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Acute Decompensated Heart Failure (ADHF), Pharmacological, 7, 11, 9, Acute…

- - - - used to treat the allergies
      - dosage is normal
  - - - used to control high blood sugar
    - - dosage is normal
  - - - used to relieve pain
      - dosage is normal
    - - used to treat the arthritis
      - dosage is normal
  - - - used to treat high blood pressure and heart failure
      - dosage is normal
  - - - used to treat depression and anxiety
      - dosage is normal
  - - - used to treat allergies
      - dosage is normal
  - - - used to treat the edema
      - dosage is abnormally high
        
        recommended dosage is 40 mg orally BID
      - indicated for hypertension
  - - - used to treat the hypertension and heart failure
      - dosage is normal
      - indicated in hypertension
  - - - used to prevent chest pain (angina)
      - dosage is normal
  - - - used to reduce the bad cholesterol (LDL and triglycerides) and increase the good cholesterol (HDL) to decrease the risk of heart disease which prevents heart attack
      - dosage is normal
  - - - Ranitidine
        
        used as antacid (reduce acid amount in stomach)
        
        used to treat GERD
        
        dosage is normal
- - - - Chest x-ray help to detect or identify the non-cardiac precipitants of respiratory failure - pneumonia or pneumothorax.
      - it is essential with pulmonary venous congestion, hilar redistribution, pleural effusions, and interstitial edema consistent with ADHF.
    - - no focal pneumonia, pneumothorax, or evidence of frank pulmonary edema.
    - - It produce image of the heart, lungs, blood vessels, airways, and bones of chest and spine.
  - - - Records the electrical signal from the heart to check for different heart conditions.
    - - While abnormal findings on ECG are non-specific for the diagnosis of ADHF, a prompt ECG is crucial in establishing precipitants of failure such as acute myocardial infarction, active ischemia, tachyarrhythmias, and bradyarrhythmias and thus should be obtained promptly.
      - While abnormal ECG is not useful for confirming diagnosis, a normal ECG may have additional value in ruling out the possibility of ADHF.
  - - - The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF)
      - In this ADHF patient - BUN level is high
    - - In this ADHF patient - SCr level is high
    - - causes
        
        When this happens, the water levels of this patient rise, and the cells begin to swell.
    - - BNP level test
        
        usually used to evaluate conditions that complaints by patients such as chest X-ray abnormalities, breathlessness, edema, and heart muscle dysfunction as an effort to determine whether the heart failure or heart pressure occurs.
      - When people get heart failure, the heart will produce two proteins, the BNP and NT pro-BNP. Both levels will increase when the heart failure gets worse and reduce when your condition gets better.
      - In this ADHF patient, BNP level is high
        
        reason
        
        High blood pressure
        
        Higher BNP levels indicate serious disease processes are present and most of it is likely linked to high blood pressure, and other conditions such as lung conditions. Higher BNP levels mean patients likely experience severe heart failure.
    - - HbA1c is usually a reliable indicator of diabetic control
      - In this ADHF patient, HbA1c is high
  - - - Pumping of blood against high pressure, the heart need to pump harder. This will thicken the heart pumping chamber.
        
        leads to
        
        Not enough blood pump for the patient's needs, which can lead to ADHF.
    - - induce hemodynamic and myocardial changes (increase myocardial workload)
        
        leads to
        
        ADHF
    - - This results from the inability of heart to receive oxygen-rich blood from the lungs
    - - The crackles themselves are not a disease but they can be a sign of an illness or infection
      - Abnormal sounds from the base of the lungs
      - causes by
        
        Failure of parts of the lungs to inflate properly which relate closely to this ADHF patient
- - - - Shortness of breath with physical activity (exertional dyspnea)
      - difficulty breathing when you’re lying down (orthopnea)
      - Episodes of waking up from sleep gasping for air (paroxysmal nocturnal dyspnea)
      - Acute pulmonary edema: sudden onset fluid buildup in the lungs
      - chest pain/pressure and palpitations.
- - - - Considered to be a substances that aid on removing excess extracellular fluid and electrolytes
      - Decreasing salt and water reabsorption
      - Many types of diuretics drug
        
        Thiazide diuretics
        
        Hypokalemia and potassium-sparing diuretics
        
        High ceiling or Loop Diuretics
        
        Cirrhosis, Renal disease, Heart failure
        
        Thick ascending limb of the loop of Henle and inhibits sodium, potassium and chloride transporter
        
        Treatment of ADHF
        
        Furosemide
        
        initially = 20-40 mg IV
        
        Torsemide
        
        initially = 10-20 mg IV
        
        Bumetamide
        
        initially= 1 mg IV
  - - - Drugs that open up the blood vessel
      - Many types of vasodilator
        
        ACE inhbitors
        
        ARB
        
        Nitrates
        
        Converted to nitric oxide which activates another chemical known as guanylate cyclase to dilates both vein and arteries by activating a cascade of protein kinase-dependant which alloe dephosphorylation of light myosin chain of smooth muscle.
        
