Management of heart failure patients

(Second of a series)

In the previous article, we learned that heart failure (HF) or pumapalyang puso is a serious life-threatening condition in which the heart cannot pump enough blood to fully meet the oxygen demands of the body.

Two types of HF

The ejection fraction (EF) is an important measurement in determining how well the heart is pumping out blood; it is also useful in diagnosing and monitoring HF. Approximately half of HF patients have a reduced ejection fraction (HF-rEF). This type of HF has worse prognosis.  The good news is nowadays, there are treatments that are available to improve quality of life and survival.

The other half of HF patients have preserved ejection fraction (HF-pEF). This type of HF is less well understood, more difficult to diagnose and has no proven treatments to date.

Signs and symptoms

The following changes in your body should be a cause for alarm: fatigue, shortness of breath even with minimal physical exertion or when lying down, almost incessant cough or wheezing, sudden weight gain from fluid retention and engorged lower extremities and abdomen, irregular heartbeat and frequent urination at night. Some would dismiss abnormally frequent urination as incontinence which is normal for the aging population, especially fat women in their 40s, 50s and up.

Some patients have thought all the while that they are asthmatic because of the chronic struggle for breath, actually it is a sign that they have been suffering from HF. Don’t play doctors. See a real heart doctor.

Management

Accuracy is vital. A patient with heart failure needs to learn about the disease so he can take good care of himself. He/she can put HF symptoms at bay by eating the right types of food, drinking the right amount of fluid, exercising within the prescribed limits and taking his/her medicines correctly.

Monitoring and recording your weight in a chart daily is a must. An increase in weight can be an early indication of worsening HF. This should be a signal for the patient to go back to the doctor.

Medications to treat HF

An HF patient needs to take his/her medications at the right dose and prescribed time. Always carry a medication list. Make sure that you have mastered the names and doses of the drugs you are taking. These drugs are usually given for HF-rEF:

• Diuretics or water pills can help avoid readmission for fluid overload by helping the body get rid of excess

retained fluid.

• Angiotensin-converting enzyme (ACE) inhibitors, like enalapril and perindopril, block the effect of angiotensin (hormone that cause increased blood pressure and make the heart work harder). Common side effects include dizziness from low blood pressure and dry cough. For patients who cannot tolerate ACE inhibitors mostly due to disturbing cough, angiotensin receptor blockers, like valsartan and candesartan, are used.
• Beta-blockers, like carvedilol, metoprolol, bisoprolol and nebivolol, block the beta-receptors on heart cells, which when stimulated make the heart rate increase. This is the body’s way to compensate for a failing heart, but can worsen heart failure. For patients who cannot take beta-blockers, ivabradine is prescribed.
• Spironolactone and eplerenone have also been proven to be helpful in patients with heart failure.
• Digoxin increases the force of the heart’s contractions and slows the heart rate. This prevents rehospitalizations in patients with heart failure. Side effects include nausea, vomiting, palpitations or a very slow heart rate.

Many people with heart failure who are compliant with their prescribed drug and lifestyle treatment given by their cardiologists can enjoy relatively active lives. A review of studies has shown that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone. This also elicited a small improvement in HF-related quality of life. The patient constitutes a pivotal part of the management of his/her disease.

However, despite the use of these drugs, there still remains an unmet need to improve the prognosis of these patients. Newer drugs and modalities of treatment will potentially improve the patients’ quality of life and survival rates.

Sources:

1. www.heart.org
2. LCZ696 Fast Facts

Dr. Alex T. Junia, president of the Philippine Heart Association (PHA) 2015-2016, completed his medical degree at the Cebu Institute of Medicine and finished his Fellowship in Cardiology at the Philippine Heart Center. The PHA is an organization of cardiovascular specialists and lay members that ensure accessible, affordable and quality cardiovascular education and care for everyone. For more information, visit www.philheart.org.