What is the treatment for heart failure?

Heart failure (HF) is a serious, sometimes fatal disease. We have discussed what HF is, what its causes are, and how it is diagnosed. It is now time to discuss treatment:


Treatment of heart failure requires several general measures, along with treatment of the disorder causing heart failure, lifestyle changes, and drugs for heart failure.

General Measures:

Although heart failure is a chronic disorder for most people, much can be done to make physical activity more comfortable, improve the quality of life, and prolong life. People may also go to specialized heart failure clinics. These clinics have doctors with expertise in heart failure who work closely with specially trained nurses and other health care practitioners, such as pharmacists, dietitians, and social workers, to care for people with heart failure. These clinics can help decrease symptoms, reduce hospitalizations, and improve life expectancy by making sure that people receive the most effective treatments. This care complements rather than replaces care provided by primary care doctors.

Treatment of the Cause:

If the cause of heart failure is a narrowed or leaking heart valve or an abnormal connection between heart chambers, surgery can often correct the problem. Blockage of a coronary artery may require treatment with drugs, surgery, or angioplasty.

Antihypertensive drugs can reduce and control high blood pressure.

Lifestyle Changes:

Changes in lifestyle can help people with heart failure feel and function better.

People who have heart failure should stay as physically fit as possible, even if they cannot exercise vigorously. People who have mild heart failure should follow an exercise program as described by a doctor. Those with more severe heart failure may need to exercise in a cardiovascular rehabilitation facility under the supervision of a trained attendant.

If people with heart failure are overweight, the heart must work harder during activity, worsening heart failure. Such people should follow a weight loss diet to attain and maintain ideal weight.

Smoking damages blood vessels. Large amounts of alcohol can act as a direct toxin to the heart. Thus, smoking and drinking alcohol can worsen heart failure and should be stopped.

Excess salt (sodium) in the diet can cause fluid retention, which counteracts drugs given to increase the excretion of water (such as diuretics) and relieve fluid accumulation. Thus, consuming excess salt worsens symptoms. Almost everyone with heart failure should limit their intake of table salt and salty foods and their use of salt in cooking. The sodium content of packaged foods can be determined by reading the label. People with severe heart failure are usually given detailed information about how to limit salt intake. People who limit their salt intake can usually consume a normal amount of water unless fluid retention is severe. Drinking extra amounts of water is not recommended.

Medications for Heart Failure:

Heart failure can be treated with several different types of drugs, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers, and digoxin.

Anticoagulants, such as warfarin (COUMADIN), may be given to prevent clots from forming in the heart chambers. If the heart rhythm is abnormal, antiarrhythmic drugs may be given, or an implantable cardioverter-defibrillator may be recommended, as the risk of sudden death may be increased. In some people with severe symptoms, a pacemaker that stimulates both ventricles may be recommended because it coordinates heart contraction and function better.

Heart transplantation may be an option for a few otherwise healthy people who have very severe, worsening heart failure and who have not responded to drug therapy. Mechanical assist devices that help pump blood are used in specialized centers for certain patients with very severe heart failure that is not responding to drug therapy. Other mechanical and novel treatments are being studied.

Hope this helps,

Dr T,

(From: The Merck Manuals, Heart failure, by J. Malcolm O. Arnold, MD)


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