        Examples
        
        Nitroglycerin
        
        Act via venodilation
        
        Cause hypotension and headache
        
        Initially 5-10 mcg IV
        
        Side effects
        
        Fast heart rate
        
        Nausea
        
        Vomitting
        
        Hypotension
        
        Nitroprusside
        
        Balanced acting on both arterial and venous dilation
        
        Very potent hemodynamic effect
        
        Initially = 5-10 mcg
        
        Side effects
        
        Fast, pounding irregular heartrate
        
        Dizziness
        
        Chest pain/discomfort
- - - - One o the coronary artery have been narrowed due to the build-up of plaque.
      - Narrowed artery reduces the amount of oxygen and nourishment reaching the heart
    - - Abnormal conditions in which ventricles of the heart beats abnormally fast
      - During paroxysmal ventricular tachycardia additional signals arise from the ventricles themselves or are caused by a defect in the heart's conduction system,
    - - Large negative intrathoracic pressures, apnea related hypoxemia and hypercapnia, terminated by an arousal and surge in systemic blood pressure associated with endothelial damage and resultant premature atherosclerosis
      - Weakens the heart muscles.
    - - It is caused by coronary heart disease
      - There might be buildup of plaque in the blood vessels that supply oxygen and nutrition to the heart.
      - Rupture of blood vessel can occur which can cause ADHF
    - - Inflammatory cells in blood vessels can cause inflammation which can cause deposited plaques prone to rupture.
    - - Excessive weights contributes to an increase of heart's workload
      - Obesity leads to increase blood volume in the body
    - - Heart's ability to pump blood is decreased because the heart's main pumping chamber,
      - Can be caused or triggered by coronary artery disease
- - - - Obesity cause difficult for enough blood to flow through the arteries
- - - - Standard non-invasive monitoring of heart rate, rhythm, respiratory rate, oxygen saturation and blood pressure
    - - patients should be weighed daily and have an accurate fluid balance chart completed. This includes accurate measurements of urine output
    - - Frequent, often daily measurement of renal function (blood urea, creatinine) and electrolytes (potassium, sodium) during i.v. therapy
    - - Transcutaneous monitoring of arterial oxygen saturation is recommended
    - - Measurement of blood pH and carbon dioxide tension (possibly including lactate) should be considered, especially in patients with acute pulmonary oedema
    - - evaluate signs and symptoms relevant to heart failure (e.g. dyspnoea, pulmonary rales, peripheral oedema, weight
  - - - starting dose of oral furosemideis 40mg BID
    - - follow up and monitoring process is done 1-2 weeks after discharge
- - - - Bolus doses
      - Continuous Infusion
    - - Intravenous furosemidecontinuous infusion alone
      - Intravenous furosemide bolus in two divided doses
      - Intravenous furosemide + intravenous dopamine
    - - Greater Diuresis
      - Relief of Dyspnea
      - Weight Loss
- - - - Aerobic activities
      - Walking
      - Stationary Cycling
      - Swimming
      - Walking Pace
    - - Fluid Restriction
        
        Fluid intake should not exceed 1.5L- 2L per day
      - Sodium increases amount of fluid in blood vessels
    - - Folate rich foods
        
        Nutrients provide a healthy and active heart for these patients. Fruits contain iron needed for the oxygenation of tissues. They are low in calories and provide freshness and strength to your heart.
        
        Green leafy vegetables like spinach, broccoli and cauliflower
      - Omega 3-fatty acids
        
        Stabilizing blood flow Reducing blood triglyceride levels, Lowering blood pressure, Preventing blood clots and Reducing inflammation.
      - Whole grain meals
        
        Wholegrain meals like bread, nuts, and cereals are good for heart. They are light foods and provide a sufficient amount of energy to the body.
      - Increase use of natural juice
        
        Old people who are most susceptible to heart diseases are unable to intake hard foods due to a weak digestive system. They usually prefer light foods and drinks. To lower the risk of heart diseases, they can intake juices and drinks of fruits and vegetable.
        
        cane juice, carrot juice, bitter gourd juice all are excellent for the health of the heart.