Living with CHF. A guide to help you and your family become more familiar with Congestive Heart Failure. Presented by your local Community Paramedics.
Objectives:We will be going over :How CHF (Congestive Heart Failure works. Medication Compliance and how we your Community Paramedics can help.How your medication help you with CHFSigns and symptoms of both Chronic heart failure and acute heart failure.And then some Frequently asked questions on CHFAnd finally at the end of the presentation you will have time to ask some of your own questions.
Pathophysiology of CHF or what CHF does to your body.Congestive Heart Failure or CHF is acondition in which the heart is unableto adequately pump enough blood tothe body to meet the body’s needs.
Each side is then separated into an atrium & a ventricle. The atrium are the upper chambers of the heart & the ventricles the lower chambers. The ventricles are the muscular power houses of the pump. The used blood from the body that has fed our organs & cells with oxygen & nutrients returns to the right atrium of the heart. From there it passes to the right ventricle that pumps it into the lungs to be oxygenated, or buffed up. The oxygen rich blood from the lungs then flows into the left atrium & then to the left ventricle where it is pumped out to the body through the systemic circulation to supply all of our organs with enriched oxygenated blood.
There are diseases that weaken the heart muscle, diseases that cause the heart muscle to stiffen, loosing flexibility to adequately fill it’s chambers, & diseases that increase oxygen demand to body cells, tissues & organs beyond what the heart is capable of delivering. Some of these diseases are:Coronary Artery diseaseFatty deposits in the arteries that circulate blood to the heart muscle eventually clog the arteries feeding the heart & stop the blood flow to certain areas damaging or killing heart muscle, thus weakening it.Viral infections.Myocarditis, an inflammation of the heart muscle causing it to weaken.Can be caused by any number of infections, viruses, immune diseases such as lupus, or conditions such as pregnancy. ToxinsDrugs both legal & illegal & alcohol all cause a weakening of the heart muscle thus diminishing the ability of the ventricles to pump.Heart valve diseases or dysfunctions a. Mitral valve prolapse, allows for leakage @ the gate between the left atrium & left ventricle allowing for inadequate filling of the left ventricle.High blood pressureOver time causes a stiffening & thickening of the heart muscle because it is being continuously overworked. This impairs the ability of the ventricles to relax & fill.Over active thyroid & anemiaThe heart can’t supply an adequate blood flow to meet the demand of these diseases.Heart attackKills heart muscle & weakens the pumping action of the ventricles.
This could be the result ofthe ventricle muscle not working properly due to a heart attack, high blood pressure or any other causes listed previously. Right side heart failure usually occurs along with left side heart failure. However in right side heart failure fluid backs up into the systemic circulation, causing the abdomen, legs, ankles & feet to swell. Again, this could be the result of any number of diseases, a heart attack, or left heart failure that is creating an increase in pressure in the lungs making it difficult for the right ventricle to pump its blood into the pulmonary circulation. All these conditions over time will lead to heart failure if untreated, however, there are things that can be done to treat these conditions with good results. Medications can improve the symptoms & help extend a good quality of life, but it is lifestyle changes that will bring about a better improvement. Some lifestyle changes can be weight loss by eating healthier & exercising, decreasing the stresses in ones life & treating depression.Prevention is the best way to keep risk factors such as heart disease, high blood pressure, diabetes, obesity & high cholesterol from further weakening the heart which will lead to heart failure.
Anne burns, director of practice development of the American Pharmacists association says “staying on a medication for a long period of time takes a lot of work on the part of both patient and caregiver”. Roughly half of all prescriptions for drugs are never filled in the first place according to KathrineBinns, president of healthcare research.
Most medications that are not complied with are for medical issues that are asymptomatic in nature. Since patients with CHF most often have high blood pressure and high cholesterol, that present no symptoms and therefore no tangible results, patients fail to take them. In CHF, this can be devastating long term. Another reason for non-compliance is the issue of being overwhelmed. Some patients are on so many medications and lack understanding of what the medications do, that patients fail to take them.
Education is a key. Other than patients being asymptomatic or overwhelmed, some of the other leading causes are; forgetting, fear of side effects, experiencing actual side effects, money issues, feeling that when the symptoms go away that the medication is no longer needed, difficulty opening the container, and difficulty swallowing the medication. Each of these reasons requires education for a specific problem. They can help the patient set daily routines by linking the administration with another daily activity like going to bed or eating meals. Another solution is the use of reminder services. Some programs send reminder alerts to doctors when patients fail to re-fill a scheduled medication. Also, understanding a medication, it’s purpose, and how it works empowers people control their disease by being compliant. (Caring Today Magazine. Home Instead Senior Care.)Beyond this, just being compliant does not mean just taking the medication. For medications to have their most positive effects they need to be taken in the right dose, right time, as well as for the proper length of the prescribed therapy. (United Health Group Company-Prescription Solutions.)
