Congestive Heart Failure: Treatment

Majdi Ashchi, DO, FACC, FSCAI, FABVM, FSVM
Medical Director

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart muscle sometimes becomes stronger. Treatment may help you live longer and reduce your chance of dying suddenly. Depending on the symptoms of patient, a combination of medications maybe used including:

  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart
  • Beta blockers. This class of drugs not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure. Examples include carvedilol (Coreg), metoprolol. These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer.

  • Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily. Because diuretics make your body lose potassium and magnesium, your doctor also may prescribe supplements of these minerals.
  • Aldosterone antagonists. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer.
  • These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
  • Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure
  • NEW DRUGS for heart failure
    • Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker. Drug called Ivabradine or Corlanor by Amgen Company. It works by affecting the heart electrical conduction in order to slow the heart rate or pulse. It should NOT be used if already have severe liver disease, very slow heart rate or blood pressure or any abnormal electrical conductions system. Do not take with grapefruit.
    • Angiotensin-Receptor Neprilysin Inhibitor- Sacubiril/Valsartan-Entresto by Sanofi Company. This drug can be significantly more effective than the ACEI vasotec in reducing the rate of death from cardiovascular causes and or hospitalization for heart failure in heart failure patients. It should be considered instead of ACEI or ARB for first line therapy in patients with LVEF <35%.

Surgery & Medical Devices: sometimes certain conditions may require surgery or medical devices to correct heart failure.

  • Coronary bypass surgery or Angioplasty stents. If severely blocked arteries are contributing to your heart failure, coronary artery bypass surgery would be recommended. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
  • Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty). Valve replacement is done when valve repair isn’t possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve. Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
  • Implantable cardioverter-defibrillators (ICDs). An ICD is a device similar to a pacemaker. It’s implanted under the skin in your chest with wires leading through your veins and into your heart. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow.
  • Cardiac resynchronization therapy (CRT), or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner. Many people with heart failure have problems with their heart’s electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
  • Heart pumps. These mechanical devices, such as ventricular assist devices (VADs), are implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body. VADs are most often used in the heart’s left ventricle, but they can also be used in the right ventricle or in both ventricles. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs are now sometimes used as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with severe heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart.
  • Heart transplant. Some people have such severe heart failure that surgery or medications don’t help. They may need to have their diseased heart replaced with a healthy donor heart. Heart transplants can dramatically improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.

 

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