What is Heart Failure?
When the myocardium can't pump effectively enough to meet the body's metabolic needs, heart failure occurs. Pump failure usually occurs in a damaged left ventricle (called left-sided heart failure), but it may happen in the right ventricle (called right-sided heart failure) primarily, or secondary to left-sided heart failure. Usually, though, left-sided and right-sided heart failure develop simultaneously. Heart failure is classified as high-output or lowoutput, acute or chronic, left-sided or right-sided. and forward or backward.
For many patients, the symptoms of heart failure restrict the ability to perform activities of daily living, severely affecting quality of life. Advances in diagnostic and therapeutic techniques have greatly improved the outlook for these patients, but the prognosis still depends on the underlying cause and its response to treatment.
Causes of Heart Failure
The main causes of heart failure are listed below:
Heart failure becomes more common with advancing age. You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes, abuse alcohol, or use cocaine.
Signs & Symptoms of Heart Failure
Some people with heart failure have few problems or symptoms. The following is a list of problems that people with heart failure might have:
Call your doctor if you have any of these symptoms, especially if you've had heart problems before.
Electrocardiography reflects heart strain or enlargement, or ischemia. It may also reveal atrial enlargement, tachycardia, and extrasystoles.
Chest X-rays show increased pulmonary vascular markings, interstitial edema, or pleural effusion and cardiomegaly.
Pulmonary artery pressure monitoring typically demonstrates elevated pulmonary artery and pul monary artery wedge pressures. left ventricular enddiastolic pressure in left-sided heart failure. and elevated right atrial or central venous pressure in rightsided heart failure.
The aim of therapy is to improve pump function by reversing the compensatory mechanisms producing the clinical effects. Heart failure can usually be controlled quickly by treatment consisting of:
Treatment of acute pulmonary edema requires morphine; nitroglycerin or nitroprusside as a vasodilator to diminish blood return to the heart; dobutamine. dopamine. or amrinone to increase myocardial contractility and cardiac output; diuretics to reduce fluid volume; supplemental oxygen; and high Fowler's position.
After recovery, the patient usually must continue taking digitalis glycosides, diuretics, and potassium supplements and must remain under medical supervision. If the patient with valve dysfunction has recurrent acute heart failure, surgical replacement may be necessary.
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