What are my treatment options for heart failure?
Heart failure is a chronic disease that requires lifelong management. With treatment, signs and symptoms of heart failure can improve and the heart sometimes becomes stronger. Treatment may help you live longer and reduce your chance of sudden death. Treatment depends on the type of heart failure you have and in part, what may have caused it. It includes the following singly or in combination, as well as in addition to other drugs your doctor may prescribe such as nitrates for chest pain, statins to lower cholesterol or blood thinners to reduce the risk of blood clots.
Medications are usually given in combination and may include the following:
- ACE inhibitors- a type of vasodilator that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload of the heart.
- ARBs- the same benefits as ACE inhibitors and may be an alternative for people who cannot tolerate them.
- Beta Blockers-slows the heart rate, reduces blood pressure and may limit or reverse some damage to the heart.
- Diuretics- often called “water pills” they make you urinate more frequently and keep fluid from collecting in your body.
- Aldosterone antagonists- another form of diuretic that spares potassium and has additional properties that are known to help people with systolic heart failure live longer.
- Inotropes- these are iv medications used in patients with severe heart failure to improve heart pumping function and maintain blood pressure.
- Digoxin- this durg increases the strength of the heart muscle contractions and slows the heart rate, decreasing the workload of the heart.
Surgery or medical devices may be recommended by your physician if they feel that it will effectively treat the underlying problem that led to heart failure.
- Coronary bypass surgery. If severely blocked arteries are contributing to your heart failure, your doctor may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
- Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty).
- Valve replacement is done when valve repair isn’t possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.
Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
- Implantable cardioverter-defibrillators (ICDs). An ICD is a device similar to a pacemaker. It’s implanted under the skin in your chest with wires leading through your veins and into your heart. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow
- Cardiac resynchronization therapy (CRT), or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner. Many people with heart failure have problems with their heart’s electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
- Heart pumps. These mechanical devices, such as ventricular assist devices (VADs), are implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body. VADs are most often used in the heart’s left ventricle, but they can also be used in the right ventricle or in both ventricles. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs are now sometimes used as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with severe heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart.
- Heart transplant. Some people have such severe heart failure that surgery or medications don’t help. They may need to have their diseased heart replaced with a healthy donor heart. Heart transplants can dramatically improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.