Easy Treatment and control of heart failure and major symptom

 Treatment of heart failure        

Until the 1980s, pharmacotherapy was driven by the aim to
control symptoms, when diuretics and digoxin were the mainstay
of treatment. While relieving the symptoms of heart
failure remains decisive in improving a patient's quality of
life, a better understanding of the underlying pathophysiology
has led to major advances in the pharmacological treatment
of heart failure. With the introduction of angiotensin
converting enzyme (ACE) inhibitors, b-blockers, angiotensin
II receptor blockers (ARBs) and aldosterone antagonists,
delaying disease progression and ultimately improving survival
have become realistic goals of therapy. An outline of
the site of action of the various drugs is schematically presented.
In heart failure patients with co-morbid conditions known to
contribute to heart failure, such as hyperthyroidism, anaemia,
atrial fibrillation and valvular heart disease, attention must
be given to ensuring these underlying contributing factors are
well controlled. Patients with atrial fibrillation may be candidates
for electrocardioversion. Tachycardia from atrial fibrillation
usually requires control of the ventricular rate through
suppression of atrioventricular node conduction. In patients
with heart failure, the use of digoxin and/or ß-blockers is recommended
in such circumstances. In these patients, the use
of either anticoagulant or antiplatelet agents is necessary and
should be based on an assessment of stroke risk.
In patients with heart failure and preserved EF, diuretics
are commonly used for symptom control and there is some
limited evidence to suggest that ACE inhibitors can reduce
hospitalisation. However, the use of all other agents of proven
benefit in treating heart failure due to left ventricular systolic
dysfunction are currently not supported by an evidence base.
There is consensus that all patients with left ventricular
systolic dysfunction should be treated with both an ACE
inhibitor and a ß-blocker in the absence of intolerance or
contraindications. The evidence base for treatment clearly
shows that use of an ACE inhibitor (or angiotensin receptor
blocker) and ß-blocker therapy in patients with heart failure
due to left ventricular systolic dysfunction leads to an
improvement in symptoms and reduction in mortality. There
is some evidence to suggest that either agent can be initiated
first, as both appear to be just as effective and well tolerated
. Beneficial effects on
morbidity and mortality have also been shown for the use of
ARBs, aldosterone antagonists and hydralazine/nitrate combinations
when used in the treatment of chronic heart failure.
Digoxin has been shown to improve morbidity and reduce the
number of hospital admissions in patients with heart failure,
although its effect on mortality has not been demonstrated.
 describes the treatment of acute heart failure in the
hospital setting, while  highlights the possible treatment
options for patients with chronic heart failure due to left
ventricular systolic dysfunction.
The selection of adjunctive therapy beyond the use of ACE
inhibitor and ß-blocker therapy is largely dependent on the
nature of the patient and the preference of the heart failure
specialist involved in the patient's care. It is accepted that
there is a limit as to how many agents any one patient can
tolerate; therefore, the selection of drug therapy will probably
be tailored to each individual patient, meaning that treatment
plans will vary.
Investigations performed to confirm a diagnosis of heart failure
Investigation Comment
Blood test
The following assessments are usually performed:
• Blood gas analysis to assess respiratory gas exchange
• Serum creatinine and urea to assess renal function
• Serum alanine- and aspartate-aminotransferase plus other liver function tests
• Full blood count to investigate possibility of anaemia
• Thyroid function tests to investigate possibility of thyrotoxicosis
• Serum BNP or NT pro-BNP to indicate likelihood of a diagnosis of heart failure (screening test)
• Fasting blood glucose to investigate possibility of diabetes mellitus
12-lead
electrocardiogram
A normal ECG usually excludes the presence of left ventricular systolic dysfunction. An abnormal ECG will require
further investigation
Chest radiograph A chest radiograph (X-ray) is performed to look for an enlarged cardiac shadow and consolidation in the lungs
Echocardiography An echocardiogram is used to confirm the diagnosis of heart failure and any underlying causes, for example, valvular
heart disease

        ALL SYMPTOM OF HEART FAILURE  

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Sudden weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack

medicine used for hf are 

• Aldosterone inhibitors
• ACE inhibitors
• ARBs (angiotensin II receptor blockers)
• ARNIs (angiotensin receptor-neprilysin inhibitors)
• Beta-blockers
• Blood vessel dilators
• Calcium channel blockers (unless you have systolic heart failure)
• Digoxin
• Diuretics