Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

2010 ◽  
Vol 19 (5) ◽  
pp. 443-452 ◽  
Author(s):  
Nancy Albert ◽  
Kathleen Trochelman ◽  
Jianbo Li ◽  
Songhua Lin
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Clinical Status ◽  
Systolic Heart Failure ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Functional Class ◽  
Convenience Sample ◽  
Loss Of Appetite ◽  
Class Iv

Background Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. Objectives To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. Methods A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. Results Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P ≤ .001). Sudden weight gain increased from 5% in functional class I to 37.5% in functional class IV (P < .001). Dyspnea occurred in all functional classes (98%–100%) and both settings (92%–100%). Profound fatigue was associated with worsening functional class (P < .001) and hospital setting (P = .001); paroxysmal nocturnal dyspnea was associated with functional class IV (P = .02) and hospital setting (P < .001). Conclusion Profound fatigue is more reliable than dyspnea as an indicator of functional class. Nurses must recognize atypical signs and symptoms of worsening functional class to determine clinical status and facilitate patient care decisions.

Effect of Cardiac Resynchronization Therapy in Patients With New York Heart Association Functional Class IV Heart Failure

2010 ◽  
Vol 106 (8) ◽  
pp. 1146-1151 ◽  
Author(s):  
Rutger J. van Bommel ◽  
Eva van Rijnsoever ◽  
C. Jan Willem Borleffs ◽  
Victoria Delgado ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Heart Association ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
New York Heart Association ◽  
Class Iv

scholarly journals Laporan Kasus: Anestesi Blok Peribulbar pada Pasien dengan Gagal Jantung Kongestif yang Dilakukan Enukleasi

2019 ◽  
Vol 7 (2) ◽  
pp. 134-138
Author(s):  
Muhamad Adli ◽  
Caroline Wullur
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Mitral Regurgitation ◽  
Aortic Regurgitation ◽  
Hypertensive Heart Disease ◽  
Functional Class ◽  
Cardiac Depression ◽  
Peribulbar Block ◽  
Class Iv

Seorang pria berusia 73 tahun datang ke Instalasi Gawat Darurat Pusat Mata Nasional Rumah Sakit Mata Cicendo pada bulan November 2018 dengan keluhan nyeri mata yang mengeluarkan darah dan disertai dengan keluhan sesak. Pemeriksaan mata menunjukkan prolaps okuli dan direncanakan untuk dilakukan enukleasi. Ahli kardiologi mendiagnosis sebagai hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, moderate aortic regurgitation. Laporan kasus ini bertujuan memaparkan keberhasilan tata laksana anestesi pada pasien usia lanjut dengan gagal jantung kongestif yang dilakukan enukleasi dalam blok peribulbar. Teknik blok peribulbar dipilih agar tidak memperberat masalah kardiovaskular serta untuk meminimalisir depresi kardiak. Teknik ini dilakukan dengan menyuntikkan obat anestesi lokal levobupivakain 0,5% pada inferotemporal, medial kantus, dan superonasal. Operasi berlangsung tanpa keluhan nyeri dan fluktuasi hemodinamik yang signifikan. Pascaoperasi pasien sadar penuh dengan skala nyeri NRS 60 menit pascaoperasi 0. Hal ini menunjukkan bahwa teknik anestesi blok peribulbar memberikan hasil memuaskan pada tindakan enukleasi. Enucleation under Peribulbar Block Anesthesia in Patients with Congestive Heart Failure: A Case ReportA 73-year-old male patient was presented to the emergency department of the National Eye Center Cicendo Hospital with a painful and bloody eye as well as shortness of breath. Eye examination revealed ocular prolapse and patient was scheduled for enucleation. The cardiologist diagnosed the patient with hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, and moderate aortic regurgitation. Patient then underwent treatment for six days. This case report aimed to describe the successful management of anesthesia in elderly patients with congestive heart failure who underwent peribulbar block for enucleation procedure. To prevent further cardiac problems and to minimize the risk of cardiac depression in this patient, the anesthetic technique chosen was peribulbar block with the injection of local anesthetic drug levobupivacaine 0.5% at the inferotemporal, medial canthus, and superonasal. The surgary took place without complaints of intraoperative pain and without significant hemodynamic fluctuations. Postoperatively, the patient was fully conscious and sixty minutes postoperative pain scale (Numeric Rating Scale) in this patient was 0. This shows that the peribulbar block anesthesia technique can provide satisfactory results for enucleation procedure.

