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Heart failure

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CHF

Congestive heart failure

Left-sided heart failure

Right-sided heart failure - cor pulmonale

Cardiomyopathy - heart failure

Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptoms to occur throughout the body.

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Self Care

Heart failure in children - home care

The Basics

Tests for Congestive heart failure

A Closer Look

Primary pulmonary hypertension

Pulmonary hypertension is the narrowing of the pulmonary arterioles within the lung. The narrowing of the arteries creates resistance and an increased work load for the heart. The heart becomes enlarged from pumping blood against the resistance. Some symptoms include chest pain, weakness, shortness of breath, and fatigue. The goal of treatment is control of the symptoms, although the disease usually develops into congestive heart failure.

Illustration

Osmolality test

An osmolality urine test is performed to measure the concentration of particles in urine. Greater than normal results may indicate conditions such as Addison disease, congestive heart failure or shock. Lower-than-normal measurements may indicate aldosteronism, diabetes insipidus, excess fluid intake, renal tubular necrosis or severe pyelonephritis.

Illustration

Heart transplant - series

Presentation

<strong>Indications</strong><p>A heart transplant may be recommended for heart failure caused by, Coronary artery disease, Cardiomyopathy (thickening of the heart walls), Heart valve disease with congestive heart failure, Severe congenital heart disease. Heart transplant surgery is not recommended for patients who have Kidney, lung, or liver disease, Insulin-dependent diabetes mellitus (IDDM), Other life-threatening diseases. </p>

<strong>Procedure</strong><p>Heart transplants are the third most common (corneas and kidneys are the most common) transplant operations in the U.S. (over 1,500 cases per year). A healthy heart is obtained from a donor who has suffered brain death but remains on life-support. The healthy heart is transported in a special solution that preserves the organ. While the patient is deep asleep and pain-free (general anesthesia), an incision is made through the breast bone (sternum). The patient's blood is re-routed through tubes to a heart-lung bypass machine to keep the blood oxygen-rich and circulating. The patient's diseased heart is removed and the donor heart is stitched in place.</p>

<strong>Aftercare</strong><p>Heart transplant prolongs the life of a patient who otherwise would die. About 80% of heart transplants are alive two years after the operation. The main problem, as with other transplants, is the rejection of the new heart. If rejection can be controlled, then survival can be increased up to 10 years or more. Immunosuppressive drugs must be taken indefinitely. Relatively normal activities can resume as soon as the patient feels well enough and after consulting with his or her doctor. However, vigorous physical activities should be avoided. The major problems are the same all major organ transplants face is a shortage of donor hearts, rejection of the transplanted heart, and the cost of the surgery and post-operative care, including immunosuppressive drugs.</p>

Heart valve surgery - series

Presentation

<strong>Indications</strong><p>Heart valve replacement may be recommended for narrowing of the heart valve (stenosis) or leaking of the heart valve. Valve problems may be caused by infections (rheumatic fever) or birth defects and may cause heart failure (congestive heart failure) and infections (infective endocarditis). The surgery is done while the patient is in deep-sleep and pain-free (general anesthesia). An incision is made through the breast bone (sternum).</p>

<strong>Procedure, part 1</strong><p>Heart valve surgery is open-heart surgery. Tubes are used to re-route the blood away from the heart to a heart-lung bypass machine to keep the blood oxygenated and circulating while the heart is being operated on.</p>

<strong>Procedure, part 2</strong><p>Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical). Natural valves are from human donors (cadavers), modified natural valves are from animal donors (porcine, pigs) which are placed in synthetic rings, and artificial valves are made of metal or plastic. Natural valves rarely require life-long medication to prevent blood clot formation (anticoagulation), whereas artificial valves will require anticoagulation. The advantage of mechanical valves is that they last longer-thus, the tradeoff of lifelong anticoagulation in some cases is worth it to avoid a second valve replacement surgery.</p>

<strong>Procedure, part 3</strong><p>The ineffective mitral valve is removed and the heart valve replacement is sutured into place. </p>

<strong>Aftercare</strong><p>The rate of success of heart valve surgery is high and increasing. The operation provides symptom relief and prolongs life. The death rate varies depending on the heart valve and averages 2% to 5%. Approximately 2 out of 3 patients who received an artificial mitral valve are still alive 9 years after the surgery. Life-long anticoagulant therapy is necessary for patients with artificial heart valves. The clicking of the mechanical heart valve may be heard in the chest and is normal. The first 2 or 3 days following the operation are spent in an intensive care unit where heart functions can be monitored constantly. The average hospital stay is 3 weeks. A few weeks to several months should be allowed for complete recovery, depending on health before surgery.</p>

Patent ductus arteriosis (PDA) - series

Presentation

<strong>Indications</strong><p>The type and timing of surgical repair depends on the child's condition and the type and severity of heart defects.
In general, symptoms that indicate that surgery is needed are difficulty breathing because the lungs are wet, congested, or fluid-filled (congestive heart failure); Problems with heart rate or rhythm (arrhythmias); Excessive work load on heart that interferes with breathing, feeding, or sleeping.</p>

<strong>Procedure</strong><p>An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is deep asleep and pain-free (under general anesthesia). For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy) instead of through the breastbone. Heart lung bypass is used to support the child during the procedure. Tubes are used to re-route the blood through a special pump that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done.</p>

<strong>Aftercare</strong><p>Most children need to stay in the Intensive Care Unit for 3 to 7 days and stay in the hospital for 5 to 14 days. By the time the child is transferred out of the intensive care unit, most of the tubes and wires have been removed and they are encouraged to resume many of their daily activities. At the time of discharge, the parents are instructed on activity, how to care for the incision and how to give medications their child may need to take such as Digoxin, Lasix, Aldactone and Coumadin. The child needs at least several more weeks at home to recover.</p>

Osmolality urine - series

Presentation

<strong>Procedure</strong><p>How the test is performed. You are instructed to collect a clean-catch (midstream) urine sample. To obtain a clean-catch sample, men or boys should wipe clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. As you start to urinate, allow a small amount of urine to fall into the toilet bowl (this clears the urethra of contaminants). Then, in a clean container, catch about 1 to 2 ounces of urine and remove the container from the urine stream. Give the container to the health-care provider or assistant. To collect a urine sample from an infant. Thoroughly wash the area around the urethra. Open a urine-collection bag (a plastic bag with adhesive paper on one end), and place it on your infant. For males, the entire penis can be placed in the bag with the adhesive attached to the skin. For females, the bag is placed over the labia. Place a diaper over the infant (bag and all). Check your baby frequently and remove the bag after the infant has urinated into it. The urine is then drained into a container for transport back to the provider. No special preparation is necessary for this test.</p>

<strong>Results</strong><p>Greater-than-normal measurements may indicate. Addison's disease (rare), Congestive heart failure, Shock, or Syndrome of inappropriate ADH secretion. Lower-than-normal measurements may indicate. Aldosteronism (very rare), Diabetes insipidus (rare), Excess fluid intake, Renal tubular necrosis, or Severe pyelonephritis.</p>

Review Date: 10/5/2022+

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