range of 3.5 – 5.0 mEq/L may cause the heart muscle to contract very fast, that it may soon weaken or even arrest. Decreased levels, on the other hand, will make it difficult for the blood to reach the cells, especially those in the peripheries, because there is no enough pumping or driving action.
A metabolic panel test is done to consult electrolyte balance or kidney failure. A Complete Blood Count (CBC) is also performed to check for anemia, as this can contribute to the worsening of the condition.
Congestive Heart Failure doesn’t happen overnight. It is a complication of all the pre-existent diseases of the patient that may emanate from different factors, such as genetic make-up, faulty lifestyle, poor diet, etc. Nevertheless, the choice is still ours. We can always opt to lead a hale and hearty life.