NR 507 Week 3 – Discussion Post

In heart failure, the heart is unable to produce enough cardiac output to perfuse and supply the body with its needs. To fix this, the body works to compensate by activating a defense mechanism in order to fulfill the demands. Gordin and Fonarow (2016) explained that it does so by activating reactions in the body’s neural and hormonal systems, including the Renin Angiotensin Aldosterone system (RAA). The authors detailed that lack of perfusion to the kidneys causes the body’s renin levels to increase. After renin converts Angiotensinogen to Angiotensin I and further to Angiotensin II, the body goes through the process of vasoconstriction, causing the release of Antidiuretic Hormone (ADH) and Aldosterone, which further releases catecholamines. The authors further explained that as this process continues for longer periods of time, the ventricles begin to remodel and become fibrotic, cardiac output is released, and fluid builds up, causing volume overload.

After understanding this process of remodeling, treatment ceases the cascade of events to prevent further decline of cardiac function. To do so, Gordin and Fonarow (2016) explained that current medications are used to block the neural, hormonal process that worsens cardiac function.

Yancy and Jessup (2017) explained that Angiotensin-Converting Enzyme (ACE) Inhibitors may be used to block the production of Angiotensin II as well as kinase. If the patient does not see effects from ACE Inhibitors, such as Enalapril, Ramipril, Lisinopril, or Catopril, the authors detailed that Angiotensin Receptor Blockers (ARB)s may be used, such as Losartan, Valsartan, and Candesartan. Yancy and Jessup (2017) explained that ARBs block the bonding of Angiotensin II to its receptors, allowing for dilation of the blood vessels and a reduction in the body’s blood pressure. Yancy and Jessup (2017) also included that another popular treatment for heart failure is Aldosterone Antagonists, such as spironolactone, which blocks Aldosterone and its function of retaining fluid while allowing for the secretion of sodium and water through diuresis while sparing potassium. Other diuretics, such as Lasix, have similar properties. However, also rids the body of potassium, which in some individuals may become problematic. Flather and Gallop (2016) explained that Beta Blockers are another effective medication that can be used to treat heart failure. The authors detailed that medications such as Metoprolol and Carvedilol block the neural pathway that allows catecholamine release and reduces the heart rate, preventing an increased workload on the cardiac muscle. Yancy and Jessup (2017) explained that medications such as Hydralazine and Nitrates can be used in heart failure patients to reduce blood pressure and improve the function of the heart by causing vasodilation. In an article by Chen et al. (2015), the inotropic medication Digoxin is explained to also treat heart failure, as it is described as having the ability to increase cardiac output by ceasing the activity of the Sodium-Potassium-Adenosine- Triphosphate pump. The authors explained that this allows for the sodium and calcium exchange, which increases the calcium on the inside of cells, improving the ability of the heart to contract.

NR 507 Week 3 – Discussion Post

Every patient with heart failure must be understood in order to provide successful treatment. Factors such as causes, individual characteristics, and circumstances must be learned and monitored throughout treatment. Body weight, vital signs, in and out-put measurements, as well as symptoms such as swelling and shortness of breath, must be understood in order to implement proper interventions. In some cases, the use of multiple medication regimens may need to be implemented, while changes may need to be made in others. Listening and assessing patients closely can greatly improve the outcomes of patients suffering from heart failure.

References

Chen, S., Khusial, T., Patel, D., Singh, S., Yakubova, T., Wang, A., & Nguyen, T. (2015). Digoxin use in modern medicine. United States Pharmacology, 40(2), 44-48. Retrieved from: https://www.uspharmacist.com/article/digoxin-use-in-modern-medicine

Flather, M., & Gallop, N. (2016). Understanding mechanisms of action of beta-blockers in heart failure with reduced and preserved ejection fraction. Journal of the American College of Cardiology. 4(2), 150- 151. doi: 10.1016/j.jchf.2015.12.009

Gordin, J., & Fonarow, G. (2016). New medications for heart failure. Trends in Cardiovascular Medicine, 26(6), 485-492. doi: 10.1016/j.tcm.2016.02.008

Yancy, C., & Yessup, M. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 70(6), 776-803. doi: 10.1016/j.jacc.2017.04.025

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NR 507 Week 3 – Discussion Post

Discuss the pathophysiological mechanisms that can lead to heart failure.

Differentiate between systolic and diastolic heart dysfunction. Discuss the causes of the patient’s SOB, awakening in the middle of the night, and the need to prop herself up on three pillows. Include pathophysiological mechanisms that cause each of the
S/SX
Include two points of teaching for this patient

Support your response with at least one current evidence-based resource.

Students must post a minimum of three times in each graded discussion.