The Treatment of heart failure
- General changes & life-style modifications
- Specific medication
- Other vasodilators (blood vessel dilators)
- Heart Transplantation
The management of heart failure is two-fold.
General changes and life-style modifications:
The aim is to reduce stress on the heart and prolong life.
Such changes would include:
- Initial bed rest in cases of acute heart failure but a modest exercise programme (such as walking on a regular basis) in chronic, treated disease,
- Reduction of salt intake which causes fluid retention and can raise blood pressure,
- Stopping smoking - which is connected to heart disease and peripheral vascular disease,
- Reduction of excess weight, if possible, as this puts a strain on the heart,
- Immunisation against influenza and pneumonia (pneumococcal injection).
Specific Medication:
(Note: In the elderly the doses may be lower).
Diuretics
Diuretics are known as water tablets. They help the body to eliminate fluid by increasing the production of fluid and this relieves oedema of the feet and legs and also fluid which has collected in the lungs.
ACE inhibitors
ACE inhibitors block the formation of Angiotensin II which constricts blood vessels. They are valuable in all grades of heart failure and are used in conjunction with diuretics. They act by relaxing smaller arteries and lowering blood pressure. They should be introduced cautiously.
Examples are Lisinopril, Perindopril, Captopril, Enalapril and Ramipril.
"Several studies have shown that ACE inhibitors significantly improve survival".
Cough may be a troublesome side - effect of Ace Inhibitors. Therefore, Angiotensin II Receptor Antagonists, which have the advantage of not causing a cough, can be used as an alternative. They act by preventing the constriction of blood vessels.
They can cause fatigue, dizziness and abdominal pain. Example are: -
- Losartan and Valsartan,
- Losartan (Cozaar) usually 50 mg once a day,
- Valsartan (Diovan) usually 80 mg once a day.
Betablockers
In chronic stable heart failure, betablockers have been shown to improve prognosis, symptoms and exercise tolerance.
They work by blocking the effects of the substances responsible for the “fright and flight” response. This reduces the energy needs of the heart.
Digoxin (Digitalis) is of benefit on patients who suffer from congestive heart failure and atrial fibrillation. It increases the strength of the heart contractions as well as reducing blood vessel resistance.
Other Vasodilators (blood vessel dilators)
These are used in combination when ACE inhibitors cannot be used.
Examples are:
- Isosorbide mononitrate (Elantan, Ismo, Monit or Isotrate) - usual dose 20mg 2 to 3 times daily or 40mg twice daily.
- Hydralazine (Apresoline) - usual maintenance dose 50-75mg 4 times daily.
The mainstay of treatment is diuretics, ACE inhibitors, spironolactone and, in some cases, betablockers. Patients with uncontrolled disease are likely to be prescribed nitrates and metolazone. Treatment with drugs such as diamorphine signal the terminal phase of the disease.
Heart Transplantation
This is a potential treatment for younger patients, with severe heart failure but it applies to only a very tiny minority, of the order of 250 out of several hundred thousand people. The rate of success is 90% surviving the first year and 75% surviving 5 years.
See the link for details of:
