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How Doctors are Using Their Skills to Combat Congestive Heart

How Doctors are Using Their Skills to Combat Congestive Heart Failure

Congestive heart failure is an insidious opponent, possessing a slow onset that results in a patient often not even noticing they are having symptoms. Over time the patient will suffer from worsening dyspnea and edema that will eventually drive them to seek treatment, where they will discover that for whatever reason their heart is no longer able to function properly.

Heart failure occurs when the cells of the heart tissue are either destroyed or made non-functional due to another cardiac event, often secondary to ischemic heart disease or coronary artery disease. As a result, the heart is no longer able to pump the blood throughout the body properly; instead the blood pools, resulting in fluids being retained rather than excreted properly and oxygen starved organs being unable to function. The death of these cells is critical because, like brain cells, once the cells of the heart die the body is unable to reproduce them and restore full function to the heart. Congestive heart failure carries with it a high mortality rate, with over fifty percent of its victims dying within five years of being diagnosed. Doctors and researchers are able to use modern advancements in medicine to make the patient more comfortable and, in many cases, to provide them with a more favorable prognosis.

Many patients do not even discover that they have suffered heart failure until they are brought into the Emergency Department of their local hospital complaining of chest pain and difficulty breathing. Doctors will stabilize them there, giving them supplemental oxygen and beginning a course of medicinal treatment that will carry them out of the hospital.

Modern science has provided physicians with a wide array of methods with which to combat the damage done by congestive heart failure. Once oxygen is returned to an acceptable level a physician will usually administer a diuretic to stimulate the renal system to pull fluid out of circulation, relieving the edema and taking a great of stress off of the lungs, heart and other organs. This will also usually be accompanied by supplemental potassium, as the renal system will remove potassium along with the excess fluid and hypokalemia carries with it its own hazards.

A great deal of attention in the field of medicine has been focused on the body’s production of angiotensin II as it aggravates congestive heart failure. Angiotensin II is a substance produced by the body which raises blood pressure and causes the blood vessels to constrict, thereby forcing the heart to work much harder to pump blood throughout the body. An ACE inhibitor will often be administered to prevent the body from making angiotensin II, and an angiotensin receptor blocker is available to those who do not respond as desired to the ACE inhibitor. Many patients with heart problems are given nitroglycerin for this reason.

Along with medicine, research into the field of congestive heart failure is ongoing. The speculated use of stem cells, particularly embryonic stem cells, has opened a whole field of debate for possible treatment of heart failure in the science community. Patients with congestive heart failure were given some of their own stem cells in the heart via injection, and all reacted favorably. Scientists are unsure as to whether this is because the stem cells aid the body in growing new vessels or simply act as a lighthouse for the body’s natural healing mechanisms, drawing other cells to the site of the damage. Whichever the case may be, stem cells present a fascinating opportunity to finally find a means by which to restore heart function to patients who have suffered heart failure.

Modern science is providing a whole new world of treatment options to patients with congestive heart failure, and researchers are making new discoveries all the time. It is the hope of all of those in the medical field that one day heart failure will be another disease medicine has the answer to.

How do Physicians Treat Congestive Heart Failure?

Congestive heart failure is precisely what it sounds like; it is a failure of the heart to properly function, and its effects on the body can be devastating. Physicians do their best to treat the symptoms and give the patient the best prognosis possible; however, no true cure for congestive heart failure currently exists.

Heart failure occurs when the heart is unable to properly pump blood throughout the body; as a result, rather than distributing nutrients and oxygen to the tissues and then excreting the excess fluid into the urine the blood pools. This results in either a systemic or localized edema as fluid builds up in the veins and organs, causing swelling of the extremities as well as the organs themselves (this fluid accumulation is responsible for an excessive amount of stress on the heart as fluid accumulates in the pleural cavity as well as the dyspnea, or difficulty breathing, often symptomatic of heart failure). The swelling and lack of oxygen and nutrients will result in permanent damage to the organs if left untreated, providing a very poor prognosis for the patient.

