Congestive heart failure (CHF) in elderly is a complex health problem that arises due to structural or functional cardiac disorder. The condition affects ventricle’s capacity to pump blood. According to Lazzarini, Mentz, Fiuzat, Metra, and O’Connor (2013), CHF is prevalent amid the elderly due to age-related issues. The majority of the patients aged above 65 who are hospitalized due to heart-related illnesses suffer from CHF. Moreover, people who survive acute myocardial infarction at a young age are at high risk of developing CHF in the future. Currently, there are no defined diagnostic procedures for CHF and doctors rely on physical examination and history of the patient. Ancillary tests like echocardiography, electrocardiogram, and radiograph facilitate the diagnosis of CHF amid the elderly.
Pathophysiology
Cellular Level
Congestive heart failure, also referred to as heart failure with low ejection fraction, arises due to the inability of the organ to produce sufficient cardiac output to perfuse essential tissues. Stroke volume and heart rate influence the cardiac output. Illnesses that interfere with myocyte activity reduce contractility. According to McCance and Huether (2014), myocardial infarction is one of the predominant causes of reduced contractility. Other causes include cardiomyopathies and myocarditis. Ventricular remodeling is another condition that causes CHF. Wakefield Boren, Groves, and Conn (2013) define ventricular remodeling as a multifaceted pathophysiologic process that is marked by a change in role, structure, and size of the myocardium. The damage to the myocardium results in the death of myocytes. The remaining myocytes enlarge and hypertrophy in an attempt to sustain the stroke volume. The process leads to the thinning out of the ventricular walls, which contributes to the dilation of heart.
Clinical Manifestation
Studies show that older adults with comorbid syndromes such as hypertension, chronic lung condition, diabetes, and angina are at high risk of suffering from CHF (Kheirbek et al., 2013). Liu and Eisen (2014) aver, “Some common comorbidities such as renal dysfunctions are multifactorial, whereas others (like anemia, depression, and cachexia) are poorly understood” (p. 5). CHF points not only to the failure of the heart to sustain sufficient supply of oxygenated blood but also systemic response trying to cater to the deficit. When both the right and left ventricles are unable to pump blood, systemic and pulmonary venous hypertension arise, leading to CHF condition. The condition is associated with lower extremity edema, resting and exertional dyspnea, and a decline in exercise acceptance.
Sequelae
As the heart starts to develop complications, numerous compensatory mechanisms are triggered. They include “increased heart rate, the Frank-Starling mechanism, increased catecholamines, activation of the renin-angiotensin system, and release of atrial natriuretic peptides” (Liu & Eisen, 2014, p. 6). The increase in natriuretic peptides may help to reduce preload. Nonetheless, they have insufficient compensatory mechanisms, thus not being able to prevent heart failure. Arginine vasopression (antidiuretic hormone) is also triggered, which leads to renal fluid retention and peripheral vasoconstriction. The two conditions aggravate edema and hyponatremia in heart failure.
Diagnosis
Diagnostic Tests
Doctors use patient’s history and physical assessment procedures to diagnose individuals suffering from CHF. Another method that is helpful in diagnosing CHF is radiograph (Azad & Lemay, 2014). Doctors can request a patient to go for a chest x-ray, which is vital in examining heart size and the possibility of pulmonary blockage. McCance and Huether (2014) aver, “Invasive catheterization to monitor hemodynamics or to document underlying coronary disease may be needed” (p. 1179). Echocardiography may be used to evaluate cardiac output.
Differential Diagnosis
Differential diagnosis entails examining non-cardiac causes of congestive heart failure. They include the measurement of serum brain-type natriuretic peptide (BNP) level to facilitate the determination of the heart condition severity. The doctors may also examine conditions like circulatory congestion, which contributes to renal failure. Other differential diagnostic approaches include examination of the evidence of dyspnoea and ankle edema.
Treatment
Pharmacological and Non-Pharmacological
Doctors use pharmacological and non-pharmacological interventions to treat patients with CHF. Non-pharmacological treatment entails checking the level of salt consumption by a patient (Abete et al., 2013). Moreover, patients are encouraged to reduce fluid intake and to use salt substitutes with a lot of care. Patients with cardiomyopathy are warned against alcohol consumption. Pharmacological interventions entail the administration of anticoagulants, digoxin, diuretics, and inotropic agents. Diuretics like Furosemide help to minimize venous congestion. Pharmacological and non-pharmacological interventions help to reduce not only mortality rate but also readmission rate and prolong the life of the patients.
Self-Management and Patient Education
The management CHF constitutes self-care supportive strategies and patient education. Patient education entails training the sick in how to recognize the different symptoms associated with the condition. They are also advised on the importance of checking their weight on a regular basis. Self-management involves regulating one’s diuretics based on pre-specified limits. It also entails exercising and eating a salt-controlled meal. Patient education and self-management help to reduce cases of patient readmission. They also help to boost the quality of life of the patient.
Conclusion
Congestive heart failure is a severe condition that affects a high number of the elderly in the society. Lack of defined diagnostic procedures makes it hard for doctors to notice the symptoms of the disease as early as possible. As the population of the seniors continues to rise, there is the need to come up with a multidisciplinary approach to deal with the condition.
References
Abete, P., Testa, G., Della-Morte, D., Gargiulo, G., Galizia, G., De Santis, D., … Cacciatore, F. (2013). Treatment for chronic heart failure in the elderly: Current practice and problems. Heart Failure Reviews, 18(4), 529-551.
Azad, N., & Lemay, G. (2014). Management of chronic heart failure in the older population. Journal of Geriatric Cardiology, 11(4), 329-337.
Kheirbek, R., Alemi, F., Citron, B., Afaq, M., Wu H., & Fletcher, R. (2013). Trajectory of illness for patients with congestive heart failure. Journal of Palliative Medicine, 16(5), 478-484.
Lazzarini, V., Mentz, R., Fiuzat, M., Metra, M., & O’Connor, C. (2013). Heart failure in elderly patients: Distinctive features and unresolved issues. European Journal of Heart Failure, 15(7), 717-723.
Liu, L., & Eisen, H. (2014). Epidemiology of heart failure and the scope of the problem. Cardiology Clinics, 32(1), 1-8.
McCance, K., & Huether, S. (2014). Pathophysiology: The biological basis for disease in adults and children (7th ed.). Amsterdam, Netherlands: Elsevier.
Wakefield, B., Boren, S., Groves, P., & Conn, V. (2013). Heart failure care management programs: A review of study interventions and meta-analysis of outcomes. Journal of Cardiovascular Nursing, 28(1), 8-19.