Download Heart Failure, HF

Heart Failure, HF
CHF develops when plasma volume increases and fluid
accumulates in the lungs, in the abdominal organs (liver especially),
and peripheral tissues. CHF is a complex and chronic disease with
frequent life-threatening acute episodes .
Cardiac reserve, especially in young and fit people
helps deliver oxygen to tissue during stress
and exercise; for example:
in crease in heart rate: 55-70 BPM to 180 BPM
cardiac output (CO = stroke volume x BPM) :
5 to >= 25 L/min
Also oxyhemoglobin-dissociation curve can provide another
reserve mechanism in HF, shift of curve to the right or
increase in the P50 value makes oxygen release from Hb
greater at the level of capillary for a given pO2
HF occurs when these reserves no longer sufficient.
Can be LV failure or RV failure, LV usually a result of coronary
artery disease, hypertension and congenital defects. RV
usually comes about after LV which causes pulmonary venous
hypertension.
So in LV failure CO declines and pulmonary venous
pressure increases and pulmonary capillary pressure
increases to levels that exceed the oncotic pressure of the
plasma proteins (about 24 mmHg) leading to lung water
which makes the lungs stiff and affects breathing and
oxygen transport.
So when pulmonary venous hydrostatic pressure exceeds
the plasma protein oncotic pressure fluid extravasates into
the interstitial space and the alveoli. Lymphatic drainage
can not keep up and the results is lowered capillary pO2.
Because of reduced CO there is reduced renal blood flow
with a lowering of GFR and retention of Na as the kidney
responds in a manner that makes HF symptoms worse.
Water follows the salt leading to edema.
Conventional treatment primarily involves Na restriction in
diet, diuretics (remove the water, but issues with K), ACE
inhibitors (vasodilation decreasing vascular resistance),
digitalis (stimulates stronger heartbeat), and -blockers.
Aquapheresis
Fluid overload simply means having an excess of
fluid in the body. The excess fluid, primarily
sodium and water, builds up in various locations in
the body and leads to an increase in weight,
swelling in the legs and arms (peripheral edema),
in the abdomen (ascites), and congestion in the
lungs causing difficulty in breathing (dyspnea).
Fluid overload can be caused by many things,
including problems with the heart, kidneys, lungs
or a combination of any of these vital organs.
Fluid overload can also be experienced after
certain surgical operations. The leading cause of
fluid overload is congestive heart failure (CHF),
sometimes referred to as just heart failure (HF).
The goals of any treatment for fluid overload are
to...
remove the excess sodium and water,
achieve fluid balance (euvolemia, dry weight),
relieve the symptoms,
improve the overall quality of life for patients.
If you’re suffering from fluid overload, your healthcare provider may prescribe the following to remove your excess sodium and water:
• Low salt diet (limits the amount of salt/sodium that you take in)
• Fluid restriction (limits the amount of liquids you take in)
• Diuretic drugs, e.g. water pills (increases urine production)
• Aquapheresis Therapy (mechanically filters the excess water
from your blood)
Many patients are helped with diuretic drugs and achieve and
maintain normal dry weights. However, these diuretic drugs don’t
always work or they temporarily stop working, and patients may
be hospitalized to adjust or change their medications and/or to
remove extra fluid by other means.
For example, approximately 50% of hospitalized heart failure
patients achieve fluid and weight reduction with diuretics.
The other 50% do not. Up to 30% of fluid overload patients
suffer from diuretic resistance. This means that their kidneys
for one reason or another, are not responding to the diuretic drugs
as they should. This condition can last for a short amount of time
(acute) or prolonged (chronic).
Aquapheresis: A Non-Drug, Non-Diuretic Treatment Option
for Fluid Overload:
Aquapheresis is a medical therapy designed to remove
excess salt and water from the body safely, predictably, and
effectively from patients suffering from fluid overload. It
removes excess salt and water and helps to restore a
patient’s fluid balance or euvolemia.
Physicians can specify and adjust the exact amount and rate of
fluid to be removed from each patient, resulting in a gradual
reduction that has no significant clinical impact on blood
pressure, heart rate, or the balance of electrolytes (chemical
substances, such as sodium, potassium, and chloride) in the
body.
Up to 500 ml or 1.1 lb of fluid can be safely removed per hour.
The average removal rate is 250 ml or ½ lb an hour and
treatment usually lasts about 24 hours. Studies have shown that
the total hospital stay with Aquapheresis therapy is around
three to four days.
The exact length of time of the treatment is determined by how
much total fluid needs to be removed and how fast your
healthcare provider can remove it. The less you move, the more
efficiently the blood gets pumped through the filter and the
sooner the desired amount of fluid may be removed. The
average treatment is approximately 24 hours in which an
average of 6 Liters or 13.2 lbs of fluid is removed.
Aquapheresis therapy complements drug-based options such as
diuretics (drugs that help rid the body of excess water),
inotropic drug therapies (drugs that stimulate the heart to expel
more blood with each beat), or vasoactive drug therapies (drugs
that dilate blood vessels) to achieve the target fluid removal
goal for the patient. And, because it removes sodium and resets
body fluid levels, Aquapheresis may also improve the
effectiveness of oral diuretics that patients take on an ongoing
basis (e.g. water pills).