X-rays also sometimes show conditions other than heart failure that possibly cause the patient's signs and symptoms (Mayo Clinic Staff, 2009). Electrocardiogram (ECG): Through electrodes attached to the patient's skin, an ECG records the electrical activity of person's heart and records the impulses. These impulses, displayed on a monitor, may also be printed on paper. From this test, the doctor can diagnose heart rhythm problems and also ascertain damage the person's heart may have experienced from a heart attack that may underlie heart failure (Mayo Clinic Staff, 2009).

Echocardiogram: From this test, the doctor can diagnose and monitor heart failure. "An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of & #8230;[the patient's] heart (Mayo Clinic Staff, 2009, ¶ 5). From the image, by measuring the percentage of blood pumped out of the heart's primary pumping chamber (the left ventricle) with every heartbeat, the doctor can better determine how well the person's heart is pumping. This measurement is known as the ejection fraction. The echocardiogram may also reveal valve problems or show signs of previous heart attacks, as well as other abnormal causes of heart failure (Mayo Clinic Staff, 2009, ¶ 5).

Ejection fraction: An echocardiogram as measures the patient's ejection fraction. This serves as a significant measurement of how well the person's heart is pumping. This test helps the doctor classify heart failure and determine the best treatment. In a person with a healthy heart, the ejection fraction measures approximately 55%. This means that the heart pumps out more than half of the blood that fills the ventricle with each heart beat (Mayo Clinic Staff, 2009).

Stress test: A stress tests measures how the person's heart and blood vessels respond to exertion. For this test, while attached to an ECG machine, the person my walk on a treadmill or pedal a stationary bike. The doctor may instead give the person a drug intravenously to stimulate his/her heart similar to exercise. From the stress tests, the doctors can better determine if the person has coronary artery disease as well as how the person's body is responding to his/her heart's diminished pumping effectiveness. A doctor may order a nuclear stress test see images of the person's heart while he/she exercises. This test resembles an exercise stress test, but in addition, the doctor injects dye into the patient that special imaging techniques trace to further reveal the patient's heart condition (Mayo Clinic Staff, 2009).

Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI): The CT and MRI tests also help diagnose heart problems and causes of heart failure. When given a cardiac CT scan, the patient lies on a table inside a doughnut-shaped machine where the machine's internal X-ray tube rotates around the person's body taking images of his/her heart and chest (Mayo Clinic Staff, 2009).

In some instances, CHF may be treated by prescribing medication for the person's high blood pressure. When an abnormal heart valve causes CHR, the valve may be surgically replaced. If the heart is too damaged to be repaired, the physician may consider a more radical approach; sometimes a heart transplant may be an option. " Most people [,however,] with mild and moderate congestive heart failure can be treated" (Congestive heart failure, 2010, ¶ 11). Proper medical supervision and treatment, a person will not likely become an invalid.

Possible Medical or Nursing Therapies

"One option you have for your CHF," Dr. Shoemaker explained to Velma, "is to receive regular treatment at an outpatient CHF clinic. These clinics asses their patients, prescribe medications and educate the patient regarding CHF."

Beth F. Crowder, M.D. (2006), an Advanced Practice Nurse, Little Rock, Arkansas, explains in the study, "Improved symptom management through enrollment in an outpatient congestive heart failure clinic," that those individuals regularly attending an OP CHF clinic typically realize improvements in their lifestyles that include increasing their functional capacity and their quality of life. They also experience a decrease in emergency room visits "hospital re-admissions, length of stay for re-admissions, and total costs" (Ibid., ¶ 2). Dr. Shoemaker explained to Velma that going to a CHF outpatient clinic would be a wise decision. "These clinics typically deal with patients who have one or more chronic illness," she told Velma. "This would prove helpful for you since you have CHF and Type 2 diabetes."

To help decrease Velma's fears, Dr. Shoemaker related what another patient who had participated in CHF outpatient treatment stated: "If I hadn't gone to the heart failure clinic I wouldn't be here. I thought I was gonna die. I'm convinced of that' (Crowder, 2006, Fear section, ¶ 1). It is also important...

