Ridryder911
EMS Guru
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Here is a post I wrote a while back on another forum, but thought it would might be helpful to some new or review for others...on CHF
I have found most EMT's do not understand CHF, I would like to try to simplify & educate some misconceptions of CHF.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What is CHF ? CHF stands for congestive heart failure. CHF is not a kind of heart disease. Heart disease is called cardiomyopathy and it's cardiomyopathy that causes heart failure. Heart failure is the set of symptoms that hit you when your heart can't pump enough blood to meet your body's needs. It's called congestive because fluid settles in your lungs, "congesting" the patients airway..
The patients may have a weak heart (pump problems), & probably an enlarged heart (cardiomegally-from working too hard.. you know muscles build up from resistance). They may have "episodes" of heart failure, meaning sometimes they have the symptoms and sometimes they don't. Or they may have symptoms all the time. However patient¡¦s are only in CHF when they have symptoms. (symptomatic). The symptoms include shortness of breath, fatigue, lightheadedness, swelling, insomnia, & may complain of increasing shortness of breath at nighttime..(nocturnal dyspnea).
If they don't usually have symptoms, they are called "well compensated." This means meds and life style changes are compensating for the weak heart function. If they are in CHF, meaning that you have all or some of those symptoms, they are called "decompensated." With good treatment your CHF (symptoms) may go away, but that doesn't mean they are cured. They should be kept on certain drugs even if they have no symptoms .
What is happening to the heart ?
Your lungs take the oxygen you breathe in and put it into your blood. Your heart pumps that oxygen-rich blood out of your lungs into the rest of your body. Your other organs and tissues get a good drink of oxygen-rich blood and then it goes back through your lungs, picking up oxygen again. The heart pumps it out again and again and again - we can only hope.
A weakened heart can't pump hard enough to keep up with this cycle. It receives more blood from the lungs than it can pump out into the body with each heart beat. The blood it can't handle backs up, spilling over into the lungs and other tissues. Cells get waterlogged. This causes swelling called edema.
This swelling often happens in the lower back (sacral), ankles (pedal) and legs first (tibial). That's because gravity pulls the backed-up, "loose" fluid straight down. The fluid also backs up into your lungs, which makes it hard to breathe. When you're lying down, gravity isn't pulling the fluid out of your lungs down into your feet, so it is even harder to breathe. Your heart can fail in two basic ways:
Systolic dysfunction is when the heart can't pump out enough blood. Most CHFers have this problem
Diastolic dysfunction is when enough blood cannot get into the heart because the heart muscle refuses to properly relax. Because the heart doesn't relax, there isn't enough room inside it for all the blood. With diastolic dysfunction, the heart may be normal size and they may have a normal ejection fraction
Do they really have heart failure?
The heart does not just stop if you go into heart failure. Usually patients get heart failure over a period of time - maybe even years - before it is diagnosed. Heart failure causes shortness of breath, swelling of legs, feet and maybe their stomach (ascites). They can get a feeling of fullness in your stomach that makes it hard to breathe. Sleeping can be difficult. Wheezing & fine mixture of fluid & air produce lung sounds called crackles or us old timer call it rales. Extreme fatigue is common.
Heart failure is often misdiagnosed as respiratory infection, bronchitis, asthma or gallstones. Certain tests can identify heart failure in different ways. A chest x-ray can show if the heart is enlarged. An echocardiogram can measure how well the heart is pumping, checking blood flow pattern & working of the valves. (Ejection fraction (EJ %) = blood flow amount ). A new 20-minute blood test called the BNP or HBNP test can confirm a CHF diagnosis, you may see this in the ER & definitely in ICU/CCU arena¡K usually > 100 represents CHF & may show up before signs & symptoms appear
. Some common causes of congestive heart failure are there are several:
„X Coronary artery disease
„X High blood pressure, usually over a period of years
„X Heart valve disease
„X Infections, such as from viruses (including Coxsackie and HIV), bacteria or parasites
„X Diseases of the pericardium - a fluid-filled sac around the heart
„X Myocarditis - inflammation of the heart walls
„X Drugs - especially chemotherapy - such as doxorubicin (Adriamycin), cyclophosphamide (Cytoxan) or cocaine
„X Excessive alcohol drinking
„X Connective tissue disease
„X Tachycardia - a too-fast heart rhythm, usually over a period of years
„X Obstructive cardiomyopathy, also called restrictive cardiomyopathy
„X Neuromuscular diseases such as muscular dystrophy or Friedreich's ataxia
„X Metabolic disorders, such as Pompe's disease or McArdle's disease
„X Nutritional disorders, such as beriberi or kwashiorkor
„X Radiation
„X Hypertrophic cardiomyopathy (HCM or IHSS)
„X Peripartum cardiomyopathy (PPCM), caused by strain on the heart during pregnancy
„X Dilated idiopathic cardiomyopathy - heart enlargement and heart weakness of unknown cause
„X Severe anemia
„X Hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid)
WOW didn't know there were so many huh ?
