Congestive heart failure is one of the most common congenital malformations. It is a systemic condition that an individual might be born with or develop as they grow up. It affects the normal functioning of the heart. Besides, it can also cause blood clots in significant heart arteries and other body parts resulting in other significant health conditions. Statistically, about 5 million Americans are at the moment living with congestive heart failure. In addition to the above, 550,000 new cases are annually diagnosed, a worrying state that has partially led the American heart association to approximate that by 2010, there will be an increase of approximately 46% of congestive heart failure cases. The prevalence of the disease is indiscriminately among different ages. Of the statistics given, 1.4 million of individuals with the condition are under 60 years of age, 2% between 40 and 59 and 5% between 50 and 59 years of age. With the given statistics, the condition is viewed to be one of the leading causes of deaths among related heart conditions. It is also one of the leading reasons for hospitalization among individuals aged 65 years and above. With the complications that are related to the above illness, it is likely to interfere with the daily life of the individual affected, a factor that necessitates better management in terms of medication prescription as well as other forms of therapy that are likely to lessen the impact of the condition on the person affected.
Pathophysiology of Congestive Heart Failure
Several complications can result in the heart failure. Examples of those include infection in the heart muscles that causes it to malfunction, pressure as well as volume overload among other defects that affect cardiac output and hence the general functioning of the heart. The performance of the left ventricle is significantly reduced as the contractility ability of the muscles is affected. The above is manifested through an abnormal increase in pressure in the left atrium, a reduction in the rate of contraction of the muscles, an afterload that results in the reduction of the heart’s output and an increase in the heart rate so as to compensate for the reduced efficiency of the heart components. As a systemic disease, those that suffer from other conditions such as coronary disease show conditions such as a significant imbalance between the demand and the supply of oxygen to the different body parts. Increased oxygen demand leads to the tension of the heart walls, a factor that is likely to cause the heart to enlarge. As the condition deteriorates and the heart output does not meet the overall need of the body and major organs such as the liver, failure is likely to occur.
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Course of Illness/ Trajectory
The disease first manifests itself in the form of heart failure in four stages of development. If untreated, it develops to congestive heart failure, a condition which leads to the accumulation of blood in different parts of the body. In the first stage of development, stage A, a person might have never possessed any symptoms of congestive heart failure but might possess other life-threatening conditions that are strongly associated with heart failure. Such conditions include diabetes, coronary heart disease as well as high blood pressure. Stage B is manifested by structural heart disease which results in the enlargement of the left ventricle. Another development could be a heart attack, regardless of the fact that such an individual might not have had signs of heart failure before. Stage C of development is characterized by the development of symptoms that are linked to heart failure. As the left ventricle contractility reduces, an individual might have difficulties in breathing and fatigue. Stage D which is the last stage is characterized by advanced structural heart disease which might lead to attacks at any time, regardless of whether the individual is at rest or in motion. Unless monitored, the above could result in an unexpected fetal attack and hence death (Yancy et al., 2013).
Congestive heart failure related symptoms are witnessed as the disease progresses in the different stages. Although the major types of the above condition are Systolic heart failure and Diastolic failure, symptoms might overlap, making diagnosis an intricate undertaking that requires specialized experience on the part of the physician (Shah et al., 2017). Significant symptoms in adults related to the condition include fatigue, gaining of weight, swelling of a person’s legs, and feet, an increase urge to pass out urine. In infants, it might be characterized by poor feeding, breathing difficulties as well as excessive sweating. Besides, one can also have difficulties in accomplishing different exercises. Although a physical examination can be carried out where the physician examines one heart rate. It can, however, be diagnosed using other intricate procedures such as blood tests, the use of x-ray, Echocardiogram, Magnetic resonance imaging, Cardiac catheterization, stress tests among other(Cardinale et al., 2015). As the condition exacerbate while it progresses from one stage to another, hospitalization, and specialized medication is required to manage the condition. With conjunction to the above, lifestyle changes also help in the management of symptoms. Inability to control factors such as stress, monitoring salt in one’s diet as well as controlling one’s intake of alcohol might lead to the disease relapsing. Other factors behind the relapsing of the above condition are not adhering to medication, smoking, uncontrolled hypertension, inappropriate medication among other factors. Relapsing causes serious health related expenditure and more often deaths. The above precipitating factors, therefore, have to be managed to ensure the effects that the relapsing of the disease has on the patient are not witnessed.
Potential Complications of Illness
Congestive heart failure is related to other major life-threatening diseases. The above contributes to the deterioration of the condition of the patient in question. According to statistics from the American college of cardiologists, approximately 55% of Medicare patients with heart failure also suffer from five or more comorbidities. Examples of such life-threatening conditions include chronic kidney disease, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, anemia, sleeping disorders among others. Other than relapsing of the condition, the above diseases are another major cause of emergency hospitalization of patients as well as high mortality rates. Although the above non-cardiac comorbidities might not be given the attention they require during the routine check, they hinder normal recuperation of the patient in question.
Interference with Daily Life According To Developmental Stage
Erickson’s Developmental stages are directly or indirectly associated with the influence that congestive heart failure has on different patients depending on their age. The eight stages are classified trust vs. mistrust, Autonomy vs. shame, and initiative vs. guilt, industry vs. inferiority, Identity vs. role confusion, intimacy vs. Isolation, generativity vs. stagnation and integrity vs. despair (Sacco, 2013).
