Heart Failure Management

Treatment of heart failure focuses on correcting the underlying pathology that is causing the syndrome and improving the efficiency of the heart in pumping blood around the body. Treatment includes:

Addressing any reversible causes of heart failure such as anemia, infection, excessive alcohol abuse, vitamin deficiency, overactive thyroid, high blood pressure and arrhythmia. Treating each of these individual factors reduces the heart's workload.

Lifestyle modifications may be made to help reduce and prevent the worsening of symptoms. Some of these include:

• Complete cessation of smoking
• Eating a healthy, balanced diet
• Reducing salt intake
• Water intake may be regulated on an individual basis
• Reducing or stopping alcohol consumption
• Engaging in regular exercise, as advised

If the onset of heart failure is sudden or acute, the immediate aim of therapy is to increase oxygen perfusion to various important organs such as the brain and kidneys. Medical staff ensure the patient is breathing and that blood is circulating. Therapies that may be immediately administered include furosemide, dilators such as nitroglycerin and sometimes non-invasive positive pressure ventilation (NIPPV).

In the case of long-term or chronic heart failure, treatment is aimed at preventing secondary acute attacks of heart failure and reducing symptoms. Examples of drugs that may be used include oral diuretics, ACE inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, beta-blockers and blood vessel dilators. A cardiac defibrillator may be needed in severe cases.

Some of the medications used for heart failure include:

• Agents that raise the contractility or force of contraction of the heart such as digoxin. This drug is suitable only for some patients and it needs to be carefully administered and its effects closely monitored.
• For acute heart failure, high efficacy diuretics may be used to reduce edema and ease the failure. Examples include furosemide and bumetanide. For chronic heart failure, furosemide or other drugs such as hydrochlorthiazide may be prescribed.
• Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure, dilate blood vessels and also prevent the remodelling or enlargement of the heart seen in heart failure. Drugs in this class include enalapril, captopril and lisinopril.
• Angiotensin receptor blockers act in a similar way to ACE inhibitors. Drugs of this class include losartan, valsartan and candesartan.
• Aldosterone antagonists such as spironolactone.
• Beta-blockers are useful in individuals with systolic dysfunction and examples include metoprolon, bisoprolol, nebivolol and carvedilol.
• Blood vessel dilators help blood vessels to dilate and reduce the pressure against which the heart has to pump. Examples include hydralazine and nitrate.
• Heart rhythm normalisers such as ivabradine.
• Anticoagulants such as warfarin prevent the blood coagulating and reduce the risk of stroke and heart attack.
• Antiplatelet medications such as aspirin and clopidogrel decrease the aggregation of blood platelets, therefore reducing complications such as stroke and heart attack.

Devices used in heart failure include:

• Cardiac pacemakers that monitor the heart rate and if the rate becomes too slow, the pacemaker triggers pulses that hasten the heartbeat.
• Cardiac resynchronisation therapy is another form of pacemaker therapy used to treat patients whose left and right heart chambers are not beating in unison.
• Implantable cardioverter defibrillatorsare used to correct an abnormal heart rhythm called ventricular tachycardia (rapid but regular beating in lower heart chamber) and ventricular fibrillation (irregular and disorganized heart beat).

In the advanced stages of heart failure, surgery or transplantation may be required. Heart valve surgery can correct some types of heart failure and other types may require coronary bypass surgery.