The first stage of treatment generally consists of the administration of extra oxygen to attempt to return the oxygen levels in the tissues to normal. Once oxygen has been administered and a pulse oximeter reveals blood oxygen levels to be acceptable the focus will shift to attempting to treat the fluid build-up in the body. Diuretics will be administered to assist the excess fluid on its path out of the body via the urinary tract, and nitrates are administered to cause the vessels to dilate, allowing blood to flow more freely without the heart having to work quite as hard. Treatment with diuretics is often accompanied by supplemental potassium, as the body will excrete potassium in the urine and long term hypokalemia may result in muscle weakness or paralysis, as well as an increased risk of fatal cardiac arrhythmia.

Patients will often be sent home from the hospital with diuretics, as well as a medication known as an ACE inhibitor (an angiotensin-converting enzyme inhibitor) which prevents the body from creating angiotensin, a substance which raises blood pressure and causes the blood vessels to constrict. An angiotensin II receptor blocker may also be administered if the patient continues to produce angiotensin. Patients may also be treated with vasodilators other than ACE inhibitors, particularly if they have responded poorly to treatments with ACE inhibitors in the past. Nitroglycerin is a common example of this type of medication.

Digitalis, or Digoxin, may be prescribed to strengthen the force of the heart’s contractions, aiding it to push blood throughout the body. Treatment with a beta blocker is also beneficial in cases of heart failure, preventing the heart from beating more rapidly in an attempt to compensate for the poor movement of the blood in the body and placing more stress on the weakened muscle.

Blood thinners are used to prevent the formation of clots in the body that may be caused by the decreased movement of the blood in the vessels. Coumadin and heparin are the most commonly prescribed blood thinners in use today; however, due to an increased risk of bleeding patients taking these medications should undergo coagulation testing regularly.

Lifestyle changes are just as important as medications in the long term treatment of heart failure. Patients should consult with their doctor to establish an appropriate (low sodium) diet and exercise program, and should do at least some moderate exercise daily. Equally important is taking sufficient time to rest every day. The heart pumps more easily when the body is at rest, which is vital to an already overstressed muscle. The nicotine from cigarettes causes an increase in heart rate, blood pressure, and the tendency for clumping in the blood vessels; patients with heart failure should abstain from smoking. Flu or pneumonia can be very difficult for hearts that are failing as they attempt to compensate for the lack of oxygen in the bloodstream being carried to the organs. It is very important that patients receive an annual influenza vaccine, as well as a dose of the pneumococcal vaccine, which will protect them from the pneumococcal bacteria that cause over eighty percent of cases of bacterial pneumonia. Wearing non-constrictive clothing will assist in preventing blood clots and facilitating blood flow to the extremeties, and in cases of extremely warm or extremely cold temperatures it is important that the patient take all precautions necessary to keep the body at an appropriate temperature..

Researchers are still seeking to find a cure for congestive heart failure; however, until that day comes it is extremely important that patients suffering from heart failure follow the treatment plan outlined by their physician. With careful attention to maintaining their condition, the prognosis associated with heart failure increases dramatically.

How CHF Patients can Take Advantage of Translational Research?

In nature every action spawns a separate and equal reaction. In the field of medicine, the reaction may not always be equal to the action. The performance of a particular treatment in the lab on test animals may not be the same as would be seen in a human subject; this is where the field of translational research comes in.

Translational research takes research from the laboratory to the patient’s bedside. This can be done in several forms. In its earliest stages a treatment will undergo controlled clinical trials with a voluntary group of test subjects. If these small, controlled tests meet the acceptable range of success the treatment is then taken to research hospitals such as St. Jude’s or Children’s Hospital of Boston. Here patients are given the opportunity to experience new methods of control and treatment of a disease with the understanding that it is still considered highly experimental; however, for many these treatments represent a chance for a cure that previously as out of reach for them as the moon.

