Biomedical subjects

Sara Paul

Publications and source records attributed to Sara Paul.

8 recordsLinked to original sources

PubMed2004

Strategies for behavior change in patients with heart failure.

Appropriate management of chronic heart failure and its signs and symptoms requires a considerable amount of participation by patients. Behavioral changes that prevent or minimize signs and symptoms and disease progression are just as important as the medications prescribed to treat the heart failure. The most difficult lifestyle changes include smoking cessation, weight loss, and restriction of dietary sodium. The Transtheoretical Model is a framework for assessing and addressing the concept of readiness for behavior change, which occurs in a 6-step process. The model consists of 3 dimensions: the stages of change, the processes of change on which interventions are based, and the action criteria for actual behavior. The stages of change are discussed, and interventions are presented to assist patients with heart failure in progressing through those stages toward maintenance of changed lifestyle behaviors. Methods for measuring the level of readiness for change of patients with heart failure are also presented, because correct staging is required before appropriate interventions matched to a patient's stage can be delivered.

Behavior Control↗

PubMed2003

Case studies in heart failure.

This article presents four case studies of patients with heart failure and the rationale for optimal treatment in each case.

Activities of Daily Living↗

PubMed2003

Ventricular remodeling.

Ventricular remodeling is an extremely complicated process that is not well understood. There seem to be multiple feedback loops that respond to mechanical events as well as to neurohormonal stimulation, cytokine release, and other, yet unidentified, agents. The progression of ventricular remodeling after the index event includes: Myocyte slippage and thinning of infarct area, chamber dilatation. Fibrosis and scar formation. Collagen strut dissolution and excessive accumulation of interstitial matrix. Increased wall stress. Myocyte hypertrophy. Neurohormonal activation. Cytokine release. Ongoing myocyte hypertrophy. Cell apoptosis and necrosis. Continued deterioration of cardiac function. It is impossible to place the sequence of events in order, because the multiple feedback systems create a complex interactive process. A basic awareness of the pathophysiology of ventricular remodeling can aid in understanding current and future treatments for heart failure. It is clear that therapeutic interventions solely aimed at improving cardiac pump function do not slow the progression of heart failure or reduce mortality. Drugs that block the neuroendocrine contribution to the remodeling process have been shown to have a greater impact. Current therapies with angiotensin-converting enzyme inhibition, beta blockade, and aldosterone antagonism are associated with significant reductions in morbidity and mortality in heart failure. Other therapeutic strategies suggested by knowledge of remodeling mechanisms, such as drugs to block cytokines, endothelins, and MMPs, may offer further benefit to patients with heart failure in the future.

Cytokines↗

PubMed2003

Diastolic dysfunction.

Although the annual mortality rate for diastolic heart failure is better than that for systolic heart failure, it is still greater than that for age-matched controls. Five-year mortality rates are about 50% for patients with systolic heart failure and are about 25% for patients with diastolic heart failure. In elderly patients (over 65 years of age), the outcome with systolic and diastolic dysfunction may be more comparable. In contrast to systolic heart failure, the effect of therapy in patients with diastolic heart failure has not been evaluated in large clinical controlled trials. Guidelines for managing heart failure with preserved systolic function broadly suggest the direction for management, but specific treatments are currently based on expert consensus, clinical experience, and scientific elucidation of diastolic mechanics. Although evidence-based guidelines are not available for all aspects of management of diastolic heart failure, future research will increase the knowledge of this disorder and improve treatment strategies.

Diastole↗

PubMed2003

The use of beta-blockers in the treatment of chronic heart failure.

The use of beta-blockers in addition to digoxin, diuretics, and ACE inhibitors was shown to be beneficial for patients with chronic heart failure. Benefits include decreased hospitalizations, decreased need for heart transplant, and decreased mortality. The fact that beta-blockers may improve a sense of well-being, as well as quality of life, for patients with chronic heart failure, is perhaps the greatest advantage to including these drugs in HF therapy.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Anemia in heart failure: implications, management, and outcomes.

Despite advances in the treatment of heart failure (HF) over the past decade, the prognosis remains poor. Anemia is a well-recognized comorbidity in many chronic conditions, but its role in HF has only recently been recognized. Anemia is significantly related to symptoms, exercise capacity, and prognosis in HF; it has been identified as an independent risk factor for mortality in those with left ventricular dysfunction. When HF patients have concomitant renal disease, they invariably become anemic owing to erythropoietin deficiency. In chronic HF patients without renal disease, erythropoietin levels may be elevated in response to anemia, but not adequately increased to overcome it. Some degree of erythropoietin resistance may also be present because of elevated plasma levels of cytokines. Several studies in anemic HF patients have shown positive outcomes using erythropoietin and iron supplementation therapy to increase hemoglobin concentrations to more normal levels. This article reviews the current information available regarding anemia in HF and discusses the clinical implications and treatment of this syndrome.

Algorithms↗

PubMedDate not supplied

Patient perceptions of quality of life and treatment in an outpatient congestive heart failure clinic.

In an effort to better understand patients' definitions of quality of life (QOL) and to determine which tools would be most appropriate for use in future studies, a descriptive study was done in a university-based congestive heart failure clinic. Participants were asked a series of five open-ended questions regarding their perceptions of QOL during recorded interviews. Most patients equated QOL with the ability to perform physical functions in the same way they did before developing heart failure. They grieved for their former abilities and expressed lower self-esteem due to loss of independence from physical limitations. The Short Form-36 and the Minnesota Living With Heart Failure Questionnaire addressed the QOL issues important to our patients. It is important for health care providers to consider the patient's perception of QOL when using quantitative tools for QOL measurement in clinical practice.

Adult↗

PubMedDate not supplied

Balancing diuretic therapy in heart failure: loop diuretics, thiazides, and aldosterone antagonists.

In heart failure, sodium is retained by the kidneys despite increases in extracellular volume. There is activation of renin secretion, which culminates in the production of angiotensin II, causing vasoconstriction and aldosterone secretion. These synergistically produce an increase in tubular reabsorption of sodium and water. Diuretics are the mainstay of symptomatic treatment to remove excess extracellular fluid in heart failure. Diuretics that affect the ascending loop of Henle are most commonly used. Thiazide diuretics promote a much greater natriuretic effect when combined with a loop diuretic in patients with refractory edema. Recently, spironolactone, an aldosterone receptor blocking agent, has been recommended to attenuate some of the neurohormonal effects of heart failure. Regardless of the diuretic, patients need to be counseled on the importance of avoiding sodium in their diet

Benzothiadiazines↗