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Making lifestyle changes can often help relieve symptoms of congestive heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial a person can make:
Doctors usually treat congestive heart failure with medications. Most patients will be prescribed two or more medications to treat congestive heart failure. A physician may prescribe other heart medications — such as nitrates (for chest pain), calcium channel blockers (which lower blood pressure and improve circulation) or blood thinners (which help prevent blood clots) — along with heart failure medications.
Several types of drugs have proved useful in the treatment of heart failure when ejection fraction (EF) is reduced. They include:
Angiotensin-converting enzyme (ACE) inhibitors
These drugs — the mainstay treatment for congestive heart failure — help people with congestive heart failure live longer and feel better. Examples include enalapril, lisinopril and captopril. ACE inhibitors lower blood pressure and decrease the heart's workload. They also blunt some of the effects of hormones that promote salt and water retention.
Angiotensin II (A-II) receptor blockers
This group of drugs has many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors. However, A-II receptor blockers — examples include losartan and valsartan — haven't been as extensively studied in people with congestive heart failure.
Beta blockers
This class of drug slows the heart rate and lowers blood pressure. These medicines also reduce the risk of some abnormal heart rhythms. Beta blockers may reduce signs and symptoms of congestive heart failure and improve heart function and survival.
Diuretics
Often called water pills, diuretics cause frequent urination and keep fluid from collecting in the body. Commonly prescribed diuretics for congestive heart failure include bumetanide and furosemide. The drugs also decrease fluid in the lungs, making breathing easier. Because diuretics make the body lose potassium and magnesium, doctosr may prescribe supplements of these minerals.
Spironolactone
This potassium-sparing diuretic may improve survival for people with severe congestive heart failure. Unlike some other diuretics, spironolactone can raise potassium levels in the blood.
Digoxin
This drug, also referred to as digitalis, increases the strength of the heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves a person's ability to live with the condition.
Nesiritide
In 2001, the Food and Drug Administration approved a new intravenous drug for congestive heart failure called nesiritide. Nesiritide is a synthetic version of a naturally occurring hormone in the body called B-type natriuretic peptide. BNP is secreted in high levels by the heart when it's overloaded with pressure and its volume is expanded. BNP causes the body to excrete excess fluid, helping to combat the effects of congestive heart failure. Nesitiride may benefit people who have severe congestive heart failure.
Sometimes symptoms of congestive heart failure become severe enough to require hospitalization and monitoring for a few days. While in the hospital, patients may take medications that work quickly to help the heart pump better and relieve symptoms. Supplemental oxygen through a mask or small tubes placed in the nose may be necessary. In cases of severe congestive heart failure that doesn't respond to treatment, supplemental oxygen may be needed in the longer term.
In some cases doctors recommend surgery to treat the underlying problem that led to congestive heart failure. For example, a damaged heart valve may be repaired or, if necessary, replaced with an artificial one.
Sometimes doctors recommend coronary bypass surgery to treat congestive heart failure if the disease is related to severely narrowed coronary arteries.
Some people have such severe congestive heart failure that medications or surgery don't provide adequate help. They may need to have their diseased heart replaced with a healthy donor heart.
About 2,000 Americans each year undergo a heart transplant. The procedure has dramatically improved the survival and quality of life of people with severe congestive heart failure. However, candidates for transplantation often have to wait years before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment and other therapy and can be removed from the transplant waiting list.
These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Heart pumps help keep heart transplant candidates alive while they're waiting for a donor heart. Studies are ongoing to examine their role as an alternative to transplantation. Despite several serious side effects, implantable heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for heart transplantation.
Biventricular cardiac heart pacemakers send specifically timed electrical impulses to the heart's lower chambers to treat moderate to severe congestive heart failure. Some 30 percent to 50 percent of people with congestive heart failure have abnormalities in their heart's electrical system that cause their already weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's precious energy and may cause heart failure to worsen. A biventricular cardiac pacemaker consists of a pulse generator that's implanted in the chest and connected to the heart by three wires (leads) that deliver electrical impulses. One wire is placed in the upper-right chamber (right atrium), one wire is placed in the lower-right ventricle and the third wire is used to stimulate the lower-left ventricle.
Patients with heart failure are at high risk of fast rhythms which are life threatening. Some patients need Internal Cardiac Defibrillators (ICD) and medicines to prevent sudden death.
Myectomy is the surgical removal of part of the overgrown heart muscle in hypertrophic cardiomyopathy to decrease the obstruction to blood flow. It is used when medication has become ineffective at relieving symptoms.
Leaky heart valves can cause or worsen heart failure by overworking the heart. Several novel, percutaneous (implanted without the need for surgery) devices to reduce or prevent leakage of heart valves are under investigation. Mayo investigators are studying one of these devices.
A change in pressures in the heart or a change in compounds in the blood often precedes worsening or the signs and/or symptoms of heart failure. Investigators are studying tiny implantable microchip sensors that can detect these changes. The sensors can be independent devices about the size of a dime or incorporated into other devices such as permanent pacemakers. The sensors record the changes. The record can be transmitted daily to the patient's doctors. The sensors help warn when a heart failure crisis is beginning, allowing doctors to treat the condition before it becomes severe enough to cause bad symptoms, become an emergency or require hospitalization. Mayo investigators have been evaluating some of these devices especially in pulmonary hypertension and right-sided heart failure.
There are several new surgical techniques being studied for the treatment of heart failure. Researchers are studying cardiac wrap surgery, which wraps a failing heart in a mesh bag. The goal is to prevent a weakened heart from enlarging and failing further. A surgeon pulls the mesh wrap over the base of the heart and attaches it with stitches. Another surgical procedure called "ventricular remodeling" involves removing heart muscle tissue that had been damaged due to a heart attack or an aneurysm (weak, bulging area of tissue) and returns the ventricle to a more normal shape. The goal of the surgery is to improve heart failure and/or angina (chest pain) symptoms and possibly to improve the pumping ability of the heart.
The all-mechanical artificial heart is a reality but is still an investigational technique due to the complexity of managing the device and the complications of the device. There are also mechanical devices that only replace the function of one side of the heart — either left or right side. Mayo's cardiovascular surgeons are actively using and investigating these devices.
The major limitation of heart transplantation in the treatment of heart failure is the supply of donor organs. Xenotransplantation is the use of animals as donors to humans. Research is rapidly progressing genetically altering pigs so that their hearts (and possibly other organs) can be used in the treatment of human heart failure. Mayo and Mayo's cardiac transplant group are doing pioneering work in the field of xenotransplantation.
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