The term “heart failure” is a blanket term used for numerous heart diseases ranging from congestive heart failure (CHF) to arrhythmia and coronary heart disease (CHD) (Bozkurt et al., 2013). It is used to describe a myriad of situations when the heart is not working properly. In the USA, heart failure is considered to be the primary cause of death for males aged 65 years or older (Roger, 2013). It is a major health problem in the country, as over 5 million people are suffering from it. This number is increased by 550.000 cases every year. Approximately 43.000 people die from CHF in the US every year, with 60% of them being males (Bozkurt et al., 2013).
The common causes of heart disease among men include physical inactivity, cigarette smoking, excessive weight and obesity, diabetes, hypertension, valvular heart disease, coronary heart disease, and others. These traits can be commonly found in elderly adult males. The purpose of this paper is to evaluate the problem of heart failure in adult males of 65 years of age and older, identify risk factors, pathophysiology, typical lab, and diagnostic health data, and goals of therapeutic management to improve the situation.
Risk Factors for Primary Diagnosis
Heart failure can be caused by a myriad of facts, which include coronary heart disease, myocardial infarction, hypertension, valve disease, congenital heart disease, cardiomyopathy, endocarditis, myocarditis, diabetes, and others (Bozkurt et al., 2013). Many of these factors can be found in adult males of the age of 65 years or older. There are several reasons for that – due to lifestyles and predispositions towards certain diseases, males are more vulnerable to these illnesses than women. According to statistics, nearly 16.7 percent of men in the US smoke (“Current cigarette smoking,” 2015).
Obesity and diabetes are influenced by dietary choices, as American cuisine emphasizes foods enriched with fat and calories. Obesity is another major problem in the US, which is associated with a myriad of health hazards, ranging from hormonal disturbances to muscular-skeletal structure diseases and, of course, heart diseases. Extra weight puts extra exertion on the heart and causes it to wear out quicker, thus leading to increased chances of a heart attack, heart congestion, or other diseases. The poor are at a particular risk of congestive heart failure and other diseases, as they do not have the funds to buy health insurance and normally go uninsured.
According to the Kaiser Family Foundation, America has over 28.5 million people uninsured, 15% of which are elders (“Key facts, 2016). Lack of insurance means that they would go without medical assistance when they need it the most. Preventive action and medicament treatment would also be limited to them, as they would not be able to afford some of the necessary medicines. Lastly, the vulnerable populations include those who had a history of heart disease running in the family. Currently available data on coronary heart disease, for example, suggests that there is a definite correlation between heart disease and familial ties, with coronary heart disease being clustered in families with a history of such (Dawber, Moore, & Mann, 2015).
Pathophysiology of Primary Diagnosis
The pathophysiologic state of the organism that predates the development of congestive heart failure, which is the primary cause of death in males of 65 years of age and older, is extremely complex (Kemp & Conte, 2012). The human body has developed numerous compensation mechanisms at all levels, from subcellular to organ-to-organ interactions. The disease develops only when all these compensatory mechanisms are overwhelmed, and there is no other way to prevent it from happening. The mechanisms involved include the Franklin-Staring mechanism, which helps sustain cardiac performance with increased preload, alterations to myocyte regeneration rates, myocardial hypertrophy, and activation of neurohumoral systems (Kemp & Conte, 2012).
In acute heart failure, these mechanisms, while aiming to maintain the adequate performance of the cardiovascular system, become maladaptive and decreases the overall performance (Kemp & Conte, 2012). One of the primary responses towards chronically increased wall stress is myocyte hypertrophy, and the changes to cell death and regeneration rates. These processes, in the long turn, cause the remodeling of the heart and the worsening of the loading conditions. The treatment that reduces heart pressure is one of the methods that is applied to this primary responsibility, as it slows down the remodeling process (Kemp & Conte, 2012).
Vasoconstriction is caused by the release of several active substances, such as epinephrine, vasopressin, norepinephrine, and endothelin-1, into the bloodstream. This increases calcium overload and cytosolic calcium entry. This, in turn, dangerously increases myocardial contractility and reduces myocardial relaxation (Kemp & Conte, 2012).
