Diastolic Heart Failure: Diagnosis and Treatment

In the occurrence of diastolic heart failure, left ventricle will have become thick and stiff leading to difficulties in its work of filling the lower chamber of the heart resulting to a reduced amount of blood to be pumped to other parts of the body. When this process continues, the end results will be a buildup of blood inside left atrium and eventually to the lungs causing congestion and signs of heart failure.

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Signs and Symptoms

The main symptom is shortness of breath. Shortness of breath is usually observed if the patient is lying flat or while engaging in physical activities. Wheezing and coughing are also common signs. The breathing is affected due to the weakness of the left side heart tasked to pump oxygenated blood. This results in a reduced supply of oxygen to various parts of the body. Other signs include fatigue, difficulty in concentration, weight gain, nausea and lack of appetite. Fluid retention is also one of the common symptoms characterized by swelling of the ankles, legs, and feet. Fluid retention occurs as a result of systolic failure causing the left ventricle to malfunction and fail to properly pump blood leading to backflow into the lungs as well as other organs. The effects on the normal anatomy of the heart making the left ventricle weaker and thinner in systolic failure and stiff and harder in diastolic failure lead to effects in the heartbeat. A patient will have a rapid or irregular heartbeat. As the symptoms progress, the heart will pump harder leading to further damages resulting to signs such as rapid heart rate, enlarged heart, hypertension and less flow of blood to the hands and legs (Zaharias et al, 2014).

Risk Factors

Age and gender are main risk factors associated with left-sided heart failure. Male gender is more affected and risk is higher in males aged 50-70 years especially if they have previously experienced a heart attack (Blair et al, 2015). Clots in lungs also result in left-sided heart failure as it affects the pumping of blood from the left side of the heart. Aortic stenosis is also associated with increased risk of left-sided heart failure. Narrowing of the aortic valve results in slow blood flow and eventually weakens the heart. Another common risk factor is cardiomyopathy. Heredity is usually associated with cardiomyopathy that weakens and damages the heart muscles. A congenital heart defect is a structural heart defect that prevents an ideal flow of blood from the heart. Chronic diseases such as diabetes, hyperthyroidism, and HIV are also risk factors causing left-sided heart failure (Aschenbrenner, 2016). Irregular heartbeats or abnormal rhythm occurring frequently and fast wears the heart muscles causing left-sided heart failure. Myocarditis refers to the inflammation of the heart muscle due to viral infection. Myocarditis is usually associated with heart failure including left-side heart failure. In addition to myocarditis, pericardial constriction causes inflammation that leads to scaring of the pericardium (sac covering the heart) and eventually tightening and thickening of the heart muscle causing heart failure. Some races are usually at a higher risk than others. African-American males are usually at a higher risk of developing left-side heart failure than others (Blair et al, 2015). Valvular heart disease leading to a damage of one of the four valves affects the effective pumping of the blood by the heart and may result in left-sided heart failure.

Diagnosis

Diagnosis of uses advanced and recent technology for effective diagnosis and inform on the most appropriate treatment.

Cardiac Catheterization

This test involves a long narrow tube inserted through a blood vessel in the groin or arm to the heart. A contrast substance is then inserted via the inserted tube. An X-ray video is used to observe the functioning of the heart and observe possible blockages in the heart. Effects on the left auricles and ventricles can clearly be observed.

Electrocardiogram (EKG)

The main aim of this test is to record the electrical activities of the heat. The electrical measurement helps to assess if some parts of the hearts are damaged, enlarged or overworked. Heart electrical current is recorded using 12-15 electrodes attached to the chest, arm or leg using a tape.

Electrophysiology Examination

This test employs recording of electrical activities of the heart as well as the pathways of the heart. This test is used to identify the cause of heart rhythm defects and identify the most effective treatment.

Echocardiogram

Echocardiogram employs ultrasound examination using sound waves to capture moving pictures of chambers of the heart and valves. The test is able to detect the size, shape, thickness as well as movement of the walls of the heart. Enlarged heart, thin, stiff or thick left ventricle may be indicative of left-sided heart failure.