Can they cure CHF ?
Cardiomyopathy may get cured, but the heart usually sustains some permanent damage pior to the underlying problem is fixed. This is one reason it's a question with no answer. It depends completely on the individual circumstances.
Some meds you might or may see:
CE Inhibitors
Vasotec enalapril
Altace ramipril
Monopril fosinopril
Capoten captopril
Prinivil/Zestril lisinopril
Accupril quinopril
Lotensin benazepril
Aceon perindopril erbumine
Mavik trandolapril
Angiotensin-converting enzyme (ACE) inhibitors are the first-line therapy for CHF. ACE inhibitors prevent worsening of heart function and lighten the heart's work load. There can be large price differences from drug to drug. Watch for lightheadedness and persistent, dry cough.
ARBs
Cozaar (losartan)
Avapro irbesartan
Atacand candesartan cilexetil
Diovan valsartan
ARBs are ACE Receptor Blockers. They are also called ACE 2 antagonists. ARBs such as losartan may give many of the same benefits as ACE inhibitors without side effects such as cough. However, ACE inhibitors are still more important in CHF treatment than ARBs because they have been thoroughly proven to make them feel better and live longer.
Part 2 to follow...
R/r 911
I have found most EMT's do not understand CHF, I would like to try to simplify & educate some misconceptions of CHF.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What is CHF ? CHF stands for congestive heart failure. CHF is not a kind of heart disease. Heart disease is called cardiomyopathy and it's cardiomyopathy that causes heart failure. Heart failure is the set of symptoms that hit you when your heart can't pump enough blood to meet your body's needs. It's called congestive because fluid settles in your lungs, "congesting" the patients airway..
The patients may have a weak heart (pump problems), & probably an enlarged heart (cardiomegally-from working too hard.. you know muscles build up from resistance). They may have "episodes" of heart failure, meaning sometimes they have the symptoms and sometimes they don't. Or they may have symptoms all the time. However patient¡¦s are only in CHF when they have symptoms. (symptomatic). The symptoms include shortness of breath, fatigue, lightheadedness, swelling, insomnia, & may complain of increasing shortness of breath at nighttime..(nocturnal dyspnea).
If they don't usually have symptoms, they are called "well compensated." This means meds and life style changes are compensating for the weak heart function. If they are in CHF, meaning that you have all or some of those symptoms, they are called "decompensated." With good treatment your CHF (symptoms) may go away, but that doesn't mean they are cured. They should be kept on certain drugs even if they have no symptoms .
What is happening to the heart ?
Your lungs take the oxygen you breathe in and put it into your blood. Your heart pumps that oxygen-rich blood out of your lungs into the rest of your body. Your other organs and tissues get a good drink of oxygen-rich blood and then it goes back through your lungs, picking up oxygen again. The heart pumps it out again and again and again - we can only hope.
A weakened heart can't pump hard enough to keep up with this cycle. It receives more blood from the lungs than it can pump out into the body with each heart beat. The blood it can't handle backs up, spilling over into the lungs and other tissues. Cells get waterlogged. This causes swelling called edema.
