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coronary artery disease, hypertension, diabetes and previous myocardial infarctions. With 70%
of heart failure cases resulting from coronary artery disease, more focus has been put on slowing
or even stopping factors that can exacerbate heart failure. Some of these improvements are faster
response to myocardial infarction and angina, and better management of factors that can cause
transient embolisms. When the left ventricle starts to reduce cardiac output, blood flow starts to
slow in the pulmonary vasculature and raises the pulmonic arterial pressure. This congestion if
untreated will start to cause pulmonary edema and will cause higher afterload on the right
ventricle. The most common cause of right sided heart failure is left sided heart failure. (Wedro,
2013)
Caring for a patient with congestive heart failure can depend on the severity of the
patients signs and symptoms. Patients present with symptoms of evectional dyspnea, orthopnea,
and other forms or shortness of breath due to the fluid buildup in the lungs caused by left sided
heart failure. During patient assessment, expected sign would be percussion dullness over the
lung bases found in left side failure, jugular vein distention, and peripheral edema which are
related to right sided heart failure or systemic vesicular congestion. (Lien & Alexis, 2012) As
progress is made in pharmacokinetics and pharmacodynamics we are starting to see more
accurate use of drugs that better treat the signs and symptoms of heart failure. Drugs like
Angiotensin-Converting Enzymes (ACE) inhibitors are used to suppress the synthesis of
angiotensin II from angiotensin I in the renin-angiotensin system. Slowing the renin-angiotensin
system will decrease the retention of salt and water thus reducing edema and workload on the
heart. (Lien & Alexis, 2012) Other symptoms like orthopnea can be relived temporarily with the
stacking of pillows behind a patients back or by raising the head of bed to semi fowler or
fowlers position. This will allow the pulmonary congestion to clear, and the patient will have an
easier time breathing. (Lien & Alexis, 2012)
Early detection of cardiomyopathy and prevention of risk factors such as hypertension
and myocardial infarctions will contribute to a lower chance of developing congestive heart
failure. As medicine advances, more information is being discovered that can almost stop the
progression of congestive heart failure. Currently, the only real way to stop heart failure is by
using preventative medicine and early detection. (Hollenberg & Heitner, 2012) Total health care
costs will decrease and overall patient health will increase as more emphasis is put on
preventative medicine.
References
Hollenberg, S., & Heitner, S. (2012). Cardiology in family practice. (2 ed., pp. 91-111). New
York: Humana Press. DOI: 10.1007/978-1-61779-385-1_5
Lien, S., & Alexis, J. (2012). Manual of outpatient cardiology. (1 ed., p. 281). London: Springer.
DOI: 10.1007/978-0-85729-944-4_11
Wedro, B. (2013, October 16). Congestive heart failure (chf). Retrieved from
http://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm