Diagnosis
To diagnose heart failure, the doctor will carefully review your medical history and symptoms and perform a physical examination. The doctor can also check for the presence of risk factors, such as high blood pressure, coronary artery disease or diabetes.
Using a stethoscope, the doctor can listen to your lungs to check for signs of congestion. The stethoscope also detects abnormal heart sounds that may suggest heart failure. The doctor can examine the veins in your neck and check for fluid buildup in the abdomen and legs.
After the physical examination, the doctor can also request any of these tests:
Blood test. The doctor can take a blood sample to check the function of the kidneys, liver and thyroid and to look for indicators of other diseases that affect the heart.
A blood test to check for a chemical called "N-terminal B-type natriuretic peptide" can help diagnose heart failure if the diagnosis is not decisive when used in addition to other tests.
Chest x-ray. X-rays can help you see the state of the lungs and heart. In heart failure, the heart may appear enlarged, and the accumulation of fluid may be visible in the lungs. The doctor may also use an x-ray to diagnose diseases other than heart failure that may explain the signs and symptoms.
Electrocardiogram. This test records the electrical activity of the heart by electrodes attached to the skin. The impulses are recorded as waves and displayed on a screen or printed on paper.
This test helps the doctor diagnose heart rhythm problems and damage to the heart due to a heart attack that may be hiding heart failure.
Echocardiogram. An important test to diagnose heart failure is the echocardiogram. An echocardiogram helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can not be filled properly.
An echocardiogram uses sound waves to produce video images of the heart. This test can help the doctor look at the size and shape of the heart and how well it is pumping.
The echocardiogram can also help doctors look for valve problems or evidence of previous heart attacks, other cardiac abnormalities, and some unusual causes of heart failure.
The ejection fraction is measured during an echocardiogram and can also be measured by nuclear medicine tests, cardiac catheterization and a cardiac magnetic resonance. This is an important measure of how well the heart is pumping and is used to help classify heart failure and to guide treatment.
Stress test Stress tests measure how the heart and blood vessels respond to the effort. You may walk on a treadmill or pedal on a stationary bike while you are connected to an electrocardiogram machine. Or, you may receive an intravenous medication that stimulates the heart in a similar way to when you exercise. Sometimes the stress test can be done while wearing a mask that measures the ability of the heart and lungs to inhale oxygen and exhale carbon dioxide.
Stress tests help doctors see if you have coronary artery disease. Stress tests also determine how well your body responds to the reduced pumping efficiency of the heart and can help guide long-term treatment decisions.
If the doctor also wants to see images of the heart while you are exercising, you can request a nuclear stress test or an exercise echocardiogram. It is similar to an exercise test, but it also uses imaging techniques to visualize the heart during the test.
Computed tomography (CT) or cardiac magnetic resonance (MR). These tests can be used to diagnose heart problems, including the causes of heart failure.
In a cardiac CT scan, you lie on a stretcher inside a circular shaped machine. Inside the machine, an X-ray tube rotates around your body and gets images of the heart and chest.
In a cardiac magnetic resonance, you lie on a stretcher inside a machine with an elongated tube that produces a magnetic field. The magnetic field aligns atomic particles in some of the cells. When radio waves are emitted to the aligned particles, they produce signals that vary according to the type of tissue. The signals create images of the heart.
Coronary angiography. In this test
Doctors use this classification system to identify risk factors and to begin an earlier and more rigorous treatment to help prevent or delay heart failure.
These scoring systems are not independent of each other. The doctor will often use them together to help decide the most appropriate treatment options. Ask the doctor about your score if you are interested in determining the severity of your heart failure. The doctor can help you interpret your score and plan the treatment according to your illness.
Treatment
Heart failure is a chronic disease that needs lifelong control. However, with treatment, the signs and symptoms of heart failure may improve and the heart may be strengthened. The treatment can help you live longer and reduce the chance of sudden death.
In some cases, doctors can correct heart failure by treating the underlying cause. For example, by repairing a heart valve or by controlling the acceleration of the heart rhythm, heart failure can be reversed. However, for most people, the treatment of heart failure involves balancing the correct medications and, in some cases, using devices that help the heart beat and contract properly.
Medicines
Doctors usually treat heart failure with a combination of medications. Depending on the symptoms, you can take one or more medications, including:
Inhibitors of angiotensin converting enzyme (ACE). These medications help people with systolic heart failure live longer and feel better. Angiotensin-converting enzyme inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow, and decrease the workload of the heart. Some examples are enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
Blockers of angiotensin II receptors. These medications, such as losartan (Cozaar) and valsartan (Diovan), have many of the benefits of angiotensin-converting enzyme inhibitors. They can be an alternative for people who can not tolerate angiotensin-converting enzyme inhibitors.
Beta-blockers This type of medication not only decreases the heart rate and reduces blood pressure, but also limits or reverses some of the damage to the heart if you have systolic heart failure. Some examples are carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).