Calcium overload is dangerous as it can seriously affect the heartbeat rate, and even cause sudden death. It is the main cause of arrhythmia, and leads to the increase of myocardial energy use, which in turn wears out the cells quicker and causes myocardial cell death. This process can cause heart failure and reduction of the heart’s working output, thus initiating a harmful cycle of a heart rate increase, myocardial contractility increase, hemodynamic and neurohormonal derangements, and neurohumoral stimulation, which solicit continuous adverse reactions on a cellular level. Other issues associated with heart failure are salt and water retention, caused by the activation of the RAAS mechanism.
Ultimately, the imbalance and misuse of hypertrophy by the organism, coupled with the death of heart cells over their regeneration, is the cause of progression of heart failure on a cellular level (Kemp & Conte, 2012).
Heart failure affects other organs, as well. The primary systems to take the hit are the lungs and the kidneys. Congestive heart failure is called that way because the heart, due to the cellular reactions that affect its pumping rate, cannot move the normal amount of blood through a normal cycle. The kidneys, on the other hand, suffer from a lack of oxygen-enriched blood (Kemp & Conte, 2012). The body delivers it to the most important organs, which are the brain and the heart. Without oxygen, over time, kidney activity diminishes to the point they could not function normally. Cells die, and the regeneration rates are not enough to replace them, causing various kidney diseases. With kidney function in disarray, excessive water is accumulated in different areas of the body, namely the ankles, feet, and legs (Kemp & Conte, 2012).
Pathophysiology for Primary Symptoms
The primary symptoms of heart failure include weight gain, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, JVD, tachycardia, hepatosplenomegaly, ascites, fatigue, weakness, nausea, poor appetite, cachexia, and renal hypoperfusion (Kemp & Conte, 2012). The symptoms associated with the heart processes are caused directly or indirectly by the attempts of the body to fix itself. Dyspnea, orthopnea, tachycardia, and others are the direct result of hypertrophy, as well as cell death and regeneration rate changes. The cycle of hypertrophy, myocardial contractility increase, hemodynamic and neurohormonal derangements, and neurohumoral stimulation cause various changes in how the heart function by weakening its productive output and wears out the heart muscles at the same time.
Fatigue, weakness, nausea, poor appetite, and the like are all connected to the effects that heart failure has on the rest of the organs (Kemp & Conte, 2012). Weakness is caused by oxygen not being delivered to the cells around the body, which is a common cause of congestive heart failure. Renal failure is also connected to the fact that oxygen is delivered to the most important systems such as the heart and the brain, rather than to secondary systems such as the kidneys, which remove excess water from the organism. Weight gain is associated with the water being accumulated in various parts of the body, as well as disturbed eating patterns and the overall delivery of nutrients and oxygen at a cellular level throughout the body (Kemp & Conte, 2012).
Typical Lab and Diagnostic Test Data
To find out if a patient has heart failure, the doctor might have to perform some tests. These tests would also tell the severity of the disease and determine the right course of action. The typical tests following a heart failure are (Tissot, da Cruz, & Miyamoto, 2013):
- Blood tests. These tests help determine the status of the patient’s kidneys and thyroid glands, as well as to measure the levels of cholesterol in the blood. They also help determine the number of healthy red blood cells. If there are not enough of them, it may cause anemia.
- BNP Blood Test. The levels of the B-type natriuretic peptide in the blood can show the level of development of heart disease. The higher the levels of the substance, the worse the situation is.
- Chest X-ray. This procedure allows the doctor to evaluate the size of the heart, as well as notice any liquid build-up in the heart or lungs.
- Echocardiogram. This test allows the doctor to evaluate the state of the heart’s valves and chambers, as well as see how well it is pumping blood. This is important during all stages of treatment.
- Ejection fraction. This test helps measure the amount of blood being pumped in one heartbeat. If it is below 55%, then the person is at risk of heart failure.
- Electrocardiogram. It is one of the first tests performed on a patient. It gives the doctor a general description of how the heart can pump blood, as well as display its overall activity.
- Stress test. By making the patient perform physical activity, and increasing the pumping rate, the doctor is capable of finding clogged arteries and other obstructions to the blood flow.
- Cardiac catheterization. It is a test used to dealing with coronary heart disease and helps to find out whether or not the patient has any clogged arteries.