Specifically for Congestive heart failure, a well conducted, large study (7247 patients) was done by Brigham and Women’s Hospital, Harvard Medical School, Boston Mass. It looked at patients from 65 to 99 years old who had been prescribed digoxin. It looked at complete prescription claims filed within the New Jersey Medicaid program. Non compliance was measured in terms of the number of days during the 12-month period after an initial digoxin prescription in which no CHF medication was available to the patient. It found that in the 12-month period that patients who were started on a regimen of digoxin were without digoxin an average of 111 days during the year. Only 10% of the population filled enough prescriptions to have daily digoxin available for the entire year. The conclusion; a large proportion of the patients who began digoxin therapy consumed substantially less medication than expected in the first year of therapy. Rates this hige represent an important impediment to effective CHF therapy. (PubMed.gov-US national library of medicine national institutes of health).Paramedics can play an important role in A. Identifying non-compliance. B. Identifying the specific reason patients are not taking the medication. C. Providing education resources about the importance of compliance. D. Setting up compliance programs for patients and monitoring compliance.
For this reason, it is very important for you to take your medications as instructed, even if you are feeling better.
ACE (angiotensin-converting enzyme) inhibitors lower your blood pressure and decrease the strain on your heart. This makes it easier for the heart to pump.Beta Blockers help lower your blood pressure and slow your heart rate. This lessens the work your heart has to do.Digoxinhelps your heart pump with more strength. This helps your heart pump blood more efficiently to the rest of your body.Isorbidedinitrate/hydralazinehelps lower your blood pressure and lessens how hard the heart has to pumpDiuretics (water pills) help rid your body of excess water. This can help decrease the edema (swelling) in your body. Having less fluid to pump means your heart doesn’t have to work as heart. Some diuretics cause your body to lose a mineral called potassium also, but your doctor will tell you if you need to take a supplement or change your diet.
3 PartsThe goal is to decrease the afterloadAngiotension Receptor BlockersAngiotension Converting Enzyme Inhibitors Alpha 2 Agonists Non-Dihydropyradine Calcium Channel BlockersThe goal to decrease the cardiac output and stroke volume Beta Blockers Cardiac GlycosidesDihydropydradine Calcium Channel BlockersThe goal to decrease the preload Diuretics: K+ Sparing, K+ Wasting, Loop Diuretics, Osmotic Diuretics
This should list not only your medications, but the doses along with your allergies, birth date, emergency contacts and personal information. Keep a copy on your refrigerator also.
SymptomsBy Mayo Clinic staffHeart failure can be chronic — meaning your condition is ongoing — or acute, meaning your condition has started suddenly.
Chronic heart failure signs and symptomsShortness of breath (dyspnea) when you exert yourself or when you lie downFatigue and weaknessSwelling (edema) in your legs, ankles and feetRapid or irregular heartbeatReduced ability to exercisePersistent cough or wheezing with white or pink blood-tinged phlegmSwelling of your abdomen (ascites)Sudden weight gain from fluid retentionLack of appetite and nauseaDifficulty concentrating or decreased alertnessAcute heart failure signs and symptomsSymptoms similar to those of chronic heart failure, but more severe and start or worsen suddenlySudden fluid buildupRapid or irregular heartbeat (palpitations)Sudden, severe shortness of breath and coughing up pink, foamy mucusChest pain, if your heart failure is caused by a heart attack
When to see a doctorSee your doctor if you experience any of the signs or symptoms associated with heart failure. These include:Chest painFatigue and weaknessRapid or irregular heartbeatShortness of breath (dyspnea) when you exert yourself or when you lie downReduced ability to exercisePersistent cough or wheezing with white or pink blood-tinged phlegmSwelling in your abdomen, legs, ankles and feetDifficulty concentrating or decreased alertnessYou may first find out you have heart failure from an emergency room visit after worsening symptoms. Other heart and lung problems can cause symptoms that are similar to heart failure.If you have a diagnosis of heart failure, and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.
Risk factorsBy Mayo Clinic staffA single risk factor may be enough to cause heart failure, but a combination of factors increases your risk.Risk factors include:High blood pressure. Your heart works harder than it has to if your blood pressure is high.Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.Congenital heart defects. Some people who develop heart failure were born with structural heart defects.Viruses. A viral infection may have damaged your heart muscle.Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention. An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight. An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe.Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each person's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable.
Living with chf online
Living with CHF From:Your Community Paramedics
Objectives• How CHF(Congestive Heart Failure) works• Medication Compliance• How your Medication help• Signs and Symptoms of CHF• Frequently asked questions
Pathophysiology of CHFCongestive Heart Failure or CHF is acondition in which the heart is unableto adequately pump enough blood tothe body to meet the body’s needs.
Pathophysiology of CHFThe heart is dividedinto two sides, theright side & the leftside.
