Heart Failure 9: Handling and Prognosis

Handling of Heart Failure

a. Reduction of burden Heart
This consists of a reduction in activity fisic, rest and emotion reduce after load. Restrictions are fisic activity light on the case and rest in bed or chair in the heart failure remains a serious primary treatment failed heart. Should eat in a little amount but more often, and every effort should be made to reduce patient worries, sometimes medications such as diazepam (2 to 5 mg three times a day) for a few days is very helpful. Rest fisis and emotions tend to reduce arterial pressure and reduce the burden by reducing the need miokard rainfall heart. The influence of this work together to reduce the need redistribution and rainfall in the heart of many patients, especially people with mild heart failure, recline and mild sedation is often an effective cause diuresis (Isselbacher et al. 2000).

b. Control the excessive fluid.
Treatment intended to reduce the volume of fluid extracellular mainly depends on the decrease in total savings of natrium body, whereas liquid few less important. Natrium negative balance can be achieved by reducing the Feed and food expenditures increase in this ion urin with the help diuretik. At the heart of failed weight, the fluid mechanical extracellular with torasentesis, parasentesis and sometimes hemodialisis or dialisis peritoneal also can be done.

Controlling excessive fluid:
1. Food.
Patients with serious heart failure, namely Feed natrium klorida daily should be reduced to between 500 to 1000 mg, milk, cheese, bread, cereals, vegetables and canned vegetables, salted pieces of meat, and some fresh vegetables such as spinach celery, and beet, should be reduced. Variety of fresh fruit, green vegetables, bread and milk, processed specifically, and salt substitute allowed.
Attention should be directed to the womb-calorie foods. Calories should be limited in obese patients with heart failure. Conversely, in patients with heart failure and weight kakeksia heart, should be arranged to maintain Feed vitamin deficiency and avoid the calories and vitamins, may need additional vitamin.

2. Diuretic.
In the patients with mild heart failure, almost all effective. However, in the form of heart failure a more serious, the selection diuretics more difficult, and each abnormalities the electrolyte in the serum should be considered. Therapy should not be excessive, because hipovolemia arising rainfall can reduce the heart, the kidney function, and cause weakness and weight lethargy. Some of the medicines that are often used are:
a. Diuretic Tiazid.
Tiazid absorbed well in the per oral, klorotiazid and hidroklorotiazid reach the peak of action in 4 hours, diuresis and settle for about 12 hours. Diuretik tiazid reduce reabsorbs natrium and klorida in the first half tubules konvolutus and distal part of the curve ascends cortical the ansa Henle, and the salt water that is not tereabsorbsi. Drugs is effective and useful therapy in heart failure during the pace filtrate glomeruler greater of 50 percent of normal. Klorotiazid given up to 500 mg every 6 hours.
Side effects from tiazid is hipokalemia, so to prevent the lack of potassium in the patients who get diuretic tiazid, preferably of intermittent doses, that is not to give diuretic every third day or potassium sparing add diuretic as spirorolakton or triamferen.
Tiazid side effects of the reduced acid ekskresi nerves, causing hiperurisemia, and effects hiperglikemik, which rarely can cause coma hiperosmoler on diabetic who controlled the poor. Skin rash, trombositopenia, and has also been reported granulositopenia

b. Metolazon.
Derivat kuinetazon this work and have a potential comparable with tiazid. Dose is usually 5 to 10 mg / day.

c. Furosemide, Bumetanide and Etakrinat acid.
Diuretic "loop" is similar but in different physiological chemical. Diuretic that this otherwise very strong reabsorbs prevent natrium, potassium and klorida on asendens thick curved ansa Henle, especially with the system impedes kontranspor in membrane lumen. Diuretic this can vasodilatasi cortex renal and accelerate the formation of urine which can speed up to a quarter filtrasi glomeruler, diuretic loop remain effective even if there is a reduction in the volume of fluid extracellular a lot. Main side effects because the medicine is a real strength diuretic, which in rare circumstances can cause a decrease in plasma volume, collapse circulation, the decline in renal blood flow and speed filtrasi glomerulus and the occurrence of azotemia prerenal. Alkalosis metabolik caused by the increased expenditure of ion klorida, hydrogen and potassium in the urin. Hipokalemia and hiponatremia can occur.
Diuretic a very effective this is useful for all forms of heart failure, especially heart failure edema and refrakter tuberculosis. In the heart failure patients refrakter, action furosemide, and bumetamide acid etakrinat could be intravena and with the addition of other types of diuretika the tiazid, resistor karbonik, anhidrase, diuretika osmotik and diuretika potassium-sparing spironolakton, triamteren and amilorid. Potassium sparing agents were divided into two classes, such as written below:

