Post Heart Attack Cardiac Failure - Essay Example

Post heart attack cardiac failure Introduction The coronary arteries are blood vessels that supply the heart muscle with oxygen and blood. A heart attack or myocardial infarction happens when one of these coronary arteries blocks suddenly. The usual cause of the blockage is a small blood clot in the artery that has been reinforced by a combination of fatty deposits on its walls. This is referred to as coronary heart failure of atherosclerosis. One is at risk of getting heart attack if he/she had one in the past due to the presence of atherosclerosis in his/her blood. They are also at risk of heart failure or stroke. This essay is going to address the issue of heart attack in details and explain the measures one is supposed to take to avoid another heart attack in the future. Heart failure management Heart failure management includes a number of pharmacologic, nonpharmacologic and persistent strategies to reduce subsequent occurrences of heart attacks. Pharmacologic management includes the use of vasodilators, beta-blockers, diurectics, digoxin and anticoagulants. Nonphamacologic management entails physical activities, dietary sodium, fluid restriction and attention to weigh gain. Persistent strategies for heart failure are implantable cardioverter-defibrillators, electrphysiologic intervention such as pacemakers and cardiac resynchronization therapy, ventricular restoration and revascularization procedures such as coronary artery bypass grafting (Ketchum, 2011: 90). Heart failure patients should be examined for coronary artery disease, which is a major cause of heart failure. It also plays a role in heart failure progression through mechanisms such as ischemia, infarction and endothelial dysfunction. Studies reveal that patients suffering from coronary artery disease demonstrate a symptomatic and survival improvement with coronary artery bypass grafting (Clifford, 2008: 62). The sections that follow outline the most effective measures for providing support for CHF patients. Despite the deadliness of myocardial infarction and other chronic heart diseases, these measures, if well taken, have the ability to markedly improve one’s health outcomes. They also have the ability to reduce the burden on the health care system. Patients, their families and caregivers can reduce worsening of the CHF condition if they are familiar with the principles of myocardial infarction management and learn to monitor the symptoms and deterioration signs on a daily basis. Whether or not the victims are enrolled into a particular management program, the availability of supportive organization and importance of self-care should be clear to them. As put by McDonagh et al. (2008:12), self-management is whereby an individual manages his/her own health. Hence the following information should be reviewed and discussed in an open forum with the patient, his/her family and the patient’s guardian There are effective strategies available to support individuals with cute heart failure to improve and extend their lives and achieve an end of life that is good. Most patients of heart failure are elderly and frail with complications such as renal dysfunction and concurrent respiratory disease likely to complicate or limit treatment. Even though formal classification systems have been developed, most practical indicator of increased risk of re-admission to hospital is the presence of the following: lack of motivation to adhere to non-pharmacological therapy and inadequate response to severe episodes of clinical deterioration. While vulnerable patients benefit from unswerving and proper treatment, they are unfortunately, subjected to inappropriate management. Their inability to tolerate even minor changes in renal and cardiac function leaves them at risk to recurrent and frequent episodes of chronic heart failure. As a matter of fact, up to two-thirds of CHF-related hospitalization can be prevented.It is beyond doubt that lifestyle affects the chances of having a myocardial infarction. Patients should talk to their physicians about the lifestyle changes that they and their families can make to reduce their risk. The food they eat is very important. A patient recovering from myocardial infarction should follow a diet with that contains vegetables. Fruits, more bread, less meat, fish and resort to products made from plant and vegetable oils such as olive oil and avoid products such as cheese or butter. They should also avoid foods that contain a lot of saturated fat, sugar and added salt, such as confectionery, takeaways, and fried foods, processed and packaged foods (Philbin and DiSalvo 2009: 1563). The victims should two to four fractions of oily fish a week such as sardines, herring, tuna and mackerel. A fraction is almost 150g. If one had a heart attack in the last three months and do not consume enough fish, then a physician is supposed to offer him/her a medicine to supplement his/her diet. One should resort to healthy ways of cooking and preparing food. He/she should not roast or fry food