11 hours ago · Case Presentation. WC is a 67-year-old man with hypertension, hyperlipidemia, and coronary artery disease, and had triple bypass surgery 17 years ago. His current home medications include amlodipine 10 mg once daily, atorvastatin 80 mg once daily, and aspirin 81 mg once daily. He presents to the clinic with shortness of breath (SOB), which ... >> Go To The Portal
What is the symptoms of heart enlargement?
What are the risk factors for heart failure?
Several specific tests are used together to diagnose congestive heart failure:
The risk factors predisposing one to heart failure are obesity, high blood pressure, diabetes, and smoking. Heart failure is commonly characterized by typical signs of fluid retention with symptoms of breathlessness, fatigue, paroxysmal nocturnal dyspnoea, and reduced exercise tolerance39.
Congestive cardiac failure (CCF) is a complex syndrome that is usually caused by the inability of heart to pump sufficient blood to meet metabolic needs of body during exercise. It is more commonly known as heart failure38 and it can affect either left or right ventricle or both39.
CCF is a common disease which affects approximately 1-2% of the general population in developed countries1. Prevalence increases with age especially those aged above 75 years where the prevalence of CCF could be as high as 10%2. In addition, men are prone to getting heart failure as compared to women1.
The mode of action of beta blockers in heart failure is poorly understood but the proposed mechanisms include antiarrhythmic action, anti-ischaemic action, and attenuation of cathecholamine toxicity as well as reduced cardiac modelling through blockade of sympathetic influences on the heart9.
Beta blockers used to be contraindicated in patients with CCF as it may worsen the condition of the heart due to its negative inotropic effect. Nowadays, beta blockers should be considered in all patients with heart failure unless contraindicated5 as they have been shown to reduce the mortality, hospitalization and the progression of heart failure7. Beta blockers should be introduced following treatment with ACE inhibitor once the patient’s condition is stable7. Only bisoprolol, carvedilol, and nebivolol are currently licensed to be used in the treatment of heart failure in UK8. Both nebivolol and bisoprolol are cardioselective where they act on beta1 receptors. On the other hand, carvedilol is a non-selective beta blocker9, 10. The mode of action of beta blockers in heart failure is poorly understood but the proposed mechanisms include antiarrhythmic action, anti-ischaemic action, and attenuation of cathecholamine toxicity as well as reduced cardiac modelling through blockade of sympathetic influences on the heart9. Besides, carvedilol has an additional antioxidant property which may be thought to slow down the process of atherogenesis by inhibiting the oxygen-free radicals11, 12. The starting dose should be low as high doses may worsen the condition of heart failure7. Over time, the dose of beta blocker should be gradually titrated upward if the patient is well tolerated until target dose is reached5.
Therefore, low dose of spironolactone (usually 25mg daily) should only be prescribed to patients who have severe heart failure (NYHA class III and IV) with left ventricular dysfunction. In addition, they should have a normal serum potassium level and renal function to begin with.
However, high levels of bradykinin also responsible for the main adverse effect of ACE inhibitors, dry cough42.
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information.
Diuretic is a very important drug for heart failure treatment especially for symptoms of fluid retention. A meta-analysis which includes 18 randomised controlled trials (RCT), n=982, had been carried out to study the role of diuretics (loop diuretics and thiazides) in patient with congestive heart failure (CHF). 8 trials were placebo-controlled and another 10 were comparison between diuretics and other drugs such as ACEIs, digoxin and ibopamine. The results had shown that diuretics reduce the risk of deterioration of disease and mortality compared to placebo group. When compared to active controls, diuretics also showed significant improvement in patient’s exercise capacity. The beneficial effects of diuretics are further supported by Cochrane database which also indicated that diuretics cause significant reduction rate and improvement in patient’s morbidity.
Heart failure can be defined as inability of the heart to supply sufficient blood flow to meet the body’s needs. HF can result from any disorder that reduces ventricular filling (diastolic dysfunction) and myocardial contractility (systolic dysfunction). The leading causes of HF are coronary artery disease and HPT. As cardiac function decreases after myocardiac injury, the heart relies on few compensatory mechanisms. Although those compensatory mechanisms can initially maintain the cardiac function, they are responsible for HF symptoms and contribute to disease progression. An initiating event such as acute MI can cause the HF state becomes a systemic disease whose progression is largely mediated by neurohormones and autocrine/paracrine factors such as agiotensin II, norepinephrine, aldosterone, natriuretic peptides, and so on. Some drugs may exacerbate HF due to their inotropic, cardiotoxic and sodium-/water- retention properties.
The signs and symptoms are the key for early detection. Breathlessness, angina, fatigue and wheeze are common signs and symptoms. Patient complains that she is having SOB and PND.
Spironolactone is the most common aldosterone antagonist used in treatment of HF. In a double-blind study (RALES), 1663 patients with severe HF (NYHA class III and IV), left ventricular ejection fraction ≤ 35% and being treated with diuretics, ACEIs or digoxin were recruited to test the effectiveness of spironolactone on their morbidity and mortality. The result showed 30% reduction in mortality rate and 35% reduction of frequency of hospitalisation compared to placebo group. Addition of spironolactone to ACEIs, diuretics or digoxin had reduced the mortality rate in patients with severe HF. Additional of spironolactone may lead to hyperkalaemia. However the problem of hyperkalaemia can be solved by closing monitoring the potassium level of patients. Another study also showed that spironolactone reduced 30% mortality rate in patients with HF when it has been added to β-blockers and digoxin.