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Chronic Heart Failure

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Introduction

In patients with chronic heart failure due to hypertension, the physician must direct the patient to exercise well and diet appropriately along with prescribing diuretics to take care of the patient.Diets and exercise are lifestyle modifications that enable a person to live healthily, maintain body weight or reduce it when needed, gain strength and vitality, and offset chronic heart failure.

In the present case, it is mentioned that Charlie is a 75 year old overweight man who has co-morbid –problems such as peripheral oedema and tachycardia. Two years ago, Charlie has a chronic heart failure as a result of that he has cardiomyopathy and hypertension and because of that he is feeling unwell from past several years. Thus, on the basis of this case, it can be said that Charlie needs to get proper clinical treatment so that health intervention can be improved. This can also assist Charlie to get proper treatment of the heart disease.

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Literature Review

Diet for Heart Failure

Diet determines the risk to heart disease to a large extent. This review undertaken by Rees et al. (2013) had the aim of providing dietary advice to healthy adults. The authors found 44 trials where healthy adults received medical advice on diet or no advice. The advice for dietary modifications included cutting down on fats and salt intake while increasing fruit and fiber and vegetable intake.Dietary modifications seem to play an important role in people with risk to cancer or heart disease. Improvements in the cardiac risk factors were found taking place where total and LDL cholesterol and blood pressure were concerned.When gender was the basis of the studies, women were seen cutting down fats to a great extent, but whether this translated to lowering of total cholesterol was not fully shown by the evidence gathered.

When two of the trials were followed up in the adultsfor 10-15 years, there were pronounced benefits on cardiovascular factors for heart failure. There was thus, a reduction in the incidence of stroke, heart attacks, and other heart diseases. The authors warranted further studies and more evidence be gathered for this study.On the other basis of Murray’s (2009), study, it can be said that there are various factors that are associated with heart failure such as hypertension and unhealthy lifestyle. The patient is having both the problem; hence the issue of tachycardia has been raised subsequently.On the contrary, research done by Takeda and et.al. (2012) states that clinical service organization is the basic dimension on the basis of which services for Charlie is dependent. In this context, it can be said that focus should be laid on proper medication so that the health aspects of the patient can be managed.

Diuretics for Heart Failure

Mortality and morbidity, to a large extent, are the result of chronic heart failure. Diuretics are the first line of treatment for congestive heart failure patients. Diuretics are capable of providing symptomatic relief.The aim of this study undertaken by Faris et al. (2006) was the analyses and assessment the benefits and harm caused by diuretics in humans, and the effect they had on chronic heart failure.Various databases were searched by the authors to include any double-blinded randomized controlled trial for therapies using diuretics in patients with chronic heart failure or CHF.

About 14 trials comprising 525 people were included in the study. Of these, seven of them were placebo controlled. Seven others had the comparison of diuretics with digoxin or ACE inhibitors. It was found that mortality rates were lower in people that had been treated with diuretics as compared with the placebo. In 4 trials which compared active control with diuretics, diuretics were seen improving the exercise capacity of the individual.It has been shown by analysis of the trials that conventional diuretics lowered the risk of mortality in patients treated for chronic heart failure compared with placebo. Exercise capacity was increased by the administration of diuretics as compare with active controls.

In the case of Charlie, it is essential for the medical practitioners to focus on diuretics and heart failure because that is one of the most common chronic condition that impacts people. The most frequent symptoms present in this disease is dyspnea which is also attributed to pulmonary edema and it occurs especially in 93% patients. Thus, Charlie also has the same sort of risk. Moving on to the treatment part, Charlie needs to get therapeutic treatment from diuretics.

Exercise For Heart Failure

The systematic review undertaken by Sagar et al (2015) depicted that no reduction was seen in the exercise intervention group for heart patients as compared with the control.
However, there was a clear lowering of the number of hospitalizations due to heart failure and it also improved quality-of-life in patients who followed exercise interventions. The Minnesota Living with Heart Failure questionnaire was filled by patients on exercise, who were 5.8 points more than the control population. The benefits gained due to including the exercise regimen in patients with heart failure were independent of type of exercise namely, aerobic exercise versus anaerobic exercise, only exercise versus comprehensive CR, and average rates/doses of interventions of exercise. The benefits obtained were also independent of characteristics of the trial such as bias risk, publication date, and length of follow-ups.

Interventions

Many studies have shown lowered rates of risks to heart disease with an adoption of healthy lifestyles. Avoiding smoking, maintaining a healthy weight, exercising, and following a healthy diet are all depicted in lowering risk factors to heart diseases, hypertension and diabetes mellitus. Lowered risks of heart failure were seen in people who participated in the physical health study, wherein their habits included not smoking, drinking moderate levels of alcohol, consuming breakfast cereals, regularly exercising, and consuming good quantities of vegetables and fruits.

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Being inactive physically is a risk factor for cardiovascular diseases. Physical activity thus is an important determinant of good health and helps reduce weight and maintain healthy weight while improving the lipoprotein profiles and lowering risks to hypertension and coronary heart disease and diabetes mellitus. Physical exercise is known to stimulate endothelial activity and lower left ventricular hypertrophy also.When one indulges in chronic physical activity, adipose tissue and skeletal muscles are promoted to produce fewer cytokines, and up regulation of antioxidant enzymes take place. Thus, exercise has preventive effects on intermediate pathways leading to heart failure, and the CHF incidence is lowered.

