Heart failure can be caused by various heart conditions. Symptoms include fluid retention, breathlessness, and tiredness. Heart failure is a common, costly, disabling and deadly condition. In developing countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6-10%. Heart failure becomes more common with increasing age. About 1 in 35 people aged 65-74 years have heart failure. This increases to about 1 in 15 of people aged 75-84 years, and to just over 1 in 7 people aged 85 years and above. It is uncommon in younger people. Heart failure can cause a large variety of symptoms such as shortness of breath (typically worse when lying flat, which is called orthopnea), coughing, ankle swelling and reduced exercise capacity. The onset of the disease is significantly influenced by Ischaemic Heart Disease in addition to Dilated Cardiomyopathy. However, predominance of causes of heart failure are difficult to analyze due to challenges in diagnosis, differences in populations, and changing prevalence of causes with age. Currently, there's no cure for heart failure. However, researchers are finding and testing new treatments. These treatments offer hope for better ways to delay heart failure and its complications.
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Diuretics is a name given to drugs that can cause diuresis i.e. elevated level of urine. In patients with heart failure, fluid will accumulate in the body due inadequate cardiac output. So the body will manifest symptoms like breathlessness due to pulmonary oedema i.e. fluid retention in the lungs. Other symptom is peripheral oedema in the ankles and legs. Diuretics promote renal excretion of salt and water. Generally they inhibits reabsorption of ions from glomerular filtrate back into the blood circulation. Because the glomerular filtrate is hypertonic to blood, this will promote secretion of water to be eliminated as urine. As fluid retention is minimized, symptoms as breathlessness and oedema are expected to subside and improve patient's overall health.
Two of them are outlined as Loop diuretics and Thiazide diuretics. Loop diuretics such as furosemide, bumetanide and torasemide. This type of drug is a very potent diuretic. It works by inhibiting reabsorption of sodium and chloride ions in the ascending limb of the loop of Henle of the renal tubule, thus the name. This is achieved by competitive inhibition of chloride ions binding site on the Na+/K+/2Cl- symporters. Loop diuretics cause an increase in the renal blood flow by this mechanism. This diuresis leaves less water to be reabsorbed into the blood, resulting in a decrease in blood volume.
Thiazide diuretics such as bendroflumethiazide, chlortaridone and cyclopenthiazide. These drugs are moderate diuretics. They work by inhibiting reabsorption of sodium ions at the beginning of distal convoluted tubule in the kidney. They inhibit the reabsorption of sodium from the distal convoluted tubules in the kidneys by blocking the thiazide-sensitive Na+-Clâˆ’ symporter. Thiazides also cause loss of potassium and an increase in serum uric acid. Treatment of chronic heart failure using diuretics aims to relieve symptoms, improve tolerance to daily activity or exercise, reduce the incidence of acute exacerbations, and reduce mortality.
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Chemical structure of
Chlorothiazide, thiazide diuretics
Social & Economy Implications
Some people with heart failure do not even believe that they are ill, and refuse to receive treatment. They may not taking medication that they suppose to consume to avoid undesirable effect. Substance abuse, (like caffeine), can also interfere with treatment effectiveness. Patients will find it difficult to hold a job or even care for themselves. These can cause a huge burden to the families and friends and the loved ones. A heart failure patient, Theo from Netherlands said that he always fell asleep waiting for a traffic light. This also happened several times during long drives. It appeared that he had been suffering with sleep apnoea, which eventually led to a heart attack. He received very good treatment in the Slotervaart hospital.
After the heart attack, he and his wife have had to adapt their lifestyles to manage his condition as best they can. To his regret it is not possible to do everything he wanted to do any more. But he and his wife have accepted that way of life. He was terribly grateful to his wife for her support and he greatly appreciated the support that he had received during the PCI, heart rehabilitation and heart failure. Thus, help and support from family and friends can be really meaningful to someone dealing with heart failure.
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Moreover, heart failure patient tend to depressed if the heart transplant could not take place. They will feel worried thinking they cannot live their life as before. From time to time they will lose all hope, thinking they were going to die due to a lack of donors.
