Individuals at high risk for Heart failure (HF)
Individuals in Stage A HF have predisposing factors that put them at high risk for developing the cardiomyocyte loss or dysfunction characteristic of HF. However, in many instances, steps can be taken to prevent or reduce the conditions that may progress to heart failure. The goal for these patients is to prevent cardiac structural changes including: hypertensive heart disease, cardiac remodeling, coronary heart disease (CHD) from developing.
Screening for Stage A patients
- Visual assessment
- Signs of distress?
- Distended neck veins?
- Peripheral circulation, edema?
- Systems assessment can identify comorbidities that may influence or indicate disease progession beyond stage A.
- BP, pulse, jugular venous distention, heart murmurs, extra heart sounds, lateral displacement of apical pulse,
- Peripheral extremity - temperature, perfusion, edema, clubbing
- Lung assessment - cough, crackles, rhonchi, decreased breath sounds
- Body mass index, rapid weight gain or anorexia
- Abdomen - distension, ascites, hepatomegaly
- Review diagnostics as appropriate to symptoms
- Laboratory evaluation of patients may include complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, fasting blood glucose, glycated hemoglobin, fasting lipid profile, liver function tests, and thyroid-stimulating hormone
- B-type natriuretic peptide (BNP): elevated levels may be helpful in diagnosing a patient suspected of having HF or used to consider a diagnosis of HF when the diagnosis is unknow
- Cardiac evaluation - 12 lead electrocardiogram, 2-dimensional echocardiogram with Doppler to assess ventricular function, size, wall thickness, wall motion, and valve function.
- Chest X-ray
- Coronary arteriography for patients with angina or significant ischemia
- A careful patient history can help to identify modifiable risk factors and comorbidities that may influence disease status or progression.
- Family history of heart disease
- Sudden death
- Familial cardiomyopathy
- idiopathic dilated cardiomyopathy
- Medical history
- Current or chronic conditions
- Sleep pattern - orthopnea, paroxysmal nocturnal dyspnea (PND), nocturia
- Rheumatic fever
- Medications history including past and current cardiac treatments, alternative therapies, and antineoplastic agents
- Substance use: alcohol, illicit drugs, smoking, OTCs, etc.
- Physical activity - level and tolerance, ADLs
Factors and conditions strongly associated with the development of HF (BCGuidelines, 2015)
- Diabetes mellitus
- Family histroy of cardiomyopathy or sudden death
- Sleep apnea
- Cardiovascular disease(e.g.,vavular heart disease, coronary heart disease, atrial fibrillation)
- Alcohol and substance abuse (current or past)
- Age (60>)
- Thyroid disease
- Chronic kidney disease
- Metabolic Syndrome management
Metabolic syndrome includes a cluster of risk factors that raises a person's risk for coronary heart disease, diabetes and stroke. Medications may be required if lifestyle changes including heart-healthy diet, weight control, managing stress, physical activity, and quitting smoking are not enough to reduce low density lipoprotein (LDL), hypertension and diabetes.
The National Institutes of Health have identified five risk factors common to metabolic syndrome. The presence of three or more of these factors may indicate metabolic syndrome. The more risk factors a person has, the greater the chance of heart disease, diabetes and stroke.
Five risk factors:
- A large waistline also called abdominal obesity or having an apple shape. The excess fat in the stomach area creates the greatest risk factor for heart disease compared with excess fat in other parts of the body.
- A high triglyceride level (or being treated for high triglycerides).
- A low HDL cholesterol level (or on medicine to treat low HDL cholesterol).
- High blood pressure (or on medicine to treat high blood pressure).
- High fasting blood sugar (or on medicine to treat high blood sugar) (NHLBI, 2016).
- Cardiotoxic substance exposure can increase the incidence of HF.
- Cocaine - Direct and indirect effects on myocardium Increase risk of CHF and sudden cardiac death Prolonged tachycardia - left ventricular systolic dysfunction
- Chemotherapy agents
- Trastuzumab and other monoclonal ab-based tyrosine kinase inhibitors
- Anthrcyclines (doxorubicin)
- Fluorouracil (5-FU)
- Antimicrotubule agents (paclitaxel, docetaxel)
- Inotropic drugs
- High Na+ content drugs
- Etanercept, Infliximab
- Herbal/natural product
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