Effects of Beta-Blockers on Congestive Heart Failure

The assignment involves a meta-analysis of published studies on the effects of beta-blockers for congestive heart failure in pediatric and congenital heart disease patients. It requires analyzing multiple sources to determine the overall impact of beta-blockers on this specific population. The studies analyzed include research on metformin use, angiotensin-receptor-neprilysin inhibitors, beta-3 adrenergic agonists, hospitalization rates for congestive heart failure, diagnosing acute heart failure in emergency departments, and more. The analysis will provide insights into the effectiveness of beta-blockers as a treatment option for patients with congestive heart failure.

Running head: ACUTE NURSING CARE
Acute nursing care
Name of the student:
Name of the university:
Author note:

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Table of Contents
Question 1: 2
Question 2: 3
Question 3: 4
Question 4: 5
References: 7

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Question 1:
The very first cause for congestive heart failure can be the coronary artery diseases; blockage
in the arteries can be formed due to either cholesterol deposition, fatty acid accumulation, or
other substances that contribute to blocking or damaging the arteries resulting in reduced blood
flow. The second cause can be the cardiomyopathy; here the heart muscles are damaged
progressively due to excessive smoking or alcohol consumption. Other common reasons leading
to congestive heart failures include impaired coronary valves, extreme hypertension, diabetes,
renal diseases. It is a fairly common health adversity that targets mainly the middle aged and
elderly population; this disease kills one Australian citizen in every 12 minutes and contributes to
30% of the total mortality (Scott & Winters, 2015).
With respect to the case study, it has to be understood that for the patient Mrs Sharon
McKenzie, a 77 year old female, the congestive heart failure that she had been suffering with had
been due to Sinus bradycardia, a very common aftermath of previous history of myocardial
infarction. She had suffered from myocardial infarction in the past at the age of 65, which has
already damaged her coronary muscles, and the sinus bradycardia must have contributed further
to her going through an episode of congestive heart failure (Pimenta et al., 2017).
Common risk factors of a heart failure generally constitutes of hypertension, previous
coronary heart diseases, diabetes, insomnia, congenital coronary abnormalities, addiction to
alcohol or prolonged history of smoking. However, the patient under consideration in the
assignment does not exhibit the above mentioned risks factors. On the other hand, the patient had
developed enlarged cardiac lobes and lower-lobe infiltrates. Hence the possible risk factors for

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patient had been due to her sinus bradycardia, presence of hypertension or high blood pressure,
and along with that her habit if forgetting taking important medication (Fry et al., 2017).
The impact of not being able to participate in certain activities that she used to participate in
the past can further irritate and depress her. The cumulative effect of all these factors and the
constant fear of exacerbations have been reported to act as a psychological burden (Swedberg et
al., 2012). Furthermore, even the family members and care providers live in constant fear and
anxiety of any possible aggravation. Her family as well might find themselves depressed due to
the helplessness of watching their loved one suffer from this disease and the impact of it on her
life.
Question 2:
One of the most important and indicative sign or symptom being exhibited in the patients is
the shortness of breath, which is also one of the most common symptoms associated with this
progressive heart disease (Hall, Levant & DeFrances, 2012). It has to be mentioned that the main
reason behind the dyspnoea is the congested lungs, due to the excessive fluid backup. The next
symptom exhibited by the Mrs McKenzie had been the presence of oedema or swollen ankles. It
has to be mentioned that the reduced blood flow throughout the body often disrupts the level of
water retention in the body which in turn affects the activities of the kidney. The lack of
oxygenated blood flowing to the kidney impairs the water or fluid retention balance of the body
resulting in swelling in the feet, ankles and even in the abdomen in certain cases (Crowley et al.,
2017). The third symptom exhibited by the patient is the dizziness and fatigue experienced. The
pathophysiology behind this can be the lack of blood flow to the major organs in the body, like
the brain and the muscles; the lack of oxygen weakens the muscles and hence, the patients feel

