Tag: treatment of heart failure

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 Can Genes Contribute to and Cure Congestive Heart Failure?

How Can Genes Contribute to and Cure Congestive Heart Failure?

It is common knowledge that heart failure follows another severe form of heart damage; however, until now scientists and doctors have had no way to identify those at risk. New research into genes and gene therapy have made them a potential weapon in the fight against heart failure.
Scientists have made several discoveries regarding the role of genes in the detection and treatment of heart failure. Several years ago it was discovered that a small percentage of patients who had suffered heart failure possessed a defect in the gene that allows the body to detect stress signals; in essence, the heart does not know that it is working to hard and is unable to adjust. This percentage may seem insignificant; however, the gene mutation was not present in any of the healthy patients examined. Researchers stress that this is a susceptibility factor, not a cause of congestive heart failure; however, it may be the breaking point when determining if a heart suffering from other disease will fail. Detection of this mutation may allow doctors to identify and treat patients at risk prior to their heart failing rather than after.

This defect is found in the ATP-sensitive potassium channels and is caused by a genetic mutation. The potassium channel regulates potassium and calcium levels in the body. While the heart must have calcium to function, an excess of calcium leads to damage. This is the reason calcium blockers are often given to patients with congestive heart failure. Fortunately, medications to open the potassium channel already exist.

In addition, a defect of the delta-sarcoglycan gene has been seen in hamsters with muscular dystrophy and cardiomyopathy. This gene is the cytoskeleton of muscle fibers, and successful transplant of a normal human delta-sarcoglycan gene has been shown to cause a tremendous improvement in these animals. This is noteworthy because current transplant attempts require open heart surgery. This type of gene transplant is carried on a virus, eliminating the need for surgery.

Scientists had been a bit concerned with using this method of gene therapy due to the need for a systemic effect. There was also some concern that the body’s natural immune system would eliminate the virus of its own accord prior to successful delivery of the gene; however, they believe they have found the best form of virus to successfully slip past the body’s defenses. When transplanting the delta-sarcoglycan gene researchers used a type eight adeno-associated virus, piggybacking the corrective gene onto it as it was inserted into the body. This allowed the gene to be carried to all areas of the body in animals with muscular dystrophy without being destroyed by the body’s own natural immunity.

Gene therapy is still highly experimental, and researchers are unsure yet of the role it will play in the conquest of heart failure; however, this represents a technology that was unavailable thirty years ago. Continuing advancements in technology and medicine’s knowledge of the body’s building blocks may one day unlock the mysteries to the cure of this deadly disease.