Pathophysiology of Congestive Heart Failure Presentation

Pathophysiology of Congestive Heart Failure

The heart fails to deliver blood to the periphery. The ventricles are enlarged with blood. Blood accumulated in the heart chambers fails to circulate. Cardiac output and stroke volume is lowered due to vasoconstriction. It causes pressure overload, which leads to congestion. Water and sodium retention may increase fluid volume and preload. The increase in fluid volume causes cardiac output reduction.

Symptoms/clinical presentation of congestive heart failure

• Excess fluid causes oedema, right upper pain, jugular pressure, ascites, Wheeze, headaches, confusion, insomnia, cough, orthopnea, swelling, dyspnea.
• Reduced cardiac output causes fatigue, weakness, and anorexia.

Goal of Treatment

• Relieve patient’s symptom.
• Improve the quality of life.
• Alleviate fluid retention.
• Symptomatic relief.
• Slow disease advancement.

Current medical management

• Lifestyle adjustment: exercises, smoking/ alcohol ban, body weight.

Pharmacologic Treatment

• Use digoxin, Diuretics, and Angiotensin-converting inhibitors (American Academy of Family Physicians, 2008).
• ACE inhibitors* use as needed.
• ARB Use as required.
• Digoxin.
• Diuretic: use as recommended.
• Aldosterone: antagonist use after myocardial infraction.
• Beta-blocker: use as needed.
• ACE inhibitors and beta-blocker slows disease advancement. ACE inhibitors can be replaced with ARB.

Pharmacokinetics and pharmacodynamics

• Fosinopril reduces CHF progression. The pharmacokinetics and pharmacodynamics of the active ingredient (Fosinoprilat). Bioavailability = 29% Protein Binding= 99% Vss was similar. Clinicians can administer Fosinopril without causing fosinoprilat concentrations.
• The combination of drugs can cause ADR. Diuretics and electrolyte imbalance can cause dehydration, hyponatremia, rash, and hypomagnesaemia.

Precautions and contraindications

• The chance of hospitalization during drug administration is high. Thus, beta-blockers, diltiazem, amlodipine, bisoprolol, trandolpril, ramipril and digoxin must be controlled.
• Special considerations include nutritional consideration, physical activity, and drug administration.

Outcome evaluation/ patient education

• Patients using enalapril showed significant improvement and symptomatic relief.
• The patient must adjust lifestyle, reduce salt intake, eat fresh vegetables, and check labels before purchase.

Reference

American Academy of Family Physicians. (2008). Pharmacologic management of heart failure caused by systolic dysfunction.