Radionuclide Imaging

This is non-invasive test used to assess whether severe heart damage has occurred. The test uses isotope that is inserted into the vein. A special camera is used to monitor how the isotope moves through the heart. The occurrence of heart damage is easily plotted to identify specific damaged regions of the heart such as blocked or damaged left valves in left-sided heart failure. The test can be performed using electrocardiogram during rest and exercises. The comparison is done to assess whether the effects are due to oxygen demand resulting from left-sided heart failure that is associated with lowered oxygenated blood in the organs. Exercises lead to increased demand for oxygen in the organs.

Treadmill Exercise Test with V02

This diagnostic test assesses the capacity of the patient to exercise recording the level of oxygen provided to the muscle by the heart during the entire test. The test provides an idea of the problem. Low oxygen is indicative of a problem on the left side of the heart that pumps oxygenated blood to the muscles.

Treatment

The main focus of treating left-sided heart failure is to manage the symptoms and eliminate the underlying causes of the problem. A treatment plan includes changes in lifestyle coupled with medications. Heart surgery may also be involved in severe cases. Surgery may occur in the form of heart transplant, device implant or reconstruction surgery of the heart.

Medication

Drugs include ACE inhibitors and vasodilators to manage blocked and narrowed blood vessels. Drugs such as benazepril (Lotensin), lisinopril (Zestril), triamterene (Dyrenium) are used. Beta blockers such as acebutolol (Sectral) and atenolol (Tenormin) are used to slow the rapid rhythm of the heart. Diuretics such as metolazone (Zaroxolyn) and furosemide (Lasix) are used to reduce the content of the body fluid (Rosenberg, 2016).

Lifestyle Changes

Changes in lifestyles can be used to manage left-sided heart failure. The patient should be advised to use low-fat, low-cholesterol and low sodium diet. The patient should also engage in gentle aerobic exercises. The patient should also avoid excessive alcohol and smoking. Low sugar diet is also recommended.

Surgery

Surgery is considered when medication and lifestyle interventions are not effective. Device implant is one of the main surgical interventions in treating heart failure. Left ventricular assist device is used to assist heart to effectively pump the blood and can be used as temporary intervention while waiting for a heart implant. Pacemaker devices can also be used in minor surgeries to assist left ventricle contract in a normal way.

Heart transplants or repair are also used in the treatment of heart failures. Congenital heart defect repair surgery is used to repair the heart and enhance blood flow. Coronary artery bypass graft uses graft technique using arteries obtained from other parts of the body. The main aim is to improve blood flow, reduce chest pain and prevent an occurrence of cardiac arrest.

Heart reconstruction surgery is used to reconstruct the shape of the heart with an aim of improving the electrical signals and functions of the heart. Movement of the electrical signals is responsible for contraction of the heart and subsequent pumping of the blood. Heart damages leading to enlarged and stretched heart affects electrical signals causing poor pumping. Artificial heart valve surgery is used to repair or replace valve leading to reducing of an enlarged heard and consequently improves the heart's functions. Dynamic cardiomyoplasty is a technique that places a muscle taken from a patient's back into the heart. The attached muscle functions just like a heart muscle to reduce stress on the heart to allow proper functioning. Dor procedure is used on left-sided heart failure caused by a previous heart attack. It involves correcting artery size using stitching technique to restore normal size after widening due to effects of heart attack.

Heart transplant surgery is considered when other interventional means to treat left-sided heart failure are infective in improving the patient's condition. The defective heart that is beyond repair is removed and healthy heart obtained from a donor is inserted.

Nursing Care

Nursing care is important in the assessment and management of left-sided heart failure. A nurse should first identify the most important problems affecting the patient and initiate interventional measures depending on the state of the patient.

Accumulation of Fluid in Organs

Accumulation of fluid occurs at the acute level. The left ventricle will pump harder in order to compensate for the shortage an act that makes it grow thinner and weaker. This results in blood flowing back to the organs leading to fluid buildup in the lungs. Swelling may also occur in the lungs as well as in other parts of the body. This situation is usually worsened by uncontrolled sodium intake. Restricting sodium intake will improve the patient's condition. Water usually follows salt and the patient at this level has accumulated too much fluid and need to reduce the levels (Amakali, 2015). Reducing sodium intake will be accompanied by reduced fluid in the organs while increased intake will lead to more accumulation of fluids in the organs and can result in other complications such as kidney failure. The patient should be advised...