Heart failure has been described as a “complex clinical syndrome that results from either structural or functional impairment of ventricular filling or ejection,” (Alspach, 2014, p. 1). Because of the multifaceted nature of heart failure, it is important to recognize its various symptoms and dimensions. Heart failure in general presents a major public health concern, with current prevalence at over five million adults in the United States and over 650,000 new cases being diagnosed each year (Alspach, 2014). Incidences are higher for persons aged 65 or older, and among certain ethnic groups as well. However, heart failure affects young children and accounts for as many as 10% of all pediatric cardiac transplants (Burch, 2002). Morbidity rates are likewise high, and heart failure is a leading cause of death in the United States. Because of this, heart failure has been described also as an “enormous clinical burden,” (Burch, 2002).
Risk factors are as varied as the expressions of the disease. The most common risk factors in adult heart failure include “hypertension, ECG LV hypertrophy, obesity, diabetes, radiographic cardiac enlargement and cigarette use,” (Ho & Magnani, 2015). Underlying causes of heart failure include coronary heart disease, hypertension or high blood pressure, and diabetes (National Heart, Lung, and Blood Institute, 2015). Biomarkers and congenital conditions also cause heart failure. For example, congenital lesions on the heart and congenital myocardial abnormalities are a few of the conditions that contribute to a large number of pediatric heart failure cases (Burch, 2002). Myocarditis and even some viruses may trigger the onset of heart failure (Burch, 2002).
When risk assessment is conducted regularly and in a systematic way, it can tremendously improve patient outcomes and reduce morbidity and mortality rates. Scores on formal risk assessment tests “are fundamental and essential for advancing risk prediction, and serve multiple functions to enhance epidemiological and clinical assessment,” (Ho & Magnani, 2015). Therefore, healthcare workers need to perform risk assessments on high risk populations, as well as on patients who have manifested potential underlying causes for heart disease such as presence of diabetes or biomarkers. Risk assessment should also take into account demographic data and exposure to infectious disease.
Manifestations of heart failure differ from patient to patient. Some unfortunate manifestations catalogued by nurses include activity intolerance, excessive fluid volume, and decreased cardiac output (Souza, et al., 2014). Shortness of breath, fatigue, coughing, especially when in a supine position, irregular heartbeat, chest pain, breathing difficulties, and swelling in the feet and ankles or in the abdomen are a few of the common signs of heart failure in adults (National Heart, Lung, and Blood Institute, 2015). Often symptoms will develop over time. Sudden changes to body weight and irregular blood sugar levels may also be signs that heart failure is manifesting. Recognizing heart failure symptoms can greatly enhance rates of survival in patients. Less recognizable manifestations of heart failure require medical monitoring. For example, diagnostic instruments can determine whether the two sides of the heart are contracting synchronously or not. Asynchronous pumping may require the insertion of a pacemaker.
Treating heart failure requires comprehensive understanding of the specific underlying causes and risk factors, with thorough explanation of individual etiology. Moreover, treatment depends on an understanding of the patient’s background and lifestyle. Reducing overall symptoms will require a multitude of interventions that may include medications. In many cases, it will be critical to treat the underlying disease such as diabetes, prior to focusing on the heart condition. Health care workers should recommend a heart healthy diet, exercise regimens, and smoking cessation when necessary (National Heart, Lung, and Blood Institute, 2015). Because rehospitalization is a major concern in healthcare, addressing underlying causes and reducing symptoms is a critical public health concern (Alspach, 2014). Ongoing care may include the administration of medications that reduce edema, including diuretics. Other commonly prescribed medications include ACE inhibitors, aldosterone antagonists, beta blockers, and digoxin (National Heart, Lung, and Blood Institute, 2015). Many of these interventions, particularly ACE inhibitors and Carvedilol, can be used on the pediatric population (Burch, 2002).
Complications in high risk persons include exposure to respiratory infections like pneumonia, which is why vaccines might be recommended to some patients. Patients who have specific underlying conditions like diabetes also need to be sure their blood sugar is regularly monitored. Additional complications could arise from the use of preventative or intervention medications. Hospitalization could help prevent the manifestations of some symptoms, via the use of medical technologies and equipment like oxygen therapy.
If a patient’s condition has worsened over time, and especially among older patients, lifestyle changes may be insufficient for treatment. Medical procedures and other invasive interventions including surgeries are occasionally warranted. Heart damage and heart failure may require the occasional use of equipment like defibrillator or a cardiac resynchronization therapy device (National Heart, Lung, and Blood Institute, 2015). If left untreated, or if symptoms are ignored, cardiac arrest may occur. An implantable cardioverter defibrillator (ICD) may need to be implanted into the body to prevent cardiac arrest via regular monitoring and the use of electronic pulses to regulate heart beats (National Heart, Lung, and Blood Institute, 2015). Other interventions that may be warranted for some patients include ventricle assistors, and even heart transplants in the most severe cases. In all cases, immune responses should also be monitored.
References
Alspach, J. G. (2014). Slowing the Revolving Door of Hospitalization for Acute Heart Failure. Critical Care Nurse, 34(1), 8-12 5p. doi:10.4037/ccn2014527
Burch, M. (2002). Heart failure in the young. Heart, 88(2), 198-202
Ho, J. E., & Magnani, J. W. (2015). The MESA heart failure risk score: can’t we do more?. Heart (British Cardiac Society), 101(1), 7-9. doi:10.1136/heartjnl-2014-306459
National Heart, Lung, and Blood Institute (2015). How is heart failure treated? Retrieved online: http://www.nhlbi.nih.gov/health/health-topics/topics/hf/treatment
Souza, V., Zeitoun, S. S., Lopes, C. T., Oliveira, A. D., Lopes, J. L., & Barros, A. L. (2014). Content Validation of the Operational Definitions of the Nursing Diagnoses of Activity Intolerance, Excess Fluid Volume, and Decreased Cardiac Output in Patients With Heart Failure. International Journal Of Nursing Knowledge, 25(2), 85-93 9p. doi:10.1111/2047-3095.12017
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