This swelling often happens in the lower back (sacral), ankles (pedal) and legs first (tibial). That's because gravity pulls the backed-up, "loose" fluid straight down. The fluid also backs up into your lungs, which makes it hard to breathe. When you're lying down, gravity isn't pulling the fluid out of your lungs down into your feet, so it is even harder to breathe. Your heart can fail in two basic ways:
Systolic dysfunction is when the heart can't pump out enough blood. Most CHFers have this problem
Diastolic dysfunction is when enough blood cannot get into the heart because the heart muscle refuses to properly relax. Because the heart doesn't relax, there isn't enough room inside it for all the blood. With diastolic dysfunction, the heart may be normal size and they may have a normal ejection fraction
Do they really have heart failure?
The heart does not just stop if you go into heart failure. Usually patients get heart failure over a period of time - maybe even years - before it is diagnosed. Heart failure causes shortness of breath, swelling of legs, feet and maybe their stomach (ascites). They can get a feeling of fullness in your stomach that makes it hard to breathe. Sleeping can be difficult. Wheezing & fine mixture of fluid & air produce lung sounds called crackles or us old timer call it rales. Extreme fatigue is common.
Heart failure is often misdiagnosed as respiratory infection, bronchitis, asthma or gallstones. Certain tests can identify heart failure in different ways. A chest x-ray can show if the heart is enlarged. An echocardiogram can measure how well the heart is pumping, checking blood flow pattern & working of the valves. (Ejection fraction (EJ %) = blood flow amount ). A new 20-minute blood test called the BNP or HBNP test can confirm a CHF diagnosis, you may see this in the ER & definitely in ICU/CCU arena¡K usually > 100 represents CHF & may show up before signs & symptoms appear
. Some common causes of congestive heart failure are there are several:
„X Coronary artery disease
„X High blood pressure, usually over a period of years
„X Heart valve disease
„X Infections, such as from viruses (including Coxsackie and HIV), bacteria or parasites
„X Diseases of the pericardium - a fluid-filled sac around the heart
„X Myocarditis - inflammation of the heart walls
„X Drugs - especially chemotherapy - such as doxorubicin (Adriamycin), cyclophosphamide (Cytoxan) or cocaine
„X Excessive alcohol drinking
„X Connective tissue disease
„X Tachycardia - a too-fast heart rhythm, usually over a period of years
„X Obstructive cardiomyopathy, also called restrictive cardiomyopathy
„X Neuromuscular diseases such as muscular dystrophy or Friedreich's ataxia
„X Metabolic disorders, such as Pompe's disease or McArdle's disease
„X Nutritional disorders, such as beriberi or kwashiorkor
„X Radiation
„X Hypertrophic cardiomyopathy (HCM or IHSS)
„X Peripartum cardiomyopathy (PPCM), caused by strain on the heart during pregnancy
„X Dilated idiopathic cardiomyopathy - heart enlargement and heart weakness of unknown cause
„X Severe anemia
„X Hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid)
WOW didn't know there were so many huh ?
Can they cure CHF ?
Cardiomyopathy may get cured, but the heart usually sustains some permanent damage pior to the underlying problem is fixed. This is one reason it's a question with no answer. It depends completely on the individual circumstances.
Some meds you might or may see:
CE Inhibitors
Vasotec enalapril
Altace ramipril
Monopril fosinopril
Capoten captopril
Prinivil/Zestril lisinopril
Accupril quinopril
Lotensin benazepril
Aceon perindopril erbumine
Mavik trandolapril
Angiotensin-converting enzyme (ACE) inhibitors are the first-line therapy for CHF. ACE inhibitors prevent worsening of heart function and lighten the heart's work load. There can be large price differences from drug to drug. Watch for lightheadedness and persistent, dry cough.
ARBs
Cozaar (losartan)
Avapro irbesartan
Atacand candesartan cilexetil
Diovan valsartan
ARBs are ACE Receptor Blockers. They are also called ACE 2 antagonists. ARBs such as losartan may give many of the same benefits as ACE inhibitors without side effects such as cough. However, ACE inhibitors are still more important in CHF treatment than ARBs because they have been thoroughly proven to make them feel better and live longer.
Part 2 to follow...
R/r 911