in fat. Instead, bake, poach, steam, microwave or stir fry and add flavor using herbs, spices and lemon juice instead of using cheesy, creamy or buttery sauces which tend to have high fat content. One should avoid beta-carotene supplements. He or she should also be aware that taking vitamins C and E or folic acid help in preventing another heart attack. Due to relative gastrointestinal hypo perfusion, constipation is something that is common and a high fibre diet is therefore recommended. This will avoid straining at stool, an issue that can bring about arrhythmia, angina or dyspnoea. In individuals with severe CHF, often small meals may avoid shunting of the cardiac output to the gastrointestinal tract, hence reducing the chances of having angina or feeling dizzy. Anaemia, cardiac cachexia and malnutrition are common medical conditions that contribute to incapacitating weakness and fatigue patients with these conditions should be investigated to find out the underlying course, and referred to a competent dietitian for nutritional advice. According to Sinoway (2008: 50), excessive consumption of foods with high sodium contents contribute to fluid overload and are major cause severe medical conditions. Reduction in consumption of foods with high sodium contents can lead to beneficial haemodynamic and clinical effects predominantly when coalesced together with regimen. For patients with mild symptoms, it is suggested that reducing sodium intake to about 3g a day is enough to control extracellular fluid volume. For patients with moderate to severe symptoms, a controlled intake of 2 g a day should be applied. To ensure that restriction of sodium is achieved, the following steps should be undertake: examine the patients knowledge of the decisive importance of sodium and current level of dietary intake; educate the patient and family to be keen on intake of sodium and monitor devotion to the prescribed sodium limitation and reapply motivation techniques as required.Careful fluid management is a major component of symptom monitoring and control for patients who have suffered from myocardial infarction. Wherever possible, determine the patient’s ideal euvolaemic weight – weight at which a patient, who has been fluid overloaded and treated with a diuretic, attains a steady weight with no remaining traces of overload. These encourage patients to keep a weight diary. The following are the principles of effective fluid management: patients should check on their weights every morning before eating breakfast or getting dressed. They should be told that a steady gain weight over a number of days indicate that too much fluid is being retained in their bodies. If the increase in weight is about 2kg in two days time they should contact their doctors or heart failure nurse immediately. On the other hand, patients who lose a similar amount of weight over the same period should also contact their doctors in case they have become dehydrated. Patients should understand that too much intake of fluid in a day is not healthy. It is vital for them to know how much their usual glass or cup hold to keep a fluid intake record until they become adapted to how much they are allowed. During fluid retention episodes, patients should be advised to reduce fluid intake to about 1.5 liters a day (Lloyd-Williams, Mair and Leitner 2002: 52) If patients are in position to take care of themselves, they may regulate their diuretic dose based on awareness of heart failure symptoms and daily weight monitoring. In many cases, a dose adjustment should be merely a single multiple of the preceding dose. For instance, if the patient is taking 30 mg of a dose daily, the dose may be increased to 60 mg once daily. The increased dose should be maintained for three days only. If the symptoms resolve or a dry weight is reached, the patient can go back to the preliminary lower dose. Restrictions of fluid intake may be eased up in warmer weather. Asymptomatic patients who have realized a drastic drop in their weight may lower their diuretic dosage to maintain the required dry weight and avoid complications such as renal dysfunction. Another issue is alcohol. If a victim must drink alcohol then he/she should stay within safe limits and not take too much like more than four units of alcohol in 12 hours. Men should not exceed 21 units of alcohol in a week while women’s maximum in a week should be 14. A unit of alcohol can be defined as a small glass of wine, or one half pint of ordinary strength lager or a single measure of spirits. Alcohol is direct myocardial venom and may have a negative effect on cardiac contractility. It contributes to the amount of fluid in the body, it caloric nature may cause increase in weight and may change the way some medicines used in heart failure work. Therefore, patients especially those with hepatic dysfunction should be very cautious. Blue et al. (2001: 717), explains that excessive intake of caffeine may increase blood pressure, aggravate arrhythmia and increase heart rate. Beverages that contain caffeine contribute to fluid