Shoemaker added, "it will help you by providing moral support and help him to overcome his fear of hospitals and clinics. Tell your husband that patients who have family members supporting them have a much higher rate of staying healthy longer."
"It is also important for you to continue to change you eating habits to healthier ones," Dr. Shoemaker also said. "CHF will cause you to retain more fluids she in addition to eating a low fat diet, you have to monitor your sodium intake and fluids. To maintain a proper fluid level, you will need to also take diuretics. Exercise is also important," Dr. Shoemaker stressed. "Walking several times a week would be a good habit to help maintain a healthier lifestyle."

Commonly Prescribed Medications

When Dr. Shoemaker reviewed Velma's medical records, she noted that Velma took insulin to control her Type 2 diabetes, not TZDs, a factor in Velma's favor. "Diabetes medications known as thiazolidinediones (TZDs) significantly increased the risk of heart attack, congestive failure and death in older patients, a study in an issue of JAMA last month found" (Diabetes medications known…, 2008, ¶ 1).

V-HeFT-I the first Vasodilator-Heart Failure Trial demonstrated that black patients had a decrease in annual mortality while taking a combination of isosorbide dinitrate and hydralazine as compared to similar white patients following the same regimen. This drug combination serves as a NO donor, thereby replenishing an important antioxidant that is diminished in blacks. (Schmitz, 2007, Research finding section, ¶ 2).

In the article, "Nutritional influences on illness: The influence of vitamins on congestive heart failure," Dr. Melvyn R. Werbach (2008) reports that as many as one-third of patients with congestive heart failure (CHF) may be thiamine-deficient. CHF may constitute "part of the presentation of wet beriberi, the classic cardiovascular disease of thiamine deficiency, manifested by peripheral vasodilatation with increased cardiovascular output, myocardial lesions, sodium and water retention, and biventricular myocardial failure" (Werbach, ¶ 1). When thiamine is replenished, however, the patient experiences a rapid improvement.

Another concern for Velma, Dr. Shoemaker noted was that the diuretic furosemide she had to take could cause urinary loss of thiamine, and lead to even more impaired cardiac function. One study, according to Werbach (2008) found that when this occurs, "thiamine supplementation has been shown to be beneficial…. Even refractory heart failure can be quickly reversed when it is secondary to a deficiency of thiamine" (Werbach, 2008, ¶ 2). Dr. Shoemaker explained to Velma that CHF generally requires a patient's treatment program to include:

Rest

proper diet modified daily activities drugs such as

ACE (angiotensin-converting enzyme) inhibitors beta blockers digitalis diuretics vasodilators. (Congestive heart failure, 2010, ¶ 7)

Different drugs used to treat CHF perform a variety of functions. For example:

ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart's work easier or more efficient" Beta blockers can improve how well the heart's left lower chamber (left ventricle) pumps. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water. (Congestive heart failure, 2010, ¶ 8)

Recommended Life Style Changes

Lifestyle changes may help those individuals with CHF experience relief in signs and symptoms of the disease and prevent it from worsening. Table 1 presents a number of significant lifestyle changes Velma and others with CHF can make.

Table 1: Lifestyle Changes for Velma (adapted from Mayo Clinic staff, 2009, ¶ 2-10).

Do not smoke

Avoid excessive second-hand smoke

Smoking damages blood vessels, reduces the amount of oxygen in your blood and makes your heart beat faster.

Weigh yourself daily

Do this each morning after urination, but before you eat breakfast. Notify your doctor of a weight gain of 3 (1.4 kilograms) or more pounds in a day.

Restrict sodium

Restrict sodium. Sodium is a component of salt. Too much sodium contributes to water retention, which makes a person's heart work harder and causes shortness of breath and swollen legs, ankles and feet. For people with heart failure, the daily recommended amount of dietary sodium is no more than 2,000 milligrams a day.

Eat Properly

Maintain a healthy weight. If overweight, a dietitian will help you work toward your ideal weight.

Limit fats and cholesterol

In addition to avoiding high-sodium foods, limit the amount of saturated fat, trans fat and cholesterol in diet.

Limit alcohol and…