A patient is followed for several years with heart failure. His case is early at stage A.
Answer the following questions.
1. Which stage A patients would benefit from adding an angiotensin-converting enzyme
inhibitor?
a. All patients in stage A, B, C, and D may benefit from the addition of an ACE
inhibitor, unless not tolerant of the medication, then an ARB may be
preferred (AHA, 2013). This is because patients who are in stage A of heart
failure are considered at-risk but do not yet have structural changes to their
heart or
symptoms associated with HF (Burchum & Rosenthal, 2020). This means there
have been one or more identified risk factors in the patient such as hypertension,
CAD, diabetes, obesity, metabolic syndrome, etc (AHA, 2013). The ACE
medication will suppress the production of angiotensin II and cause dilation of the
arterioles and veins (Burchum & Rosenthal, 2020). This will in return improve
blood flow through the cardiovascular system and kidneys. It will decrease
afterload and increase stroke volume and cardiac output (Burchum & Rosenthal,
2020). The venous dilation also helps in this patient population because it will
decrease the risk of pulmonary congestion and peripheral edema, as well as
decreasing preload (Burchum & Rosenthal, 2020). The suppression of aldosterone
will suppress the degradation of kinins, as well as increase the secretion of excess
sodium and water in the body (Burchum & Rosenthal, 2020). This medication has
been proven to be very effective in managing hypertension and improving
hemodynamics in patients at risk or currently diagnosed with heart failure in all
stages (Burchum & Rosenthal, 2020).
2. As the patient progresses through the heart disease stages, when are diuretics typically
added? Are all heart failure patients candidates for diuretics at this stage?
a. Patients in stage B of heart failure present with structural heart disease but still do not
exhibit symptoms of HF, this is typically due to prolonged risk factors, MI, reduced
ejection fraction, etc (AHA, 2013). It is recommended by the AHA to treat these patients
with an ACE inhibitor as well as the addition of a beta blocker if additional management
is necessary (AHA, 2013). Once patients progress into stage C, these patients now have
structural heart disease with the addition of past or present symptoms of HF such as
shortness of breath, exercise intolerance, peripheral edema, etc (Burchum & Rosenthal,
2020). Because of this, diuretics
are typically introduced at this stage to help manage symptoms related to
congestion (AHA, 2013). Most patients will likely be candidates for diuresis at
this stage as well as stage D, however, there may be some contraindications to
Answer the following questions.
1. Which stage A patients would benefit from adding an angiotensin-converting enzyme
inhibitor?
a. All patients in stage A, B, C, and D may benefit from the addition of an ACE
inhibitor, unless not tolerant of the medication, then an ARB may be
preferred (AHA, 2013). This is because patients who are in stage A of heart
failure are considered at-risk but do not yet have structural changes to their
heart or
symptoms associated with HF (Burchum & Rosenthal, 2020). This means there
have been one or more identified risk factors in the patient such as hypertension,
CAD, diabetes, obesity, metabolic syndrome, etc (AHA, 2013). The ACE
medication will suppress the production of angiotensin II and cause dilation of the
arterioles and veins (Burchum & Rosenthal, 2020). This will in return improve
blood flow through the cardiovascular system and kidneys. It will decrease
afterload and increase stroke volume and cardiac output (Burchum & Rosenthal,
2020). The venous dilation also helps in this patient population because it will
decrease the risk of pulmonary congestion and peripheral edema, as well as
decreasing preload (Burchum & Rosenthal, 2020). The suppression of aldosterone
will suppress the degradation of kinins, as well as increase the secretion of excess
sodium and water in the body (Burchum & Rosenthal, 2020). This medication has
been proven to be very effective in managing hypertension and improving
hemodynamics in patients at risk or currently diagnosed with heart failure in all
stages (Burchum & Rosenthal, 2020).
2. As the patient progresses through the heart disease stages, when are diuretics typically
added? Are all heart failure patients candidates for diuretics at this stage?
a. Patients in stage B of heart failure present with structural heart disease but still do not
exhibit symptoms of HF, this is typically due to prolonged risk factors, MI, reduced
ejection fraction, etc (AHA, 2013). It is recommended by the AHA to treat these patients
with an ACE inhibitor as well as the addition of a beta blocker if additional management
is necessary (AHA, 2013). Once patients progress into stage C, these patients now have
structural heart disease with the addition of past or present symptoms of HF such as
shortness of breath, exercise intolerance, peripheral edema, etc (Burchum & Rosenthal,
2020). Because of this, diuretics
are typically introduced at this stage to help manage symptoms related to
congestion (AHA, 2013). Most patients will likely be candidates for diuresis at
this stage as well as stage D, however, there may be some contraindications to