intake and may tamper with levels of plasma electrolyte in patients taking diuretics. A patient recovering myocardial infarction should not take more than two cups of caffeinated drinks a day. Another habit that increases the chances of another myocardial infarction is smoking. If a heart attack victim smokes, then he/she should seek advice from their physicians so that they can help them to stop. Regular exercise helps the heart in its functioning. One should exercise for at least 30 minutes a day. Whatever exercise they resort to should be enough to make them a bit breathless but not to the extent of feeling discomfort or pain. It is a good idea to choose physical exercises that are good to the heart. Swimming, cycling and walking are excellent examples and can easily become part of one’s daily routine. If one is overweight, he/she is putting an extra strain on the heart and increasing his/her likelihood of another myocardial infarction. One needs to lose some weight. His/her nurse or doctor can give support and advice about reaching and maintaining ideal weight (Stewart and Horowitz 2002: 2862). Patients with chronic heart failure are recommended to have regular physical activities on the following basis: regular physical activities can limit physical deconditioning that may develop in patients. When their medical conditions have stabilized, all patients should be recommended for a specifically designed physical activity program. If such a program is impossible, patients may resort to a modified cardiac rehabilitation program. Cardiac rehabilitation is a program of education and activity to assist individuals recover from heart attack and lead normal lives. Advice is given on the program and patients invited to attend these programs that includes exercises and a number of sessions such as stress management, health education and information and reassurance of sexual activity. Cardiac rehabilitation program should include supervised sessions. Patients with any heart problems or other conditions that deteriorate when they exercise, they should be treated by their physicians before they commence the exercise part of the program. For those with left ventricular dysfunction (LVD) condition – one of the heart chambers does not work optimally; they should only attend the exercise session once their condition is stable. One will most likely be able to return to normal daily life and job after myocardial infarction. This will depend on the treatment administered since the time of heart attack and how well the patient has recovered and the activities planned for. Patients should receive information and advice on using a simple scale known as ‘perceived exertion scale’ which indicates how hard or how easy they find it to do various activities. Spicuzza et al. (2003: 904) records that if a CHF victim plays a competitive sport, he/she may need a specialist to decide whether it is safe to continue playing after recovery. This will depend on the type of sport and how competitive it is. Stress management sessions should be part of the cardiac rehabilitation program. But if the patient feels depressed or anxious after heart attack he/she should seek counseling, medicine or self-help advice from the doctor. Sexual activity may worsen pre-existing arrhythmia, but it rarely happens. Sexual activity cannot be a threat in patients who can achieve approximately six metabolic equivalents of exercise – able to climb a pair of staircase without stopping due to dizziness, dyspnoea or angina. If a patient has made tremendous recovery after heart attack, he/she can resume sexual activity after about four weeks. When one has recovered from myocardial infarction, the chance of another heart attack being triggered by sexual activity is no greater that for the other who has never had a myocardial infarction. If one is experiencing an erectile dysfunction and his myocardial infarction was over six months ago, and he has fully recovered, he should see his physician to offer medicine that can help. Chronic heart failure is a societal epidemic. Promotion of effective self-care and education on the pandemic, combined with optimal medical management, are essential for improved outcomes. The following ate the components of self care: having overall knowledge on the pathology as well as treatment; monitoring their condition and adjusting treatment accordingly; holding on pharmacological and non-pharmacological treatments and seeking healthcare when signs and symptoms deteriorate. Heart attack victims should be educated about: their fundamental condition; function of their medicine; beneficial lifestyle changes; importance of adhering to therapy; signs of worsening of their condition and possible side effects of therapy (Pitt, Zannad and Remme 1999: 715). If both patients and their guardians understand the condition, then non-adherence to fluid restriction, diet or medicine is not likely to happen. Healthy, consistent relationship with patients, combined with active role for patients and families is crucial. Multimedia resources (written, audio