Infants born with congestive heart failure do suffer not only suffer from physical development but also from emotional development. Weight gain is one of the difficulties associated with the condition. Autonomy vs. doubt might manifest due to the inability of the infant to grow at a normal rate, one which makes them be unable to accomplish small tasks without the help of their guardians. They might, for example, be unable to learn to crawl in time and hence will not be autonomous at this stage. Trust and mistrust might also be evident as the condition causes discomfort in an infant and might respond negatively to different undertakings by physicians during routine checkups. They might grow to detest medical institutions as well as environments that resemble such. Besides, due to the discomfort that comes with the condition, as they require more parental care, they might associate more with them and less with other people, hence, less ability in trusting other individuals that they might not interact with more often.
As the infant grows into early childhood, a stage where significant learning takes place during early schooling as well as they interact with the environment, their lives might differ from children with typical development. Although some children with CHF might have normal development and participate in school-related activities fully, some might have delayed development which might, in turn, affect their learning abilities. At this stage, the two stages of development, Initiative vs. guilt and Industry vs. inferiority might be evident. As children with the condition might have learning disabilities, it is possible that they will feel inferior when compared to their peers. They might also feel guilty for being unable to accomplish some tasks that children of their age perform with ease.
During adolescence, those affected by critical congestive heart failure are likely to be in and out of the hospital for the better part of their lives. They might hence miss critical developmental milestones. They might consequently develop identity crisis as they grow up. For adults, the disease might render them incapable of accomplishing their daily tasks at home as well as in the workplace. As a result, they might feel stagnated and view themselves as people who have a minor contribution to other people lives as well as their own. During late adulthood, as the circle of friends a person socializes with reduces, such an individual is likely to feel isolated and might even despair on life. Such individuals need to be shown love so that they can easily cope with their condition.
Current Management Recommendations
Management of congestive heart failure depends on the severity of the condition. Nonpharmacological therapies are applicable where the condition is not critical. Control of weight gain, monitoring of dietary sodium and the amount of liquid consumed go a long way to ensure that the situation does not affect the normal functioning of the individual in question. Besides the above, the condition can also be managed by the use of different types of clinically available medicine. They include ACE inhibitors and ARBs, Diuretics and digoxin, Beta-blockers, Aldosterone blockers, BiDil (isosorbide dinitrate/hydralazine) (Shah et al., 2017). Among other medications approved by FDA to manage the condition. The above drugs are administered by qualified physicians after an individual has been diagnosed with the condition. The above medication is recommended for adults with chronic congestive heart failure as a result of the a reduction in contraction of the left ventricle, heart failure symptoms, those with a heart rate of 70 beats per minute while at rest and those who have been prescribed to a dose of beta blockers considered to be highest but tolerable to them.
Non-Pharmacological Interventions/Counseling/ Spiritual Care
CBT is one of the approaches that can be used in the management depression, anxiety as well as stress in individuals suffering from congenital heart failure. The efficacy of the above approach has been proven in enabling individuals to control thoughts that might exacerbate the primary condition. Besides the above, counseling is also crucial for individuals who are dealing with risky behaviors such as drinking, smoking and using other drugs that might inhibit the action of the prescribed medication. Besides the above, it counseling can also help individuals who might have despaired with life to find a purpose and hence, adhere to medication prescription. Emotional as well spiritual support, besides, helps the individuals affected to find solace in what they believe. It also helps them to see that there much more to live for, other than focus on their illness. Most importantly, children need emotional support from their guardians, their peers as well as instructors at school. The above will ensure that regardless of the difficulties they might have with coping with the condition, they are supported throughout their journey.
In conclusion, congestive heart failure is one of the diseases that cause the death of thousand adults as well as children annually. Weight gain, difficulties in breathing and fatigue are some of the symptoms that adult with the above condition might manifest. Among infants, they might have difficulties in feeding and normal development. Diagnosis at early stages might be confused with other systemic heart-related conditions related to heart failure. Even though as the disease progresses from stage A which is the first developmental stage to stage D which is the last one, it becomes more evident that they suffer from the given condition. Depending on the severity of the disease, it can be managed by changing one’s lifestyle or by taking medication prescribed by a qualified physician. Due to the fact that the disease affects one’s daily life, there is need to incorporate non-pharmacological interventions that ensure the person is not only able to live with the condition but he or she can also accomplish other tasks just like other individuals do. CBT, counseling as well as physical therapy for the children whose development have been derailed by heart condition are necessary interventions that help the individuals in question to adapt living with the condition. In addition to the above, management of comorbidity, as well as relapsing of the conditions should be taken seriously to avoid high mortality rates usually related to the above factors.
References
Cardinale, L., Priola, A. M., Moretti, F., & Volpicelli, G. (2014). Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World journal of radiology , 6 (6), 230.
Sacco, R. G. (2013). Re-Envisaging the Eight Developmental Stages of Erik Erikson: The Fibonacci Life-Chart Method (FLCM). Journal of Educational and Developmental Psychology , 3 (1), 140.
Shah, A., Gandhi, D., Srivastava, S., Shah, K. J., & Mansukhani, R. (2017). Heart Failure: A Class Review of Pharmacotherapy. Pharmacy and Therapeutics , 42 (7), 464.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & Johnson, M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure: executive summary. Circulation , 128 (16), 1810-1852.
