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Content
Heart Disease
Heart Attack
Congestive Heart Failure
Generic Drugs
Alternative Heart Disease Treatment |
Heart Disease
Congestive Heart Failure Treatment
Congestive Heart Failure Treatment
From the National Institute of Health
Heart failure requires monitoring of the condition by the health care
provider. The first step is usually to identify and treat any underlying
disorders and precipitating factors. This may require a thorough diagnostic
work-up, medications or certain medical procedures (catheter procedures or
surgery).
The goals of treatment in heart failure include reduction of the heart's
workload, control of excess salt and water retention (swelling, decreased
urinary output) and improvement of heart function. In advanced cases or when the
heart failure occurs suddenly (acute heart failure), bed rest or reduced
physical activity are recommended to minimize the heart's workload.
If salt and fluid intake have been reduced and swelling persists or there are
signs of severe systemic (body) or pulmonary (lung) congestion, it may be
necessary to use diuretics (water pills). Diuretics include loop diuretics
(e.g., furosemide, bumetanide) for moderate symptoms; thiazide diuretics (e.g.,
hydrochlorothiazide, chlorthalidone, chlorothiazide) for mild symptoms; and
diuretics in combination. Potassium-sparing diuretics (spironolactone,
triamterene) are frequently used to prevent excessive potassium losses.
Digoxin may also be given, especially if the heart rhythm is irregular due to
atrial fibrillation.
Medications used to reduce the heart's workload include angiotensin converting
enzyme (ACE) inhibitors such as captopril and enalapril, and angiotensin
receptor blockers such as losartan and candesartan. Other medications frequently
used are vasodilators such as hydralazine and long-acting nitrates.
Some patients, particularly those with a history of coronary artery disease, may
benefit from low doses of beta-blockers.
Weight loss may be recommended for overweight patients. Eliminate smoking and
excessive alcohol consumption (which decrease the pumping efficiency of the
heart).
If symptoms are very limiting and minimal activity causes difficulty breathing,
or if there is no response to the initial treatment, hospitalization may be
required. Hospitalized patients may receive oxygen and intravenous medications
such as vasodilators and diuretics.
The heart's ability to pump blood can be directly increased by medications
called inotropic agents. These include dobutamine and milrinone, which are given
intravenously.
Unstable patients receiving several medications usually need also hemodynamic
monitoring with Swan-Ganz catheterization.
Severe cases 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.
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