Heart failure

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Circulation of blood through the heart

Heart, front view

Heart, section through the middle

Your doctor may consider prescribing the following medications:

• ACE inhibitors such as captopril and enalapril -- these medications open up blood vessels and decrease the work load of the heart. These have become an important part of treatment
• Diuretics -- there are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.
• Digitalis glycosides -- increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances
• Angiotensin receptor blockers (ARBs) such as losartan and candesartan which, like ACE inhibitors, reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
• Beta-blockers -- this is particularly useful for those with a history of coronary artery disease

Sometimes, hospitalization is required for acute CHF. Hospitalized patients may receive oxygen and intravenous medications such as vasodilators and diuretics. Medicines such as nesiritide (Natrecor) help dilate blood vessels and may also be helpful.

Medicines called inotropic agents help improve the heart's ability to pump blood. Such drugs include dobutamine and milrinone. They are given by IV.

Unstable patients receiving several medications usually need also hemodynamic monitoring with Swan-Ganz catheterization.

Severe cases of CHF require more drastic measures. For example, excess fluid can be removed through dialysis, and circulatory assistance can be provided by implanted devices such as the intra-aortic balloon pump (IABP) and the left ventricular assist device (LVAD). These devices can be life-saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

A number of studies have shown that heart failure symptoms can be improved with a special type of pacemaker. It paces both the right and left sides of heart. This is referred to as biventricular pacing or cardiac resynchronization therapy. Ask your provider if you are a candidate for this.