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exceeding dizziness and lack of energy for prolonged period of the day. The fourth symptom
exhibited by the patient had been the cold feet and hands. The main reason behind this symptom
in the patient can be due to the blood circulation throughout the body. In severe congestive heart
patients, the heart is unable to provide warm oxygenated blood flow across the body and as the
hands and feet are the extreme ends of the body they receive least amount of fresh blood flow
leading to cold to tough feeling in the feet and hands throughout the day. The last symptom
exhibited by the patient had been the occurrence of rapid and irregular heart rate at 54 beats per
minute. As the patient had the presence of several blockages in the heart, her coronary muscles
pumped faster than in a normal heart to compensate for the lack of blood flow (Bartunek et al.,
2016).
Question 3:
The very first class of drugs that are recommended for any congestive heart disease can be
the beta blockers, as they have the potential active agents that can manage and reverse the
pathophysiological changes that occur during a congestive heart failure. They are known to
target the manifestation if the heart failure by allowing the left ventricle of the heart to fill
completely, and slows the heart rate down significantly enhancing the chances of survival of the
patient. These drugs help in treating left ventricular systolic dysfunction. Certain beta blockers
can even improve the percentage of ejection fraction from the left ventricle of the heart allowing
more blood to be pumped from it with each heart beat. Along with that the beta blockers help in
widening and opening the blood vessels all throughout the body acting like a vasodilator. This
action of the beta blockers also help in reducing the high blood pressure of the patient and allows
increased blood flow all throughout the body. The patient in the case study can be administered
beta blockers like metaprolol or carvediol safely (Cho et al., 2015).

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The second class of drugs that have a significant impact can be the angiotensin receptor
blockers. The role played by renin-angiotensin aldosterone system in the pathogenesis of
congestive heart failure is extreme. As angiostenin serves as a key vasoconstrictor, the
angiostenin receptor blockers act as the perfect vasodilator inhibiting any progression of blood
vessel constriction. It has to be understood that the hormone catecholamine play a crucial role in
the manifestation of the different symptoms during the congestive heart failure. This class of
medicines help in reducing the damaging effect of these hormones in the body that are secreted
by a signaling mechanism activated in the body during a severe congestive heart failure. The
medication blocks the angiotensin receptors disrupting the signaling pathway and reduces the
production of the hormones. These medicine helps is reducing blood pressure and widening the
blood vessels as well. Losartan is a common option that the patient in the case study can take
safely as well (Desai et al,, 2015).
Question 4:
Congestive heart failure is a chronic progressive condition impairs the ability of the heart of
pumping blood and affects the coronary muscles, which in turn contribute to the reduced
potential of the heart to circulate sufficient amount of oxygen and nutrients throughout the body.
There are many complications associated with the diseases and its manifestations and each one if
associated with different threats to the health and wellbeing of the patient. The most important
symptom in case of any congestive heart failure is the shortness of breath that can lead to fatal
consequences if not addressed immediately. With respect to the case study, Mrs. McKenzie had
been experiencing shortness of breath as well along with nausea, dizziness, hypertension and
high heart rate. It has to be understood that the risk of mortality in the heart failure conditions
can be avoided if the immediate care actions are taken followed by prompt and instant diagnosis

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and relocating the patient to the ICU from the emergency as early as possible (Vijayakrishnan et
al., 2014). In this case as well, upon arrival to the emergency department, the primary care team
must take additional emphasis on the prompt recognition of the severity level of the patient and
the signs and symptoms exhibited. Followed by the patient should be administered nitroglycerin
and should be taken to the intensive care environment immediately. Followed by the nursing
triage and the identification of the severity status, an interdisciplinary coronary care team must
be employed to the patient as well. Beta blockers and ACE inhibitors should be administered
right away with objective monitoring to check for the response level in the patient to the
medication or treatment trajectory (Martindale et al., 2016).
It has to be mentioned that congestive heart failure is a lethal health adversity and given the
age of the patient, the chances of co-morbidities and aggravation is higher, especially due to the
dyspnoea, nausea, and weakness due to reduced blood flow and sinus bradycardia. Hence, the
patient should be given external oxygen supply to help prevent any chances of exacerbation of
the breathing problem. Along with that in the next 24 hours, the patient should be diligently
monitored by the interdisciplinary coronary care team; the vital signs of the patients including
dyspnoea, hemodynamic status, heart rate, cardiac output and oxygen saturation has to be
monitored effectively (Bartunek et al., 2016). The effect of vasodilators and other medication has
to be monitored as well to ensure that the level of congestion is reducing steadily in the patient
and no immediate surgical intervention is required. In case the patient responds to the medication
positively, the patient should be transferred to coronary rehabilitation ward for further treatment
with extra emphasis to reduce the anxiety and psychosocial burden of the patient is reduced by
relaxation intervention and psychosocial counseling. In case the patient does not respond