Pathophysiology of CHF • Coronary Artery Disease • Viral InfectionsThere are many • Toxinsdiseases that may • Heart Valveaffect the ability of Disordersthe heart to pump • High Blood Pressureblood. • Over active Thyroid • Heart Attack
Pathophysiology of CHFWith left side heartfailure, the mostcommon form ofheart failure, youmay see shortnessof breath due to aback up of fluids inthe lungs
Monitoring ComplianceIn the words of C. Everett Koop,former Surgeon General, “A drug can’twork if you’re not taking it”
Monitoring ComplianceNoncompliance is one of the biggestissues in health care today and, inpatients with congestive Heartfailure(CHF), compliance is critical tokeep their cardiovascular system inbalance
Monitoring ComplianceIt is important to identify the reasonan individual fails to take a medicationso the root of the problem can beidentified and addressedHow can care takers help?
Monitoring ComplianceThe Community A. Identifying non-Paramedic can help compliance.with Medication B. Identifying reasonsCompliance. patients are not taking medication C. Providing education resources D. Setting up compliance programs
CHF and Your MedicationsThe purpose of Heart Failuremedications is to make you feel betterand to treat the disease that is causingyou to feel bad.
Goal of Medicating CHF• The goal is to decrease the afterload• The goal to decrease the cardiac output and stroke volume• The goal to decrease the preload
CHF and Your Medications Important Things to Remember• Get your medications from one pharmacy.• Store all medications in original containers away from heat and light and as directed.• Carry a list of your medications in your wallet or purse. Use the Universal Medication Form.
CHF and Your Medications Important Things to Remember• Take all your medications as directed by your doctor.• Try to take your medications at the same time every day.• If you miss a dose, do not take two doses at once.• If you cannot take your medications, call your doctor immediately.• Do not stop any medications without your doctor’s instructions.• Do not take any over-the-counter medicines, herbals, home remedies or vitamins without asking your doctor or pharmacist. They may interfere with your medications or make your CHF worse.
CHF Signs and SymptomsHeart failure can be chronic — meaning yourcondition is ongoing — or acute, meaning yourcondition has started suddenly
Chronic vs. Acute Signs and SymptomsChronic Heart Failure Acute Heart Failure• Shortness of breath • Symptoms similar to those• Fatigue of chronic heart failure, but• Swelling in your Lower limbs more severe and start or• Rapid or irregular heartbeat worsen suddenly• Reduced ability to exercise • Sudden fluid buildup• Persistent cough or • Rapid or irregular wheezing with white or pink blood-tinged phlegm heartbeat (palpitations)• Swelling of your abdomen • Sudden, severe shortness• Sudden weight gain from of breath and coughing up fluid retention pink, foamy mucus• Lack of appetite and nausea • Chest pain, if your heart• Difficulty concentrating failure is caused by a heart• Decreased alertness attack
When to see a DoctorSee your doctor if you experience any of the signs orsymptoms associated with heart failure.These include:• Chest pain• Fatigue and weakness• Rapid or irregular heartbeat• Shortness of breath (dyspnea) when you exert yourself or when you lie down• Reduced ability to exercise• Persistent cough or wheezing with white or pink blood- tinged phlegm• Swelling in your abdomen, legs, ankles and feet• Difficulty concentrating or decreased alertness
Frequently Asked QuestionsWhat is Congestive Heart Failure?• Congestive heart failure occurs when your heart cannot pump enough blood to your body.What causes Congestive Heart Failure?• Heart failure is caused by damage to your heart muscle and how it functions.What types of activities are safe for someone with heart failure?• Heart failure patients should coordinate their activity level with their physician. Depending on the severity of their heart failure and the presence of other health conditions, patients can tolerate a range of activity levels. Walking, working out with light weights, stretching and other less strenuous activities can help improve heart function in some patients.
Frequently Asked QuestionsIs heart failure the same as a heart attack?• Being diagnosed with heart failure isnt the same as having a heart attack. The two conditions, though sometimes related (an earlier heart attack can lead to the muscle damage that is a precursor to heart failure) are completely different.How many people have heart failure?• According to the American Heart Association, nearly five million Americans are living with heart failure, and there are almost 600,000 new cases diagnosed each year.Is there a cure for heart failure?• While there is no specific cure for heart failure, the good news is that with proper medical care symptoms can be improved. What Is the Outlook for People With Heart Failure?• If you have heart failure, your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan. With the right care, heart failure will not stop you from doing the things you enjoy.
Frequently Asked QuestionsWhat are the side effects of some CHF medications?• Medicines used to treat your heart failure may cause dizziness, low blood pressure, and kidney problems. The levels of potassium in your blood may change and lead to abnormal heartbeats. Your heart may beat too fast or too slow.When should I seek immediate help?• You feel confused, dizzy, or lightheaded, and your fingers or toes are cold and turning white or blue.• You are coughing up pink and frothy, or bloody sputum, or you have a constant dry cough.• Your heart is beating more than 120 times each minute.
Summary• What and how CHF(Congestive Heart Failure) works• Community Paramedic assisted medication Compliance• How your Medications help with CHF signs and symptoms• Signs and Symptoms of CHF Acute vs Chronic
References• PubMed.gov-US national library of medicine national institutes of health• United Health Group Company-Prescription Solutions• www.mayoclinic.com/health/heart- failure/DS00061To revisit this Power Point presentation go to:Universal Medication Form: http://www.lexmed.com/patients/admission /universal-medication-form.aspx