Congestive heart failure is, at the moment, an incurable event, occurring when for whatever reason the cells of the heart muscle are destroyed and the heart can no longer adequately pump blood throughout the body. Once the cells in the heart tissue are non-functional the body is unable to replace them, making it impossible for the heart to regain full heart function on its own. The current mortality rate is high, and over fifty percent of patients with congestive heart failure will die within five years of being diagnosed. There are many treatment options currently being considered for congestive heart failure, however, and a number of new technologies being tested daily. For example, Montefiore Medical Center in New York City is currently doing clinical trials on a drug known as Lovosimendan, a calcium sensitizer that does not trigger cardiac arrhythmia, and research into the possibility of using stem cells to regrow cardiac tissue is ongoing.

For a patient to take advantage of these options they should discuss the possibility of being a subject for clinical testing with their physician to see if they would be a good candidate, then allow the physician to make a recommendation on a course of action from there. It may be suggested that the patient contact a research facility, or the physician may suggest their name for a clinical trial they know is occurring soon. If the patient lives in an area with a research hospital nearby, chances are there will be an opportunity for them to benefit from the hospital’s policy on translational research.

It should be understood that translational research is precisely what it sounds like; research. Scientists and doctors are often still learning about the treatment and its effect on the human body, and there is always a possibility that it will be unsuccessful or carry with it many hazardous side effects. These courses of treatments are unknowns to physician and researcher alike. For patients who have run out of options, however, even the possibility of a negative effect cannot stifle what the opportunity to be part of a translational research project provides: hope.

How Can Continuing Medical Education Credits Be Obtained?

While physicians spend many, many years in school prior to receiving their MD, it is impossible for them to learn everything there is to know. The medical field is simply too vast, and it is constantly in motion; therefore, it is important that every physician complete continuing medical education.

Continuing medical education (CME) allows a physician to stay abreast of new discoveries, treatments, and other advancements in their chosen field. What worked thirty years ago is not usually the method of choice for today’s physicians, and clinicians who do not complete these continuing education credits may often be placing their patients at risk because of a lack of knowledge of treatments that have been deemed ineffective or hazardous. Unfortunately, often when a physician is wrong it is the patient‘s life that pays the price.

Due to this, every physician is required to complete a minimum number of CME credits every year; however, they are certainly not required to stop once that number is met. This does not necessarily mean returning to school, although this is certainly an option; however, for most physicians caring for their patients leaves them little time for the heavy workload of a secondary education institution. Many other more convenient options are available to them.

Across the nation hundreds of thousands of medical conventions, symposiums, workshops and conferences are available to healthcare professionals, covering topics from new surgical techniques to treat collapsed heart valves to the use of stem cells to treat congestive heart failure; all cutting edge technology not yet taught in the classroom. These often take place over the course of a weekend, often last more than one day and are held in various locations, so physicians from any location in the country may attend at their discretion.

In many rural areas there is only one doctor available, often with no one to see to their patients when they are unavailable. These are the physicians who are still on call twenty four hours a day, make their own hospital rounds and see patients from birth to death for everything from a toothache to a heart attack. Needless to say they are often unable to get away from their practice to attend weekend workshops. Another option is available for them so they can continue to provide their patients with around the clock care. The internet has opened up a whole new world to the field of continuing education. Many organizations, such as the American Medical Association (AMA) and the American Association for Continuing Medical Education (AACME) offer resources online for healthcare workers to complete their continuing medical education credits. Here clinicians will have the opportunity to complete coursework online, view online conferences and use the teleweb to attend lectures and symposiums.

These CME resources may be found free of charge or for a small fee per credit hour, depending on the situation; however, this is infinitely less expensive (and time consuming) than returning to a college or university, and offer greater benefits because attendees are able to stay apprised of new research and untried methods that are not taught to students.

It is true that no one ever stops learning, and this is especially true in the medical field. Continuing medical education allows clinicians to stay on top of their field and provide the best, most advanced care options available to their patients.