These medications reduce the risk of some abnormal heart rhythms and decrease the chance of dying unexpectedly. Beta-blockers can reduce the signs and symptoms of heart failure, improve heart function and help you live longer.
Diuretics Diuretics, often called "water pills," cause you to urinate more often and prevent fluid from collecting in the body. Diuretics, such as furosemide (Lasix), also decrease the fluid in the lungs, so you can breathe more easily.
As diuretics cause the body to lose potassium and magnesium, the doctor can also prescribe supplements of these minerals. If you take diuretics, the doctor is likely to monitor the levels of potassium and magnesium in the body through periodic blood tests.
Aldosterone antagonists. These medications are spironolactone (Aldactone) and eplerenone (Inspra). These are diuretics that conserve potassium and, in addition, have properties that can help people with severe systolic heart failure to live longer.
Unlike other diuretics, spironolactone and eplerenone can raise the level of potassium in the blood to dangerous levels, therefore, talk to your doctor if you are worried about the increase in potassium and discover if you should modify your food intake with high levels of potassium. potassium content.
Cardiotonic. These are intravenous medications used in the hospital by people with severe heart failure to improve the pumping function of the heart and maintain blood pressure.
Digoxin (Lanoxin) This medication, also known as "digitalis", increases the strength of the contractions of the heart muscle. It also tends to slow down the heartbeat. Digoxin reduces the symptoms of heart failure that causes systolic heart failure. It is more likely to be given to a person with heart rhythm problems, such as atrial fibrillation.
You may need to take two or more medications to treat heart failure. The doctor may also prescribe other heart medications, such as nitrates for chest pain, a
Although it can be difficult, talk about terminal care issues with your family and medical team. Part of this discussion will generally include advance directives, a general term for oral and written instructions you give related to medical care in the event you can not speak for yourself.
If you have an implantable cardioverter defibrillator, an important consideration to discuss with your family and doctors is defibrillator deactivation so that you can no longer send stimuli to keep your heart beating.
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Lifestyle and home remedies
Making changes in lifestyle can often help alleviate the signs and symptoms of heart failure and prevent the disease from getting worse. These changes may be the most important and beneficial you can make. The changes in lifestyle that the doctor can recommend are the following:
Stop smoking. Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in the blood and makes your heart beat faster.
If you smoke, ask your doctor to recommend a program that helps you stop smoking. You will not be considered for a heart transplant if you continue to smoke. You should also avoid passive smoking.
Discuss weight control with the doctor. Ask your doctor how often you should weigh yourself. Ask the doctor what weight gain you should notify. Weight gain can mean that you are retaining fluids and you need a change in the treatment plan.
Check every day if you have swelling in the legs, ankles and feet. Check every day if there are changes in swelling in the legs, ankles or feet. Check with your doctor if the swelling gets worse.
Follow a healthy diet. Choose to eat a diet that includes fruits and vegetables, whole grains, low-fat or low-fat dairy products, and lean proteins.
Limit salt in your diet. A lot of sodium contributes to water retention, which causes the heart to work harder and causes shortness of breath and swelling in the legs, ankles and feet.
Ask your doctor what is the recommended sodium restriction for you. Keep in mind that prepared foods already have added salt and be careful when using salt substitutes.
Maintain a healthy weight If you are overweight, the dietitian will help you work to achieve the ideal weight. Even losing a small amount of weight can be useful.
Consider receiving vaccines If you have heart failure, it is convenient to receive vaccines against influenza and pneumonia. Ask your doctor about these vaccines.
Limit fats and cholesterol. In addition to avoiding foods high in sodium, limit the amount of saturated fat, trans fat and cholesterol in your diet. A diet high in fat and cholesterol is a risk factor for coronary artery disease, which often underlies or contributes to heart failure.
Limit the consumption of alcohol and liquids. Probably, the doctor will recommend that you do not drink alcohol if you have heart failure, as it can interact with your medications, weaken the heart muscle and increase the risk of abnormal heart rhythms.
If you have severe heart failure, the doctor may also suggest that you limit the amount of fluids you drink.
Stay active Moderate aerobic activity helps keep the rest of the body healthy and in good condition, which reduces the demands on the heart muscle. Talk with your doctor about the exercise program that is right for you before you start exercising. The doctor could suggest a walking program.
Check with the local hospital to see if it offers a cardiac rehabilitation program, if you do, talk to the doctor about enrolling in the program.
Reduce stress When you are anxious or upset, your heart beats faster, your breathing becomes heavier, and your blood pressure often increases. This can worsen heart failure, because the heart already has problems satisfying the demands of the body.
Find a way to reduce stress in your life. To give your heart a rest, try to nap or raise your feet whenever possible. Share time with friends and family to socialize and help manage stress.
Sleep quietly. If you lack air, especially during the night, sleep with your head elevated using a pillow or cushion. If you snore or have had other problems sleeping, make sure you get a sleep apnea test.
