In most cases, chronic heart failure occurs among seniors according to an article in the British Medical Bulletin. The most common symptoms associated with the condition are dyspnea and fatigue. If any of these symptoms occur, medical professionals will tell the patient to call a doctor.
If the physician suspects heart failure, the doctor has to assess the condition to confirm his or her findings. Afterward, the doctor will lead and investigation and suggests treatment and care for the patient.
Diagnosis and Care of Chronic Heart Failure
Diagnosis and care of acute and chronic heart failure include assessing the condition. There is also a need for investigating and prescribing a treatment for the illness.
Assessing the Condition of Heart Failure
Sudden heart failure occurs in older patients. The patient complains of shortness of breath because the heart is working overtime to do its job. The condition is pulmonary edema. People experiencing pulmonary edema complain of fatigue or lack of energy.
It is easier for doctors to confirm the symptoms if the condition is dyspnea and or orthopnoea. The patient may complain of peripheral edema. There may also be other causes. There is not much access to the investigation in a primary care setting, so this might cause a problem. Other issues include acute and chronic illness similarities, differences, and challenges between them.
Prolonged bed rest or extra weight gain in older patients can lead to exertional dyspnea. Testing those patients might be difficult. In most cases, patients might have had a history of cardiac disease or hypertension. However, that is not always the case.
Further clinical testing can yield useful information. For example, tests can show patients with signs of atrial fibrillation. Other symptoms include cardiac murmur or a displaced apex beat. Symptoms from the analysis would show an elevated JVP, which could explain fluid overload. That does not mean cardiac disease. There are different explanations and possible conclusions based on clinical signs. Thus, making it difficult to get a diagnosis of heart failure based on those assessments alone.
Investigating Chronic Heart Failure
Doctors use an electrocardiogram (ECG) to examine patients suspected of having heart failure. A normal ECG does not mean heart failure. The condition might be chronic versus acute. A routine ECG suggests that there could be other underlying causes for the problem.
If the ECG result is abnormal, the doctor has to run an echocardiography to assess the problem. The test could gather information on structural heart disease. It would tell the severity of the heart failure. The abnormality would show evidence of heart problems before symptoms develop. Such problems include left ventricular hypertrophy, atrial fibrillation, and left bundle branch block.
Other circumstances influencing the left ventricular preload would be an obstructive valvular disease. Structural heart disease occurs in older patients. The disease would affect the choice of treatment for patients suffering from aortic stenosis.
If echocardiography is not possible, doctors can get information from plain chest radiology. Other means of information include blood sample B-type natriuretic peptide or BNP. A chest X-ray can show pulmonary diversion and the presence of fluid in the horizontal tissue. Please note that an X-ray is not used to exclude heart failure. In an older patient, the quality of the X-ray might be weak due to chest wall abnormalities.
Further Investigations of Chronic Heart Failure
An optional form of research is BNP. Patients with left ventricular systolic dysfunction have an elevated plasma level of BNP. High levels of BNP can also appear in renal impairment and cor pulmonale. This option has proven to be more useful in excluding a diagnosis of heart failure.
Additionally, doctors can use BNP to predict the outcome of a disease. Please note that this type of BNP testing may not be available in some health care facilities. Furthermore, doctors can rule out heart failure with a normal BNP reading.
However, if the patient 12-lead ECG and CXR have a high BNP, doctors may have to do an echocardiography test. All patients may not need the complete testing mentioned above before getting treatment. Moreover, older chronic heart failure patients may need to have blood tests often such an FBC and serum electrolytes.
How to Classify Chronic Heart Failure
Doctors place heart failure in four classes. They base the levels on the severity of the condition. The levels may change over time. It depends on how severe the symptoms are. Please see below for the various classes of chronic heart failure.
Class I > Mild
There are no symptoms in this class. The patient is allowed to do physical activities without any limitations.
Class II > Mild
The symptoms are mild and do not occur often. Doctors limit the amount of exercises or strenuous activities the patients can do. There are no symptoms reported while the patient is resting.
Class III > Moderate
Doctors limit the amount of exercises and strenuous activities. The patient feels comfortable when relaxing. Too much activity can lead to fatigue, palpitation, and dyspnea.
Class IV > Severe
If the patient does physical activity, she or he will feel some discomfort. The patient will also experience symptoms of chronic heart failure while resting.
Based on the classification, chronic heart failure can get worse over time. See a doctor right away if you think you have heart failure. It does not matter the class in which you appear. It is important to see a doctor when fighting chronic heart failure.
Treating Chronic Heart Failure
Doctors need to administer treatment if they suspect heart failure based on their assessment. It will curtail drug interactions and polypharmacy risks. It is preferable to have various evaluations  when dealing with older chronic heart failure patients. Applying multiple assessments will improve care and reduces hospital stays.
Other treatments involved include heart failure nurses and treatment with an ACE inhibitor. The person managing the inhibitor needs to keep an eye on the doses and the patient’s tolerance. Doctors can dispense B-blockade, spironolactone or digoxin. B-Blockers work best with patients who are stable even if they do not have any symptoms.
Diuretic therapy is another treatment for acute, chronic illness diagnosis, and care. It reduces left ventricular preload and improves cardiac output. This method requires monitoring weight, postural blood pressure, and electrolyte value. The method has proven problematic for older chronic heart failure patients with disturbed fluid balance homeostasis. The problem occurs because the patient’s intravascular volume is low.
Patients can lessen large doses of diuretic with the use of blockade angiotensin-renin. They can combine it with other treatment methods. When using Loop diuretic, use it at the lowest dose after the removal of excess fluid. Loop diuretic is necessary if the patient is on long-term diuretic therapy.
If the condition is acute, doctors use alternatives to intravenous diuretics. Such methods include intravenous nitrates. But, patients with chronic resistant edema need a short-term use of metolazone. It is advisable to adjust the dosage based on the condition of the patient.
Caring for the Patient
Patients can reduce hospital stays by getting care from the nurse and clinical pharmacists. It will also improve the patient’s quality of life. If treatment includes titration of B-blocker dose, nurse practitioners can follow up with patients. Furthermore, the nurse’s job is to adjust the diuretic dosage and track the patient’s condition. The procedure prevents any adverse drug interactions.
In conclusion, it is hard to diagnose older patients who have experienced chronic heart failure. Doctors should do a thorough investigation by using ECG, chest X-ray, and echocardiogram. Patients diagnosed with left ventricular systolic dysfunction need other forms of treatment. They include an exact dosage of diuretic therapy, ACE inhibitor, and B-blocker. Sometimes the doctor uses digoxin and angiotensin antagonist. Treatments work best with a well-coordinated team of nurses and clinical pharmacists. It will be an improvement in the delivery of patient care.
Do you know of anyone who has experienced chronic heart failure? Please feel free to leave a comment.
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