Heart failure treatment - Early stages

- In the early stages of Heart Failure the patient might not even have symptoms. And they might only have risk factors for Heart Failure. This means that they probably have some kind of pre-existing condition that might, if you leave it unchecked, will lead to Heart Failure in the future. Or lead to worsening Heart Failure if it's already present. But these conditions haven't led to full blown Heart Failure with, with symptoms. So patients are likely still able to go about their daily lives. Some example of Risk Factors might include something like hypertension, or high blood pressure, or coronary artery disease, or diabetes. The doctor might recognize these conditions as red flags for Heart Failure. And even though they're just seeing it as these preliminary signs and risk factors, they'll emphasize the importance of improving these conditions before Heart Failure gets worse. Because most of the time especially with structural changes to your heart, where it starts to look different, these tend to be unidirectional. Meaning that those changes only tend to get worse not better. So with that said, a very important early stage treatment that's recommended is exercise. With exercise your cardiovascular fitness increases. This increases your heart's efficiency so your heart gets better at pumping blood. And we know that a reduced pumping efficiency is a main theme in Heart Failure. And in addition to exercise another lifestyle change that might be recommended is a change in diet. And reducing salt intake is a common and important change. And doing this tends to reduce your blood pressure, making it easier to pump blood out. And this lowers the chances of the heart to start to compensate and start making structural changes to the heart's ventricles which, like we said, is a one way street. The doctor might also decide to prescribe medications. And these will often be targeted at reducing blood pressure which, like we said, makes it easier for the heart to pump blood out. And reduces the chance of compensation and structural changes to the heart. So the first class of medications are ACE inhibitors or A-C-E inhibitors. This stands for angiotensin-converting-enzyme and these are vasodilators. And from this word we've got vaso which means vessels so your blood vessels. And then you've got dilator which is to widen so these cause your blood vessels to dilate or get bigger. And when they dilate they aren't squeezing the blood inside them as much and so the pressure in your blood vessels goes down. And if the pressure in your blood vessels goes down your heart's going to have an easier time pumping blood out to this lower pressure system. Just remember that analogy about trying to blow air through a really small straw and then a really big tube. Which one's more difficult? It's the straw, right? Well, in the same way your heart's going to have an easier time pumping blood through these dilated blood vessels. And another set of medications that might be prescribed are Hydralazine and Nitrates. And these also tend to reduce your blood pressure. Hydralazine specifically acts as a vasodilator for arteries and arterials. Which are the blood vessels going away from the heart, right? And like we just mentioned this makes it easier for your heart to pump blood out. Nitrates, on the other hand, although they can act on your arteries as well mostly act on your veins. So they act to reduce your venous blood pressure. And this reduces the pressure in getting blood back to the heart. Which also reduces your Preload. Remember, that the Preload is one of those mechanisms of compensation. So if we reduce the Preload we can limit the structural changes that might start to happen as a result. Finally, the last class of medications are called Beta Blockers. And these help inhibit the activation of the sympathetic nervous system. Remember how the sympathetic response in the heart is activated, with these receptors on the heart. Well these receptors are generally known as Beta Receptors. So Beta Blockers tend to block these receptors from being activated. That makes sense. So if they were activated, the heart rate and pumping force increases, right? But if they're blocked this tends to slow down the heart rate and limits that sympathetic response. And limiting this is important because just like increased Preload, we remember that over activation of the sympathetic nervous system is a method of compensation which can lead to structural changes to the heart. And so we want to try to reduce the chances of any structural changes.