In the DASH diet or Dietary Approaches to Stop Hypertension, people, are asked to consume more of 1) grains and grain products, 2) fruits and vegetables, 3) fish, poultry, and lean meats, 4) nonfat dairy foods, and 5) nuts, legumes, and seeds. Reduced consumption of fat, red meat, and sugar along with decreased amounts of consumption of sodium are recommended. About 37% of participants who adhered to the DAHS diet had reduction of risks to heart failure.Heart failure is prevented by the DASH diet by the lowering of blood pressure and coronary heart disease (Appel et al., 1997). The DASH diet helps reduce oxidative stress and LDL cholesterol level and promotes estrogenic effects by phytochemicals that are beneficial to the heart.

A 30% lowered rate of heart failure was seen in people consuming whole grain breakfasts (Djoussé and Gaziano, 2007);a 20-31% reduced risk of heart failure was observed in people consuming fish (Mozaffarian et al., 2005). Consumption of over 100 mmol of sodium caused an increase in heart failure in people by 26% (He et al., 2002). Animals fed on high fructose diets had worse survival following more cardiac remodeling.Wholegrain cereals help reduce the incidence of heart failure due to a positive effect on weight, and thus, reduction of myocardial infarction and hypertension, and diabetes mellitus. Potassium found in whole grains may reduce blood pressure, phytoestrogens improve insulin sensitivity, and lipid levels and other components of grains may cause beneficial amounts of lipids and homocysteine levels be maintained.

The improvement in the prognosis and relief from symptoms are the aims of treatment of any patient with heart failure. Of all the medications available for heart failure, the diuretics are definitely the most superior in terms of alleviating the signs and symptoms of the condition. Upon administration of the diuretics intravenously or orally, there is a marked reduction in the pulmonary vascular pressure accompanied by reduction, albeit small, in cardinal output. The release of renin is accompanied with diuretic administration and the renin–angiotensin–aldosterone system is activated. In mild heart failure patients, plasma catecholamine levels are reduced by diuretics (Taylor, 2000).

However, the sympatholytic effects in severely affected heart patients are known only to a limited extent. Thus, diuretics are known to alleviate signs of breathlessness and peripheral edema in congestive heart disease patients. These effects are due to the direct relationship with the diuresis induced. Thus, with these changes in place with the administration of diuretics, the quality-of-life is increased in congestive heart patients.

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Implications for Clinical Practice

Diet: Changes in diet in terms of making food choices heart healthy go a long way in alleviating risks to heart failure in many people.

1. The patient who has hypertension and thus, chronic heart failure must be advised a low-salt diet. Fish, poultry, and lean meat and plenty of fruits and vegetables should be included in the diet.

2. Spice mixtures contain salt and must be replaced with lemon juice or freshly ground pepper to season the food.

3. The food labels must be read by the patient when he/she is buying packaged food. If the salt or sodium is above the allowed amount per day in the packaged food, then one must refrain from purchasing it.

Exercise: Patients suffering from chronic heart failure need complementary strength training so as increase their muscle strength and mass. Research has pointed out that dynamic resistance exercises are well tolerated in CHF.However, care should be taken that the exercising involves: 1) a small group of muscles, 2) work phase are maintained for short periods, 3) repetition per se is small, and 4) the initial intensity of contraction is low.

Diuretics: In patients with heart failure, the volume status must be evaluated and optimized as part of the drug regimen. Diuretics therapy helps to remove the excess of extracellular fluids and helps treat edema as a measure of volume management in patients with chronic heart failure (Taylor, 2000)).

Thus, Charlie’s overweight problems are taken care of by exercise and diet, while his breathlessness and edema are taken care of by diuretics.

In terms of implications of care plan, it can be said that it is essential for the medical practitioners to focus on suitable therapeutic treatment so that health facets can be improved accordingly. Moreover, emphasis should also be laid on giving medical treatment on frequent basis. Proper dietary should be followed upon so that sedentary lifestyle can be avoided. This might impact the health aspects of Charlie; hence recommended practices should be adhered accordingly.

References

1. Appel, L. J. et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. The New England Journal of Medicine, 336(16), 1117–1124.

2. Djoussé & Gaziano. (2007). Breakfast cereals and risk of heart failure in the Physicians' health study I. Archives of Internal Medicine, 167(19), 2080–2085.

3. Faris, R., Flather, M., Purcell, H., Poole–Wilson, P. & Coates, A. (2006). Diuretics for heart failure. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD003838. DOI: 10.1002/14651858.CD003838.pub2

4. He, J. et al. (2002). Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: first national health and nutrition examination survey epidemiologic follow-up study. Archives of Internal Medicine, 162(14), 1619–1624.

5. Mozaffarian, D. et al. (2005). Fish intake and risk of incident heart failure. Journal of the American College of Cardiology, 45(12), 2015–2021.

6. Rees, K., Dyakova, M.,Wilson, N., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD002128. DOI: 10.1002/14651858.CD002128.pub5.

7. Sagar, V., Davies, E., Briscoe, S., Coates, A., Dalal, H., Lough, F., & Taylor, R. (2015). Exercise – based rehabilitation for heart failure: Systematic review and meta-analysis. Open Heart, 2 : e000163. doi:10.1136/openhrt-2014- 000163.

8. Taylor, S. H. (2000). Diuretic therapy in congestive heart failure, Cardiol Rev. 8(2), 104-14.

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