In addition, patients need huge adherence to treatment or hospitalization that can cause great financial burden and economic impact. Diuretics is highly costs and can also cause a big burden for the patient.
Benefit and risks
Diuretic is commonly needed to ease fluid retention. This is taken in addition to an ACE inhibitor and beta-blocker. Diuretics work on the kidneys and make patients pass out extra urine. This helps to clear excess body fluid that builds up. There are different types and brands of diuretics. The dose depends on how bad the fluid retention has become, and can be increased if necessary if fluid retention becomes worse. Diuretics reduce the amount of water and salt that is re-absorbed by the kidneys. So, more water and salt passes out with the waste products into urine. This means that patients make more urine and so lose more water from the blood. The overall volume of blood is reduced, which gives the heart less work to do and helps to reduce the blood pressure. This is why diuretics are used to treat heart failure and high blood pressure. But doctors have realized in the past few years that the drugs raise the risk of developing diabetes, which itself can lead to heart attacks and strokes. As a result, some doctors were afraid that diuretics' risks would cancel out their benefits. The first long-term study to examine the question found that while diuretics do raise the risk of diabetes, the rate of death from heart attacks or strokes was still nearly 15 percent lower in patients getting a diuretic compared to those who were given dummy pills.
"This is the most conclusive information we're likely to have, at least for some time," said Dr. Jeffrey Cutler, senior scientific adviser at the National Heart, Lung and Blood Institute, a sponsor of the study.
Higher doses of Thiazide diuretics may give patients an upset stomach or make them feel faint or dizzy when stand up. Thiazide diuretics can upset the balance of minerals in the body, leading to low levels of potassium (hypokalaemia) and sodium (hyponatraemia), and reduced levels of body water (dehydration). If patients are taking other medicines for any heart problems, low levels of potassium may cause them to have irregular heartbeats.
The side-effects with loop diuretics are similar to those seen with thiazides, although side-effects such as muscle cramps and skin rash may occur. The first time patient take a loop diuretic they may need to pass a very large volume of urine and take regular trips to the toilet. The doctor may advise them not to take this medicine in the evening as it works within one hour and acts for up to six hours - this will increase the number of times they have to get up in the night to go to the toilet.
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft (CABG) surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery. More recently the term aortocoronary bypass (ACB) has come into popular use. People undergoing coronary artery bypass are at risk for the same complications as any surgery, plus some risks more common with or unique to CABG.
Â Aortic & Mitral Valve Surgery
Mitral valve replacement has been performed for decades to fix problems with the mitral valve.Â In mitral valve replacement, the diseased valve is removed during surgery and replaced with an artificial valve.Â This method is highly effective in fixing problems with the mitral valve, and remains the treatment of choice for certain situations.Â There are some disadvantages of mitral valve replacement when compared with mitral valve repair.Â In mitral valve repair, the patient's own mitral valve is repaired and function is restored to the valve.Â There are many advantages to mitral valve repair in the hands of a skilled and experienced surgeon.Â By using the patient's own valve, there is better flow of blood through the valve because the basic structure remains.Â Mitral valve repair has been shown to be superior to valve replacement in terms of surgical mortality, long term durability of repair (which means a longer time before another operation might be needed), heart function, and long-term survival.Â
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A diuretic is any drug that elevates the rate of urination and thus provides a means of forced diuresis. There are several categories of diuretics. All diuretics increase the excretion of water from bodies, although each class does so in a distinct way, from reference [http://www.answers.com/topic/diuretic#High_ceiling_loop_diuretics]. This sources is reliable since it also agrees with many other sources and the following extract. Spironolactone competes with the hormone aldosterone for receptor sites in the cells of the distal tubules of the nephrons, which the fluid reaches from the loops of Henle. Since aldosterone promotes absorption of sodium from the tubular fluid, and secretion of potassium into it, spironolactone opposes these actions, enhancing excretion of sodium in the urine - and of water along with it - and decreasing potassium excretion. The diuretics triamterene and amiloride have similar overall effects, though by different molecular mechanisms." By Chris Lote. The information in this source is valid