Heart Failure Treatment
Treatment for heart failure depends on the underlying cause for the heart failure and the severity of the symptoms. Sudden, severe symptoms of congestive heart failure require urgent treatment in the hospital for oxygen therapy and intravenous (IV) medications.
Medications are the main form of treatment for heart failure, but it is important to treat underlying causes, such as diabetes, hypertension, congenital heart disease, coronary artery disease, arrhythmia, and valvular heart disease. Common medications used for the treatment of congestive heart failure include nitroglycerin, diuretics, beta-blockers, ACE inhibitors, and potassium supplements. Additional procedures include angioplasty, cardiac surgery, heart pacemaker placement, and kidney dialysis.
Lifestyle changes that can help reduce symptoms of congestive heart failure include smoking cessation, a heart-healthy diet, a low cholesterol diet, a low salt diet, an exercise plan, and weight reduction.
A person with congestive heart failure, who has damage to the heart from an underlying illness, requires life-long treatment. However, a person can recover completely if the symptoms of heart failure are caused by an illness that does not damage the heart.
General treatment for congestive heart failure usually includes:
- Healthy heart diet:
- Fluid restriction for congestive heart failure
- Elastic support stockings fro swollen lower legs
- Exercise plan developed by a doctor
- Smoking cessation
Medications for the treatment of congestive heart failure may include:
- Beta-blocker medications
- ACE inhibitor medications
- Angiotensin receptor blocker medications
- Long acting nitroglycerin
- High dose nitrates:
- Morphine sulfate (Duramorph, Astramorph)
- Medications for low blood pressure:
- Human B-type natriuretic peptides:
Additional treatment for congestive heart failure may include:
- Oxygen therapy
- Heart valve surgery
- Coronary artery bypass surgery for coronary artery disease
- Angioplasty for coronary artery disease
- Pacemaker therapy for cardiac arrhythmias
- Automatic implantable cardioverter defibrillator
- Cardiac resynchronization therapy:
- Uses a special biventricular pacemaker that allows the right and left ventricle to be stimulated automatically.
- Also has defibrillator capability
- Mechanical ventilation:
- Kidney dialysis
- Effective in the presence of end stage renal disease
Heart Failure Angioplasty
Congestive heart failure due to coronary artery disease may benefit from correcting blocked coronary vessels.
Angioplasty is a procedure that involves the passage of a balloon-tipped catheter into a narrowed coronary artery. When the balloon is inflated, it widens the artery by cracking plaques.
There are newer variations of this procedure that remove plaque with a rotating blade or laser.
After angioplasty, a stent is used to help hold the artery open. Stents are tiny struts that expand against the inside wall of the artery. They prop open the blood vessel after it has been opened.
Heart Failure Drugs
Congestive heart failure is often treated with a combination of medications. There is no standard combination: what works for one person may not work well for another.
Congestive heart failure medications may include:
- ACE inhibitors:
- Help the heart work more efficiently
- AR2 blockers:
- Reduce blood pressure in those with heart failure and hypertension.
- Beta blockers:
- Reduce the work the heart must perform
- Remove excess fluid from the body
- Improves the pumping ability of the heart
- Nitrate medicines:
- Reduce the work the heart must perform
- Blood thinners:
Heart Failure ACE Inhibitors
The chronic management of congestive heart failure usually includes the use of an ACE inhibitor medication. ACE inhibitors dilate the arteries and allow blood to flow with less resistance. This has the effect of reducing the pumping work of the heart.
These drugs have clearly been shown to reduce mortality and delay the progression of congestive heart failure. Other studies have shown that ACE inhibitors improve life expectancy in patients who have suffered a heart attack. Higher doses of ACE inhibitors appear to be more effective than lower doses without additional side effects.
Heart Failure AR2 Blockers
A newer class of drugs similar to ACE inhibitors is known as angiotensin II receptor blockers. These medications are usually prescribed for people who cannot take ACE inhibitors because of side effects. Most patients may benefit from a drug in this class or an ACE inhibitor, but will seldom need both.
These drugs work by blocking the binding of angiotensin II to type 1-angiotensin II receptors in the body. The effect is a reduction in the effects of the hormone angiotensin II. Angiotensin II plays a major role in the maintenance of blood pressure in the human body.