- CT coronary angiogram. This method involves using an X-ray in conjunction with a contrasting dye. But introducing it into the blood flow, the doctor is capable of identifying any clogged arteries, which is why it is useful for treating coronary heart disease.
- Cardiac MRI. This test, though not used very frequently, enables the doctor to assess the physical state of the heart muscles and tissues. This is important in cases with old patients, particularly over the age of 65, as by that time, their hearts are worn out.
Goals of Therapeutic Management
Since males aged 65 and older are one of the largest groups to be affected by heart failure, the therapeutic management goals would be aimed at prevention of CHF, CHD, and other kinds of heart failure, reducing the workload on the heart, and working towards lessening the negative effects of the disease on the organism (Bozkurt et al., 2013). The suggested activities can be separated into three large groups (Murad & Kitzman, 2012):
- Medical interventions.
- Diet and healthy way of life.
- Physical activity.
All three are very important, especially for elderly patients, as at the end of their lives, they tend to forsake all physical activity and are less than selective with their dietary choices. Also, some of them tend to forget to take their prescribed medicine, thus putting themselves at risk of heart failure (Murad & Kitzman, 2012).
Medical treatment of heart failure involves taking medicines that reduce the pressure on the heart and stop the symptoms of the disease from spreading even more. These medicines include:
- ACE inhibitors – reduce the chances of heart attack and lower the pressure on the heart.
- Aldosterone antagonists – this medicine helps remove the extra sodium from the body. Also, it lowers the heart rate by lowering the amount of blood for the heart to pump through the body.
- Beta-blockers – affect the patient on a hormonal level and reduce the heartbeat rate.
- Diuretics – help remove the excess liquids from the limbs and lungs, thus allowing the patient to lose weight.
- Isosorbide dinitrate – widens and relaxes the blood vessels, allowing the heart to pump blood through them with ease.
- Digoxin – a cardio stimulant that makes the heartbeat stronger and pumps more blood. This medicine is not recommended for those with weakened heart muscle tissues, as it can trigger a cardiac arrest.
Diet and healthy habits would be helpful for males of 65 years and older, as they would massively increase their chances of survival and promote longevity. Excluding foods with high amounts of fats and carbons as well as calories in them would help reduce weight and decrease the workload on the heart. Diet specialists recommend eating fresh fruits and vegetables as well as meats without salt (Di Nicolantonio, Pasquale, Taylor, & Hackam, 2013). Quitting smoking would be considered a major improvement, as smoking causes damage not only to the heart but to the lungs, directly affecting the amount of oxygen in the blood flow.
Exercises for male patients of 65 years and older must be done with caution, as one of the primary causes of heart failure is overextension. Cardiovascular exercises are aimed at strengthening the vascular system, reducing cholesterol, improving heart failure symptoms, and increasing oxygen circulation (Bozkurt et al., 2013). The exercise regimen must be approved by the therapist to ensure that the patient would not overexert himself. Primary exercises that are available to the patients suffering from heart failure are walking and swimming. Any exercise that does not require straining muscles or pushing against a heavy or immovable object is considered beneficial. At the same time, typical exercises like squats, push-ups, and heavy lifting are to be avoided.
References
Bozkurt, B., Butler, J., Casey, D.E., Drazner, M.H., Fonarow, G.C., … Wilkoff, B.L. (2013). 2013 ACCF/AHA Guideline for the management of heart failure. Heart Rhythm Society, 28, 24-59.
Current cigarette smoking among adults in the United States. (2015). Web.
Dawber, T.R., Moore, F.E., & Mann, G.W. (2015). Coronary heart disease in the Framingham study. International Journal of Epidemiology, 44(6), 1767-1780.
Di Nicolantonio, J.J., Pasquale, P.D., Taylor, R.S., & Hackam, D.J. (2013). Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart, 2013, 5-17.
Kemp, C.D., & Conte, J.V. (2012). The pathophysiology of heart failure. Cardiovascular Pathology, 21(5), 365-371.
Key facts about the uninsured population. (2016). Web.
Murad, K., & Kitzman, D.W. (2012). Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Failure Reviews, 17(4), 581-558.
Roger, V.L. (2013). Epidemiology of heart failure. Circulation research, 113, 646-659.
Tissot, C., da Cruz, E.M., & Miyamoto, S.D. (2013). Congestive heart failure. Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 1, 2045-2062.