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MEDICAL MANAGEMENT

The overall goals of management of heart failure are to relieve patients symptoms, to improve functional status and quality of life and to extend survival. Medical management is based on the type, severity and causes of heart failure.Specific objectives of medical management include the following: eliminate or reduce any etiologic contributory factors, especially those that may be reversible, such as atrial fibrillation or excessive alcohol ingestion. y reduce the workload on the heart by reducing afterload and preload. y Optimize all therapeutic regimens y Prevent exercerbation oh HF y Treatment options vary according to the severity of the patients condition and may include basic lifestyle changes. Oral and IV pharmacological management, supplemental oxygen, implantation of assistive devices and surgical approaches including cardiac transplantation. Managing the patient with HF includes providing general education and counseling the patient and family. It is important that the patient and family understand the nature of HF and the importance of their participation in the treatment regimen. Lifestyle recommendation include restriction of dietary sodium, avoidance of excessive fluid intake, alcohol, and smoking: weight reduction when indicated and regular exercise.Medications are prescribed based on the patients type and severity of HF. Oxygen therapy is based on the degree of pulmonary congestion and resulting hypoxia. Some patients may need supplemental oxygen therapy only during activity.

SURGICAL MANAGEMENT Surgery can repair some underlying causes of heart failure, such as blockage of the coronary arteries, a valve problem, a congenital heart defect, or too thick of a pericardium. However, once the heart's ability to pump blood is severely, permanently, and irreversibly impaired, no surgery can repair the damage. The only alternative is a heart transplant. This option is for patients who are not elderly and who do not have other medical conditions that would make it unlikely for a heart transplant to be successful. Heart transplant evaluations are done in specialized centers.
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Intra-aortic balloon pump is used as a temporary support of left ventricle function, such as in a large heart attack, waiting for the heart to recover. Left ventricle assist device (LVAD) is surgically implanted to mechanicallybypass the left ventricle. A clinical trial showed that complications are too high and the device did not significantly prolong life if used on a long-term basis. This device is used as a temporary left ventricle support to get the patient awaiting a heart transplant out of bed. Left ventricle volume reduction surgery, which removes a piece of dead heart muscle, is considered experimental at this time. Totally implantable artificial hearts are being developed for patients with severe, endstage heart failure.
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These devices are most commonly used as a temporary bridge to heart transplantation. This technique is constantly improving but is still limited to specialized centers and is considered experimental at this time.

DISCHARGE PLANNING
M EDICATION TO TAKE Instruct and explain the patients relative that the medication is very important to continue depending on the duration that the doctor ordered for total recovery of the patient.

E XERCISE Explain to the patients relative the importance of exercise to help decrease the symptoms and improve the heart function. Exercise also helps with weight control and keeps the muscles strong. Instruct to avoid hard, prolonged exercise and lifting heavy objects. Walking, swimming and bicycling are the best exercise!

T- REATMENT Instruct to balancing activity with rest periods, reducing stress, eating less salt, keeping body weight within normal ranges and sometimes limiting fluids. Instruct to take medication as prescribed by your physician on a consistent basis. Encourage to reduce sodium intake to 2 grams or less (2000 mg) daily. This means only 1-teaspoon of salt per day and includes the amount of salt contained in processed foods that you buy. Weigh daily and record the amount. This should not increase more than 4 lbs. in 4 days without notifying your physician. Eat a high fiber, low fat, low cholesterol, low-sodium well balanced diet

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H - EALTH TEACHING y y Instruct to the patients relative to restrict sodium intake, avoiding excess fluids, avoiding noxious agents ( eg. Alcohol, tobacco ) Instruct to maintain proper diet and drink only when they are thirsty. Drink no more than 6 to 8, 6 oz. glasses of fluid per day, to equal 36 to 48 ounces of fluid daily, unless otherwise directed by your physician. Avoid high stress and excessive fatigue. During extreme temperatures adjust workload to minimize overworking the heart. Encourage to place a scarf around the face for protection on cold, windy days when outdoors.

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O - UT PATIENT FOLLOW UP Regular consultation to the physician can be a factor for recovery and to assess and monitor the patients condition.

D IET You may need to limit the amount of sodium (salt) you eat to 2 to 3 grams each day. Too much potassium can also cause health problems.