Heart Failure Treatment And Management

Heart Failure Treatment And Management

Question. Outline the management of congestive cardiac failure.
Answer. The management of cardiac failure aims to restore balance between metabolic demands of the body and person heart’s ability to meet these demands.

• Rest: Complete bed rest is the key stone of management. When the patient is dyspneic, bed rest is given with the head end of bed raised to 45°.
• The legs should be kept below the pelvis to prevent the flid present in legs to return to vascular system and precipitate pulmonary edema.
• Diet: Basic aim is to restrict sodium in the diet.
  Quantity of salt intake per day should not exceed 0.5 gm.
  Salt substitutes may be used to make diet more palatable.
• Diuretics: In cardiac failure there is always sodium and water retention.
  Hence, diuretics are given to increase sodium extraction.
  Furosemide 40 to 80 mg orally produces effct in 4 to 6 hours and on IV administration of furosemide 40 to 100 mg produces its effct in 20 minutes. Spironolactone which is potassium sparing diuretic is given 25 mg orally 4 times a day which removes the symptoms like hypokalemia due to action of furosemide.Triamterene or amiloride hydrochloride is given along with spironolactone.
• Digitalis: It increases the force of myocardial contraction and decreases work of heart.
  The commonly used drug is digoxin which is administered orally 0.25 mg BD.
• For rapid digitalization digoxin 0.5–0.75 mg is given slow IV over a period of 5 to 10 minutes under electrocardiographic control.
• Sympathomimetic amines: Dopamine at low doses of 3 to 5 μg / kg / min increases contractility of heart.
• Vasodilators: Sodium nitroprusside in the dose of 5 to 10 μg / min have balance dilator effct.
  Besides this hydralazine, nitrates and ACE inhibitors are used.
• Inodilator levosimendan: This is a calcium channel sensitizer. It has positive inotropic and vasodilator effct.

Heart Failure Treatment And Management

Managing Heart Failure: Symptoms and Treatment Options

• It is given IV with loading dose of 6–12µg/kg/ min over 10 min followed by infusion 0.05 to 2 µg/ kg/min infusion.
• Oxygen: It is given via Woulfe’s botte at rate of 5 to 8 lts/min.
• Miscellaneous drugs: Tranquilizers such as diazepam 2 to 5 mg TDS are given to reduce anxiety.
• Cardiac re-synchronization therapy or biventricular pacing: It is used in patients with symptomatic refractory cardiac failure with conduction abnormality or left bundle branch block.
• This therapy involves pacing the right atrium, right ventricle and left ventricle to improve synchrony of the cardiac chambers.
• Left ventricular assist device: Devices such as intraaortic balloon pump, impella device, heart­mate, thoratic are considered when medical management fails.
• They are usually used as a bridge to cardiac transplant.