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positively to the pharmacological interventions, further surgical intervention should be planned
and executed after taking informed consent from the patient and her family.

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References:
Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C.
(2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART‐1)
trial design. European journal of heart failure, 18(2), 160-168.
Cho, M. J., Lim, R. K., Jung, M. K., Park, K. H., Kim, H. Y., Kim, Y. M., & Lee, H. D.
(2015). Effects of beta-blockers for congestive heart failure in pediatric and
congenital heart disease patients: a meta-analysis of published studies.
Crowley, M. J., Diamantidis, C. J., McDuffie, J. R., Cameron, C. B., Stanifer, J. W., Mock,
C. K., ... & Williams, J. W. (2017). Clinical outcomes of metformin use in
populations with chronic kidney disease, congestive heart failure, or chronic liver
disease: a systematic review. Annals of internal medicine, 166(3), 191-200.
Desai, A. S., McMurray, J. J., Packer, M., Swedberg, K., Rouleau, J. L., Chen, F., ... & Finn,
P. V. (2015). Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696
compared with enalapril on mode of death in heart failure patients. European heart
journal, 36(30), 1990-1997.
Fry, N., Liu, C., Garcia, A., Galougahi, G. K., Hamilton, E., Harris, J., ... & Rasmussen, H.
(2017). From Bench-Based PhD Project to First-in-Man Use of β3 Adrenergic
Agonist in Patients with Treatment-Resistant Decompensated Congestive Heart
Failure. Heart, Lung and Circulation, 26, S134.
Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalization for congestive heart
failure: United States, 2000–2010. age, 65(23), 29.

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Martindale, J. L., Wakai, A., Collins, S. P., Levy, P. D., Diercks, D., Hiestand, B. C., ... &
Sinert, R. (2016). Diagnosing Acute Heart Failure in the Emergency Department: A
Systematic Review and Meta‐analysis. Academic Emergency Medicine, 23(3), 223-
242.
Norhammar, A., Johansson, I., Thrainsdottir, I. S., & Rydén, L. (2017). Congestive heart
failure. Textbook of Diabetes, 659-672.
Pimenta, E., Jensen, M., Jung, D., Lobmeyer, M., Schmitt, W., Schaumann, F., ... & Truebel,
H. (2017). A Novel Balanced Dual Vasopressin V1a/V2 Receptor Antagonist for
Treatment of Congestive Heart Failure: Results From a First-in-Man Study.
Scott, M. C., & Winters, M. E. (2015). Congestive heart failure. Emergency Medicine
Clinics, 33(3), 553-562.
Swedberg, K., Komajda, M., Böhm, M., Borer, J., Robertson, M., Tavazzi, L., ... & Shift
Investigators. (2012). Effects on outcomes of heart rate reduction by ivabradine in
patients with congestive heart failure: is there an influence of beta-blocker dose?:
findings from the SHIFT (Systolic Heart failure treatment with the If inhibitor
ivabradine Trial) study. Journal of the American College of Cardiology, 59(22),
1938-1945.
Vijayakrishnan, R., Steinhubl, S. R., Ng, K., Sun, J., Byrd, R. J., Daar, Z., ... & Stewart, W.
F. (2014). Prevalence of heart failure signs and symptoms in a large primary care
population identified through the use of text and data mining of the electronic health
record. Journal of cardiac failure, 20(7), 459-464.

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