Heart Failure, HF

1. Heart Failure, HF CHF develops when plasma volume increases and fluid accumulates in the lungs, in the abdominal organs (liver especially), and peripheral tissues. CHF is a complex and chronic disease with frequent life-threatening acute episodes . Cardiac reserve, especially in young and fit people helps deliver oxygen to tissue during stress and exercise; for example: in crease in heart rate: 55-70 BPM to 180 BPM cardiac output (CO = stroke volume x BPM) : 5 to >= 25 L/min Also oxyhemoglobin-dissociation curve can provide another reserve mechanism in HF, shift of curve to the right or increase in the P50 value makes oxygen release from Hb greater at the level of capillary for a given pO2 HF occurs when these reserves no longer sufficient. Can be LV failure or RV failure, LV usually a result of coronary artery disease, hypertension and congenital defects. RV usually comes about after LV which causes pulmonary venous hypertension.

2. So in LV failure CO declines and pulmonary venous pressure increases and pulmonary capillary pressure increases to levels that exceed the oncotic pressure of the plasma proteins (about 24 mmHg) leading to lung water which makes the lungs stiff and affects breathing and oxygen transport. So when pulmonary venous hydrostatic pressure exceeds the plasma protein oncotic pressure fluid extravasates into the interstitial space and the alveoli. Lymphatic drainage can not keep up and the results is lowered capillary pO2. Because of reduced CO there is reduced renal blood flow with a lowering of GFR and retention of Na as the kidney responds in a manner that makes HF symptoms worse. Water follows the salt leading to edema. Conventional treatment primarily involves Na restriction in diet, diuretics (remove the water, but issues with K), ACE inhibitors (vasodilation decreasing vascular resistance), digitalis (stimulates stronger heartbeat), and -blockers.

3. Aquapheresis Fluid overload simply means having an excess of fluid in the body. The excess fluid, primarily sodium and water, builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), in the abdomen (ascites), and congestion in the lungs causing difficulty in breathing (dyspnea).Fluid overload can be caused by many things, including problems with the heart, kidneys, lungs or a combination of any of these vital organs. Fluid overload can also be experienced after certain surgical operations. The leading cause of fluid overload is congestive heart failure (CHF), sometimes referred to as just heart failure (HF). The goals of any treatment for fluid overload are to... remove the excess sodium and water, achieve fluid balance (euvolemia, dry weight), relieve the symptoms, improve the overall quality of life for patients.

4. If you’re suffering from fluid overload, your healthcare provider may prescribe the following to remove your excess sodium and water: • Low salt diet (limits the amount of salt/sodium that you take in)• Fluid restriction (limits the amount of liquids you take in)• Diuretic drugs, e.g. water pills (increases urine production)• Aquapheresis Therapy (mechanically filters the excess water from your blood) Many patients are helped with diuretic drugs and achieve and maintain normal dry weights. However, these diuretic drugs don’t always work or they temporarily stop working, and patients may be hospitalized to adjust or change their medications and/or to remove extra fluid by other means. For example, approximately 50% of hospitalized heart failure patients achieve fluid and weight reduction with diuretics. The other 50% do not. Up to 30% of fluid overload patients suffer from diuretic resistance.This means that their kidneys for one reason or another, are not responding to the diuretic drugs as they should. This condition can last for a short amount of time (acute) or prolonged (chronic).

5. Aquapheresis: A Non-Drug, Non-Diuretic Treatment Option for Fluid Overload: Aquapheresis is a medical therapy designed to remove excess salt and water from the body safely, predictably, and effectively from patients suffering from fluid overload. It removes excess salt and water and helps to restore a patient’s fluid balance or euvolemia.

7. Physicians can specify and adjust the exact amount and rate of fluid to be removed from each patient, resulting in a gradual reduction that has no significant clinical impact on blood pressure, heart rate, or the balance of electrolytes (chemical substances, such as sodium, potassium, and chloride) in the body. Up to 500 ml or 1.1 lb of fluid can be safely removed per hour. The average removal rate is 250 ml or ½ lb an hour and treatment usually lasts about 24 hours. Studies have shown that the total hospital stay with Aquapheresis therapy is around three to four days. The exact length of time of the treatment is determined by how much total fluid needs to be removed and how fast your healthcare provider can remove it. The less you move, the more efficiently the blood gets pumped through the filter and the sooner the desired amount of fluid may be removed. The average treatment is approximately 24 hours in which an average of 6 Liters or 13.2 lbs of fluid is removed.Aquapheresis therapy complements drug-based options such as diuretics (drugs that help rid the body of excess water), inotropic drug therapies (drugs that stimulate the heart to expel more blood with each beat), or vasoactive drug therapies (drugs that dilate blood vessels) to achieve the target fluid removal goal for the patient. And, because it removes sodium and resets body fluid levels, Aquapheresis may also improve the effectiveness of oral diuretics that patients take on an ongoing basis (e.g. water pills).