TeleMedicine – How To Detect At Earliest Worsening Heart Failure?
1. Did you weigh yourself today?
2. What is your current daily weight?
3. Have you taken your medications?
1. Do you have any chest discomfort?
2. Are you more short of breath?
3. Does your abdomen feel bloated?
4. Are you urinating less than usual or the same amount?
5. Are you more tired than usual?
6. Do you feel dizzy or light-headed?
If there are many Yes in the evaluation question set then the patient has sings of possible early deterioration.
Prompt intervention is needed with pre-emptive measures:
· Withhold diuretics if vomiting or diarrhea
· Relax fluid restriction regimen when patient has vomiting or diarrhea
· Hold ACEI or BB if dizziness or low BP.
· Call again from the office in the afternoon if worse
· Take extra dose of diuretic if gain more than 2 lbs.
· Call again from the office if urine output no higher
What to do When the Patient Does Not Do Well Even with Optimal Medical Treatment?
Millions of patients suffer from myocardial infarction and many succumb to the morbidity of the ensuing cardiac failure, a protected condition in need of healing. Despite improvements in the understanding and therapy of many stages of cardiovascular disease, there has been little progress in treating HF. While pharmacological agents have been the mainstay intervention that ameliorates cardiac failure through increased contractility or reduction of cardiac workload, these agents do not inherently heal the wounds inflicted by poor perfusion of the affected cardiac tissue. The chemically injured failing heart lacks contractile myocardium, functional vasculature, and electrical integrity, which has made treatment of the underlying injury untenable in the past. Current options are cell therapy, cardiac transplantation and long term mechanical support. Restoring all of these components at once seems to be an overwhelming challenge.