Using carvedilol to treat heart failure.

Despite current treatments, including use of angiotensin-converting enzyme (ACE) inhibitors, digoxin, and diuretics, morbidity and mortality remain alarmingly high. An estimated 50% of patients with severe signs and symptoms of heart failure will die within 1 year and 70% within 3 years. Additional pharmacological therapies to mitigate this disorder, such as β-blockers, continue to be investigated. βBlockers were thought to be contraindicated in patients with heart failure because of the drugs’ negative chronotropic (heart rate) and inotropic (contractility) actions on the heart. However, the findings of several recent studies indicate that β-blockers decrease morbidity and mortality and improve signs and symptoms and quality of life for patients with heart failure. In this article, I review the pathophysiology and compensatory mechanisms in patients with heart failure and discuss the beneficial effects of β-blockers, especially carvedilol, in the treatment of heart failure. Nursing diagnoses and interventions provide nurses with information on how to safely administer carvedilol and monitor its clinical effects. The included guide for teaching patients is a tool nurses can use to instruct patients being treated with carvedilol. Marie Taccetta-Chapnick is a staff nurse in cardiac critical care at Victory Memorial Hospital, Brooklyn, NY, and an adjunct lecturer at New York City Technical College in Brooklyn. Currently, she is a postgraduate nurse practitioner student at Wagner College, Staten Island, NY. DEFINITIONS AND CLASSIFICATIONS Heart failure is classified as systolic and/or diastolic dysfunction. Systolic ventricular dysfunction is a defect in the expulsion of blood (ie, systolic/forward failure) from the ventricles into the aorta and pulmonary artery caused by an impaired inotropic state. The principal manifestations of systolic failure are due to inadequate forward output, causing an increase in end-diastolic volume, and a normal or reduced stroke volume, resulting in a decreased ejection fraction of 0.45 or less. Causes of systolic failure include hypertension, coronary artery disease, valvular disease, pulmonary embolism, and idiopathic cardiomyopathy. Diastolic ventricular dysfunction occurs when the filling of one or both ventricles is impaired, causing inadequate emptying of the venous reservoir (ie, diastolic/backward failure). The transient inability of the ventricles to accept blood may occur because of slowed or incomplete ventricular relaxation (lusitropic properties), such as acute ischemia, or may be sustained, as in restrictive cardiomyopathy or concentric myocardial hypertrophy. Diastolic failure due to increased diastolic stiffness causes high ventricular filling pressure and Using Carvedilol to Treat Heart Failure