or video) can play an important role in patient education.There is unswerving and strong proof of an independent casual relationship between social isolation, depression, lack of quality social support and chronic heart disease. Moreover, the seriousness of depressed mood shows a relationship with both impaired function capacity and chronic heart failure symptoms. Cognitive behavioral therapy plays a role in reducing depression in cardiac patients. Kober et al. (2008:2678) argue that when administered in the early post-heart attack period, beta-blockers limit the successive development of chronic heart failure in individuals with preserved ventricular function and also the succession of condition in individual with impaired ventricular function. When beta-blockers are combined with standard management during the post-heart attack period, the regularity of all-cause and cardiovascular mortality and recurrent non-fatal heart attack can be reduced drastically. The beta-blockers reduce the severe effects of chronic activation of major neurohormonal system – the sympathetic nervous system – acting on the myocardium. The severe effects of the sympathetic activation are alleviated through alpha-1 receptors, beta-1 receptors and beta-2 receptors. Three beta-blockers: carvedilol (alpha-1, beta-1 and beta-2); metoprolol extended release (beta-2 selective antagonist) and bisoprolol (beta-1 selective antagonist) lengthen the survival of patients with mild to moderate chronic heart failure already under appropriate medication. This continued existence benefit includes both reductions in sudden death and death due to progressive pump failure. Patients with severe symptoms who did not have recent acute decompensation can also benefit from carvedilol. In recent findings, nebivolol - a selective beta-1 receptor antagonist – has been approved for the treatment of stable chronic heart failure. It has been found to be harmless and effective in old patients with impaired ejection fraction. Beta blockers should not be initiated during acute decompensation phase, but only after the condition of the patient has stabilized (Taylor et al. (2004: 2051). Severe effects of beta-blockade include bradycardia, symptomatic hypotension and worsening of symptoms due to withdrawal of sympathetic drive. Nonetheless, such effects are usually momentary and do not necessitate drug’s cessation. One can limit the severe effects by beginning at low doses with gradual increases.Aldesterone receptors within the heart can arbitrate hypertrophy, fibrosis and arrhythmogenesis. Hence blockade of these receptors with agents like spironolactone, may be beneficial. The agent has other important properties that make it a crucial drug in treatment. The risk of hyperkalaemia (which is potentially dangerous in the presence of renal impairment) requires strict monitoring when using spironolactone. A unique aldesterone antagonist, eplerenone which does not have antiandrogenic effects, has been found to reduce hospitalization and mortality in the immediate post-MI period. Hypertension is a foremost risk factor for the successive development of chronic heart failure. It has been proved severally that lowering blood pressure limits the chances of chronic heart failure a great deal. There is no clear-cut information to indicate that newer agents such as calcium channel blockers work more effectively than older agents such as beta-blockers and diuretics (Chien and Rugo 2010: 340). The main force behind reduced heart failure incidences in patients with hypertension is blood pressure control. This gives better results than beta-blockers and diuretics that are used to achieve this. The only exception is alpha-blockers which reduce the incidences of heart failure with a small margin compared with other drugs used for lowering blood pressure. Conclusion Both pharmacological and non-pharmacological management of chronic heart failure provide an insight into the complexities of handling patients who have experienced a heart attack before. There are reliable data to suggest that up to 70 percent of CHF-related hospitalizations are for sure preventable. Treating physicians should openly discuss with victims the level of intervention appropriate of desirable, so that superfluous traumatic interventions are avoided in their lives. Individuals who have experienced myocardial infection before should also work on their lifestyles and quit habits such as smoking and excessive drinking that can cause subsequent heart attacks. They should also have a good diet and avoid sugary and fatty foods. Organizations should come up to support health and medical professionals in providing local and national education and rehabilitation programs for people chronic heart failure to ensure their psychological, physical and social wellness, so that they may achieve their maximum potential. References Blue L, et al. (2001): Randomised controlled trial of specialist nurse intervention in heart failure. BMJ; 323:715–18. Chien J and Rugo S. 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