Abstract 15597: Acute Venous Congestion Causes Angiotensin II formation via Angiotensin-Converting Enzyme Activation in Compensated Ambulatory Patients with Systolic Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ka Yuk Wong ◽  
Yacki Hayashi ◽  
Duygu Onat ◽  
Ante Harxhi ◽  
Michiyori Wakabayashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Systolic Heart Failure ◽  
Functional Class ◽  
Enzyme Activation ◽  
Venous Congestion ◽  
Study Cohort ◽  
Converting Enzyme ◽  
Ambulatory Patients

Background: Plasma levels of angiotensin II (AII) are increased in congestive states such as heart failure (HF). The current study examined i) whether venous congestion (VC) itself promotes AII formation, and ii) the contributions of angiotensin-converting enzyme (ACE) vs. other enzymes such as chymases to AII generation in patients with systolic HF. Methods: 42 ambulatory patients with NYHA functional class II or III, an LVEF <40%, no evidence of VC on physical exam and on stable medical therapy were studied. To experimentally model VC, venous arm pressure was increased to 30 mmHg above baseline by inflating a pressure cuff around the dominant arm. Blood was sampled from test and control arm (lacking an inflated cuff) before and after 90 minutes of VC. Radioimmunoassay was used for plasma AII measurements.The effect of ACE inhibitor (ACEI) based therapy (N=29) vs. non-ACEI (N=13) was compared. Results: The age of the study cohort was 53±12 years, 29% were female, 31% had an ischemic etiology and the LVEF was 22±8%. Baseline AII levels were 3-times lower in the ACEI vs. non-ACEI group (24±10 vs. 76±40 pg/mL, P<0.001). Plasma AII was significantly higher in the congested over control arm only in non-ACEI group after 90 minutes of VC (figure). No adverse event was observed during the test. Conclusions: Our study provides the first direct evidence that VC is sufficient to cause AII formation in compensated ambulatory HF patients on non-ACEI based therapy. ACEI treatment completely abolished this increase suggesting activation of ACE, rather than other enzymes such as chymases, to be the cause of volume-dependent AII formation in response to peripheral VC.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals A Comparative Open Labelled Study on Ivabradine and Bisoprolol Prescribed in Combination Versus Maximum Dose Titration of Bisoprolol in Patients with Systolic Heart Failure and Left Ventricular Systolic Dysfunction

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Functional Class ◽  
Ventricular Systolic Dysfunction ◽  
Nyha Functional Class ◽  
Group 2

Background: Increased resting heart rate is associated with cardiovascular outcomes in patients with heart failure and reduced ejection fraction (HFrEF). Despite high volume prescribers of beta blockers patients does not achieve recommended target heart rate. The primary objective of this study was to assess the efficacy of ivabradine as adjunct therapy with beta blockers in south east Asian population systolic heart failure and left ventricular systolic dysfunction. Methodology: This single center, open labelled, randomized study included 113 patients in sinus rhythm with HFrEF and left ventricular systolic dysfunction from outpatient department. Ivabradine was initiated in 45% patients with SR. Patients with LVEF < 35% by Teichholz method, NHYA class II-III, sinus rhythm and resting HR > 70 bpm, already on bisoprolol 5 mg were divided into 2 groups; Group 1 (n= 56) patients were uptitrated to bisoprolol 10 mg and Group 2 (n= 57) patients received ivabradine 5 mg b.i.d in addition to bisoprolol 5 mg. Blood samples for NTproBNP level, an ECG, echocardiogram, NYHA functional class, systolic and diastolic BP were taken at baseline and at the end of 6 months follow-up in both groups Results: After 6 months HR decreased significantly from 94.82±7.03 to 68.75±5.35 bpm (p < 0.0001), with more patients in NHYA functional Class I than Class II and III and decrease in BNP level from 969.8.3±348.9 to 348.6±230.2 pg/ml (p < 0.0001) in group 2 patients. A significant increase in LVEF was observed with the addition of ivabradine from 31.40±5.37 to 41.68±5.33 % (p < 0.0001). However, mean systolic and diastolic blood pressure was not affected by the addition of ivabradine. Conclusion: This study concludes that patients with HFrEF demonstrated good tolerability, efficacy and NYHA functional class with the combination of ivabradine and bisoprolol therapy.

Activities of Home-Based Heart Failure Nurse Specialists: A Modified Narrative Analysis

2005 ◽  
Vol 14 (5) ◽  
pp. 426-433 ◽  
Author(s):  
Patricia Davidson ◽  
Glenn Paull ◽  
David Rees ◽  
John Daly ◽  
Jill Cockburn
Keyword(s):  
Heart Failure ◽  
Narrative Analysis ◽  
Health Professionals ◽  
Clinical Status ◽  
Death And Dying ◽  
Signs And Symptoms ◽  
Self Management ◽  
Psychosocial Issues ◽  
Clinical Notes ◽  
Home Based

• Background Heart failure nurse specialists strive to optimize patients’ outcomes in home-based settings. • Objective To document the activities of home-based heart failure nurse specialists. • Method A modified narrative analysis of clinical notes of home-based heart failure nurse specialists during a 12-month period was used. • Results Data analysis revealed 7 key activities of home-based heart failure nurse specialists: (1) monitoring signs and symptoms and reinforcing patients’ self-management: identifying trends and appropriate action; (2) organization, liaison, and consultation with other health professionals to deal with changes in clinical status; (3) clarifying and reinforcing patients’ self-care strategies; (4) assisting patients in their desire to avoid institutionalized care; (5) identifying patients’ psychosocial issues: dealing with social isolation; (6) providing support: journeying with patients and patients’ families; and (7) helping patients and patients’ families deal with death and dying. • Conclusions A major proportion of the activities of home-based heart failure nurse specialists are related to facilitating communication between health professionals and providing information and support to patients and patients’ families.

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