Which treatment measures are available to treat congestive heart failure?
A typical treatment plan consists of multiple measures, including some or all of the following:
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Medications to help remove fluid and make the heart work better
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Dietary modifications, such as reducing salt and cholesterol intake
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Lifestyle changes, such as smoking cessation
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Exercise regimen.
Which types of medications provide the most benefit in patients with congestive heart failure?
Vasodilators help relax and dilate blood vessels so blood flows more easily. This lowers blood pressure and allows the heart to pump more blood without doing more work. The most effective types of vasodilators are ACE inhibitors, which have been shown to reduce deaths in congestive heart failure due to weak heart function (systolic dysfunction). Other types of vasodilators include nitrates and hydralazine.
Diuretics work by removing the excess fluid from the body that often accumulates in those with congestive heart failure. Fluid removal reduces the workload of the heart, since it has less fluid to circulate around the body. Because some diuretics deplete potassium levels, potassium supplements may be required in conjunction with diuretic therapy. Spironolactone and eplerenone are potassium-sparing diuretics that have recently been shown to have a significant benefit in congestive heart failure due to systolic dysfunction.
Beta blockers slow heart rate and lower blood pressure, reducing the workload on the heart. Beta blockers appear to improve the pumping action of the heart over long periods of time and also are beneficial in people with congestive heart failure due to diastolic dysfunction, since a slower heart rate allows better relaxation of a stiff left ventricle.
Digoxin helps the heart pump more vigorously, resulting in more blood being pumped per heartbeat. Digoxin also helps regulate a heartbeat that is too fast or irregular (such as atrial fibrillation). Long-term digoxin therapy has not been shown to reduce the death rate, but it does reduce the incidence of hospitalization in people with severe congestive heart failure.
Anticoagulants thin the blood and help reduce the incidence of blood clots. Individuals who have atrial fibrillation, have had valve surgery, or have weak hearts are inclined to develop clots. Anticoagulants help reduce the complications associated with clot formation, especially stroke.
Antiarrhythmics are used to help control irregular or rapid heart rates. Examples include amiodarone, beta-blockers, calcium channel blockers, and digoxin.
Which medications are used when patients require hospital admission due to congestive heart failure?
Intravenous medications are typically utilized when patients are sick enough to require admission for heart failure treatment. Diuretics are commonly used to aggressively remove excess fluid from the lungs and rest of the body. Potent intravenous medications called inotropes (examples include dopamine, dobutamine, and milrinone) that help the heart squeeze better are occasionally used when blood pressure is very low due to poor heart function. Other intravenous drugs, such as nitroglycerin and nesitiride, reduce the pressure inside the left ventricle and reduce shortness of breath.
What measures can be taken to help reduce salt intake?
Too much sodium intake results in the body retaining water, which typically makes the symptoms of congestive heart failure worse. A common recommendation for total daily sodium intake is 2,000 mg. Suggestions to help reduce salt intake include the following:
- Don't add salt to food during or after cooking; season foods with other flavorings, such as pepper, onion, and garlic
- Eat low-salt snacks, such as no-salt crackers and pretzels and air-popped popcorn
- Use sodium-free antacid tablets
- Read labels carefully when purchasing canned, processed, or frozen foods; many of these foods are high in salt content
- Use a cookbook containing many low-salt recipes.
When should an individual with congestive heart failure call his or her doctor's office?
When any of the following conditions exist, the individual should contact his or her doctor:
- Weight gain of 3 to 5 lb (or more) in 1 week or 2 or more pounds in 1 day
- Breathing becomes more difficult, especially if it occurs at rest or at night
- Increasing fatigue and weakness
- Increasing swelling in feet or ankles
- Less frequent urination
- New symptoms/side effects possibly related to medications (for example,frequent dry cough from ACE inhibitor therapy).