Common AR2 blockers:
Heart Failure Beta-Blockers
Beta-blocker drugs have also been shown to slow the progression of chronic congestive heart failure. Metoprolol (Lopressor) is one of three beta-blockers that have been shown to help some people with heart failure. The other two that have been shown to be beneficial are carvedilol (Coreg) and bisoprolol (Zebeta).
Heart Failure Blood Thinners
Congestive heart failure patients who regularly take anti-platelet agents such as aspirin, dipyridamole, and Plavix have better survival, and a reduced risk of death or hospital admission for heart failure.
More aggressive anticoagulation may need to be undertaken in those who are at risk for deep venous thrombosis and pulmonary embolism.
Heart Failure Cardiac Glycosides
Cardiac glycosides are a group of medications that can improve the pumping ability of the heart. Options include digoxin and digitoxin.
Digoxin may decrease symptoms and increase exercise tolerance in some congestive heart failure patients. These drugs work by helping the heart to contract more forcefully. They help clear excess fluid from the lungs and eliminate salt from the body.
Cardiac glycosides can be very effective but must be closely regulated. It can easily cause side effects and toxicity. Blood levels are routinely measured to make sure they remain within a normal level.
Heart Failure Diuretics
Diuretics, such as furosemide (Lasix), bumetanide (Bumex), or torsemide (Demadex), help to reduce excess fluid in the body by increasing urination and eliminating salt. The effect is reduced strain on the heart and more effective pumping.
Heart Failure Nesiritide
Nesiritide is a purified, natural hormone called human B-type natriuretic peptide, which is produced in the ventricles of the heart. Nesiritide causes veins and arteries to dilate and promotes renal excretion of sodium and water. These actions reduce stress on the weakened heart seen in patients with congestive heart failure. This allows the weakened heart to function more efficiently and improves patient symptoms.
Concurrent administration with ACE inhibitors and other vasodilators may cause low blood pressure.
Heart Failure Nitrates
These drugs are useful in the care of congestive heart failure due to coronary artery disease. A regular schedule of nitrates can help to decrease the incidence of anginal attacks and control blood pressure.
Nitrates dilate the veins encouraging blood to more readily return to the heart. They also open up the arteries that supply the heart itself. Both of these effects work together to reduce the heart muscles demand for oxygen and increase its supply.
Heart Failure Questions For Doctor
The following are some important questions to ask before and after the treatment of congestive heart failure.
Questions to ask before treatment:
- What are my treatment options?
- Is surgery an option for me?
- What are the risks associated with treatment?
- Do I need to stay in the hospital?
- How long will I be in the hospital?
- What are the complications I should watch for?
- How long will I be on medication?
- What are the potential side effects of my medication?
- Does my medication interact with nonprescription medicines or supplements?
- Should I take my medication with food?
Questions to ask after treatment:
- Do I need to change my diet?
- Do I need to lose weight?
- When can I resume my normal activities?
- When can I return to work?
- Do I need a special exercise program?
- Will I need physical therapy?
- Will I need occupational therapy?
- What else can I do to reduce my risk for having heart failure again?
- How often will I need to see my doctor for checkups?
- What local support and other resources are available?
Heart Failure Specialist
Physicians from the following specialties evaluate and treat congestive heart failure:
Heart Failure Surgery
Surgical options for the treatment of congestive heart failure include:
Heart valve replacement or repair:
Valvular surgery can help many patients with severe aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation.
Coronary artery bypass grafting:
In this procedure, vein grafts are taken from the patient's leg and then used to reconstruct a new coronary vessel. In certain patients, surgery can remove scarred heart tissue to improve overall pumping action.
Some individuals with severe heart failure and pulmonary hypertension may be candidates for heart lung transplantation. Heart transplantation is becoming more and more effective with the advent of chemical agents that suppress the immune response and inhibit organ rejection.
Also referred to as cardiac resynchronization therapy, it involves the placement of two pacemaker electrodes in the heart: one in the front and one in the back of the heart. This procedure has been shown to improve exercise capacity as well as prolong life.
Continue to Heart Failure Home Care
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- Ebinger MW, Krishnan S, Schuger CD. Mechanisms of ventricular arrhythmias in heart failure. Curr Heart Fail Rep. 2005 Sep;2(3):111-7. 
- Mitchell J, Taylor A. Congestive heart failure in women. J Fam Pract. 2005 Jul;Suppl:6-7.