1. Antagonis Aldosteron.
17-spironolakton drugs that resemble aldosteron structure and work on the distal half tubulus konvolutus and the korteks duktus kolektivus between the natrium and potassium hydrogen on tubulus distal and duktus kolektivus. Aldakton A can be given in doses 25 to 100 mg three to four times a day per oral .. Spironolakton most effective if given together with tiazid and diuretika or loop. Action on the contrary this drug urin and serum potassium diuresis natrium possible without going hiperkalemia or hipokalemia if spironolakton be supplied with one of the few agents this. Spironolakton, triamteren and amilorid should not be given in the patients with hiperkalemia, kidney failure or hiponatremia. Complications were reported include nausea, malaise epigastrium. Mental confusion, dizziness, ginekomastia and erupsi eritematosa.

2. Triamteren and Amilorid.
Two drugs provide a comparable kidney effects with spironolakton, namely preventing reabsorbsi natrium and potassium sekresi prevent secondary in the distal tubuli. Triamteren effective dose is 100 mg once or twice a day, and amilorid is 5 mg / day. Side effects are nausea, vomiting, diarrhea, headache, granulositopenia, eosinofilia and skin rash. Effective in preventing the typical hipokalemia in tiazid, furosemid, and acid etakrinat (Isselbacher et al. 2000).

c. Vasodilator therapy.
Farmakologik efforts to reduce barriers to ejeksi ventrikel left with vasodilator drug therapy is important in facing handling heart failure. Vasodilator should certainly not be used in patients with hipotensi.
Some of the vasodilator effects that are available have hemodinamik, place and duration of action and a different way. Some vasodilator such as hidralazin, and resistor minoksidil alpha adrenergik such as prazosin, especially in the work and especially the arterial duct to increase the volume of sekuncup, vasodilator such as nitroglycerine and isosorbid dinitrat, working almost entirely on the vena circulation. Isosorbid dinitrat the collection of blood on the ball and especially the blood vessel to reduce the pressure ventrikel. Resistor angiotensin enzyme modifier, prazosin and natrium nitroprusid is a "balanced vasodilator," which reacts to the vein and vena arterial. Some agencies, such as natrium nitroprusid should be given in the form of salp or intravena if the desired effect and a longer isosorbid dinitrat most effective if given via sublingual (Isselbacher et al. 2000).

d. Digitalis therapy.
Prevent pump Na +, K +, ATPase pump thus reduced Natrium, Calcium intraseluler still increase because they do not participate out of the heart contraction increased (Ngatijan, 2001).
Digitalis action kronotropik showed a negative meaning in the clinical, usually only in the failed ventrikel. At the heart fails, slowing the speed of sinus after digitalis also arise due to termination of sympathetic activity secondary to the general improvement in the status of the circulation caused by the effects inotropik positive glikosida. Use of the heart fails to stimulate the kontraktilitas miokard enough, digitalis improve evacuation ventrikel, with increasing rainfall heart, strengthen ejeksi faction, make diuresis and lower volume end sistolik ventrikel failed due to the reduction of symptoms due to blood vessel dam tuberculosis and the increase in systemic pressure vein (Isselbacher et al. 2000).

e. Heart transplants.
If the patient's heart does not fail again respons against all combinations of therapeutic action, including a class IV New York Heart Association, and is estimated will not survive for 1 year, patients must be obtained heart transplant. Figures viability 1 year and 5 years old at the time this is 95% and 70%, shows that heart transplantation is the therapy chosen in patients with heart disease end of the stadium that will not seem to take life more than 6 to 12 months longer. Generally, the left wing ejeksi ventrikel under 15% to 20% and the aritmia ventrikel denotes a serious level of resistance of living is 50% or less (Isselbacher et al. 2000).
Main complications are infection, hypertension, and kidney disfungsi because siklosporin, progressive coronary aterosklerosis quickly, and as a result of cancer drugs imunosupresif. The high cost and limited number of the donor heart must be careful selection of patients since the beginning (Tierney et al. 2002).

Prognosis
Heart failure prognosis depends on the nature of the primary that underlie heart disease and the factors are not treated can be a spark. If one of the last one can be identified and removed, the immediate survival far better than if the heart fails to occur without a visible cause of fuse. In this last situation, survival usually ranges between 6 months to 4 years depending on the illness failed heart. Also, long-term prognosis for heart failure is the most good if the form of heart disease that may underlie therapy .

Prognosis can be estimated also with the response to therapy. If clinical improvement occurs only with the restrictions in the diet are salt and digitalis or diuretik small doses, the results far better than if, in addition to this treatment, diuretik required intensive therapy and vasodilator. Other factors that have been seen associated with poor prognosis in heart failure include the time it is a short exercise