Acute Heart Failure - Non-pharmacological Treatment

Introduction

Heart failure is a long-term condition that restricts the heart from pumping enough blood to meet the body’s requirements. It is a long-term condition and worsens over time. When the heart pumps less, this, in turn, damages the organs and fluid that is collected in the lungs. It is the most commonly diagnosed in America and other parts of Asia. It is a leading cause of hospitalization, mainly affecting older individuals about 65 years of age. There are two types of heart failure; Left-sided heart failure and right-sided heart failure. Congestive heart failure is the most commonly found heart failure. It occurs because the heart cannot handle the blood volume, which leads to accumulation in other parts of the body, mainly affecting the lower extremities and lungs.

What Are the Causes of Heart Failure?

Many medical conditions damage the heart muscles and lead to heart failure. These conditions include

• Heart attack.

• Cardiomyopathy.

• Diabetes.

• High blood pressure.

• Coronary artery disease.

• Obesity.

• Kidney disease.

• Tobacco and recreational drugs.

• Arrhythmia.

• Medications- mainly drugs used to fight cancer can lead to heart failure.

What Are the Symptoms of Heart Failure?

The symptoms of heart failure are

• Weight gain.

• Swelling in ankles, legs, and abdomen.

• Shortness of breath.

• Urge to urinate more while on rest or at night.

• Dry, hacking cough.

• Bloated or hard stomach.

• Loss of appetite.

• Nausea.

• Rapid and irregular heartbeat.

• Usually, heart issues worsen over time, and different individuals exhibit different symptoms ranging from mild to severe.

What Are the Complications of Heart Failure?

The complications of heart failure are

• Heart valve issues.

• Pulmonary hypertension.

• Liver damage.

• Malnutrition.

• Kidney damage.

• Irregular heartbeat.

• Sudden cardiac arrest.

• Pulmonary hypertension.

• Fluid collection in the lungs.

How to Improve Outcomes of Heart Failure?

The main aim of treatment is to improve patients' life and survival rate. Readmission in hospitals is common in heart failure individuals due to worsening symptoms. Many preventable and interrelated factors contribute to readmission. They are

• Inadequate follow-up.

• Problems with caregivers or the care facilities.

• Co-prescribed medications.

• Early clinical deterioration.

• Non-compliance prescribed treatment.

• Inappropriate medical treatment.

• Discharge in an unstable condition.

• Inadequate knowledge of chronic heart failure and treatment provided.

Around 45 to 60 percent of readmissions will be avoided if there are better assessments and the discharge is more carefully planned. If an individual is non-compliance with the diet and medication are instructed to seek medical attention right when the first symptom occurs.

How Is Acute Heart Failure Treated?

No treatment can reverse heart failure. Some strategies can help improve the individual's life quality:

• Lifestyle changes: maintaining a healthy lifestyle, limiting salt intake, becoming smoke-free, limiting alcohol, and joining a support program.

• Medications: Medications to lower blood pressure, ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists are recommended to control blood pressure.

• Other treatments include implants, pacemakers, and bypass surgery.

• In severe cases, a heart transplant is the only option left. After a transplant, lifelong antirejection medication and following a healthy lifestyle are required.

What Are the Non-pharmacological Measures to Treat Acute Heart Failure?

Both pharmacological and non-pharmacological measures complement each other in treating acute heart failure. The non-pharmacological measures of management are

• Compliance - Clear, detailed advice about the nature of the disease, the treatment provided, and the helpful strategies that should be given.

• Fluid - Restrict fluid intake in individuals with severe congestive heart failure.

• Alcohol - Moderate consumption is advised.

• Salt - It is recommended to avoid high salt intake and not add salt.

• Diet - Weight reduction in obese individuals and ensuring they get adequate general nutrition.

• Exercise - Regular walking and normal exercises should be encouraged.

• Smoking - Smoking should be avoided.

• Vaccination - The individual should consider pneumococcal vaccination and influenza vaccination.

Positive Airway Pressure Therapy and Its Types

Positive airway pressure therapy is the main tool used in treating several forms of acute respiratory failure and represents a valuable non-pharmacological tool that helps manage acute heart failure. These therapies include both invasive and noninvasive methods. It has several effects on hemodynamics, like

• Right ventricular unloading by increasing intrathoracic pressure and systemic venous return.

• It also changes the total pulmonary vascular resistance characterized by a U-shaped curve to the lung volume variation.

The types of positive airway pressure therapy that can be considered for the management of acute heart failure are:

• Invasive ventilation.

• Noninvasive ventilation.

• Continuous positive airway pressure.

• Bilevel positive airway pressure.

Contraindications and Complications of Noninvasive Positive Airway Pressure

The contraindications of noninvasive positive airway pressure. The absolute contraindications are

• Pneumothorax.

• Nausea and vomiting.

• Agitation.

• Significant chest trauma.

• Severe hypoxemia.

• Hemodynamic instability.

• Significant facial fractures.

• Inability to protect the airway.

• Active gastrointestinal and upper airway bleeding.

• Recent gastrointestinal and upper airway surgery.

The possible complications are

• Dry mucous membranes.

• Claustrophobia.

• Gastric distention.

• Injuries to the nasal bridge.

• Individuals' discomfort.

• Hypotension.

What Measures Are Taken to Treat the Underlying Disease?

Treatment of the underlying disease aims to reverse and slow the disease process.

Controlling Hypertension:

Controlling blood pressure is much more important, angiotensin converting enzyme inhibitors are the main drug of choice. Verapamil and diltiazem have a theoretical advantage in treating severe left ventricular hypertrophy. Angiotensin ll receptor antagonists are considered if angiotensin-converting enzymes cause problems inducing cough.

Surgery:

Surgery is done to treat the underlying cause. Here are the following surgeries according to the diseased condition. The types of surgery recommended for the conditions are

• Ventricular assist device surgery - Short-term ventricular support.

• Valve replacement - Mitral regurgitation, aortic stenosis.

• Cardiac replacement - End-stage heart failure.

• Coronary revascularization - Reverse ischemia, angina.

• Pacemakers and implantable cardio defibrillators - Arrhythmias, bradycardia.

• Novel surgical techniques - High mortality conditions.

Conclusion

The most typical type of heart failure is congestive heart failure. It happens when the heart cannot pump enough blood through the body, which causes buildup in other areas, primarily affecting the lower limbs and lungs. The most successful non-pharmacological management of acute heart failure is always multifaceted. It consists of phases of patient care, optimization of medical regimen, self-care supportive strategy, management of clinical deterioration, and ongoing surveillance. Heart failure management programs are important to emphasize the improvement of compliance with acute heart failure recommendations.