Congestive Heart Failure: Treatments

How is congestive heart failure treated?

Congestive heart failure is a complex disease that requires a treatment plan that uses a multifaceted approach that is individualized to the type and severity of your congestive heart failure, your risk factors, lifestyle, medical history, age, and other factors. Congestive heart failure is a serious, life-threatening disease, but it is not always fatal. The prognosis depends on the severity of congestive heart failure, the underlying cause, your age and general health, and the presence of coexisting diseases, such as diabetes.

General prevention and treatment measures for congestive heart failure

Treatment for congestive heart failure includes preventive care aimed at minimizing the risk factors for having a heart attack and other forms of heart disease. General preventive and treatment measures include:

• Lifestyle and dietary changes to achieve and maintain an ideal weight and fitness level. It is generally recommended that people with congestive heart failure follow a heart-healthy diet that is low in saturated fat, trans fats, and sodium. Excessive salt leads to fluid retention and increases blood pressure.

• Periods of prescribed rest

• Regular medical care and treatment of risk factors, such as high cholesterol, hypertension, obesity, smoking, diabetes, and excessive alcohol consumption

Medications used to treat congestive heart failure

Treatment of congestive heart failure also includes medications. Medications include:

• ACE inhibitors (ramipril, lisinopril, enalapril, captopril), which lower blood pressure and reduce strain on the heart

• Aldosterone blockers (Aldactone), which may be used for severe congestive heart failure

• Anticoagulants (aspirin, Coumadin, Plavix), which prevent the formation of blood clots that can lead to heart attack and stroke

• Beta-blockers (metoprolol, atenolol and propranolol), which lower blood pressure, control heart rate, and reduce strain on the heart

• Cholesterol-lowering medications (statins), which can reduce the risk of heart attack and stroke. Cholesterol-lowering medications also reduce the risk of recurrent heart attack and stroke.

• Digitalis drugs (digoxin), which slow and strengthen the beating of the heart to make the heart muscle more effective in pumping blood

• Diuretics (Lasix, Bumex, HCTZ), which pull excess fluid out of the lungs and tissues of the body by increasing urine production

Treatment of severe congestive heart failure

Severe congestive heart failure with acute pulmonary edema (a rapid buildup of fluid in the lungs) is often diagnosed and initially treated in an emergency room setting. Treatment includes:

• Intensive monitoring and stabilization of heart rhythm and vital signs. In some cases, this may require cardiopulmonary resuscitation (CPR), and advanced life-support measures, such as intubation and mechanical ventilation to support breathing.

• Intravenous medications to rapidly draw fluid out of the lungs and reduce strain on the heart

• Monitoring your heart rate and rhythm with an electrocardiogram (known as an EKG or ECG) and blood tests to determine the extent of heart damage

• Supplemental oxygen to ease breathing and increase the amount of oxygen that is delivered to the heart tissue and the rest of the body

• Treatment of abnormal heart rhythms (cardiac arrhythmias) with medications and possibly electrical cardioversion or defibrillation

Surgical treatments for congestive heart failure

A variety of surgical procedures may be used in the treatment of some cases of congestive heart failure including:

• Angioplasty and stent placement may be recommended for people with congestive heart failure who have severely blocked coronary arteries. In this procedure, the affected artery is widened using a balloon device, and a stent (hollow tube) is placed in the artery to keep it open.

• Coronary artery bypass may be recommended for people with congestive heart failure who have severely blocked coronary arteries. In this surgery, new graft arteries are placed to bypass the blocked coronary artery or arteries. Blood flow is then redirected through healthy new graft arteries to the affected heart tissues.

• Heart transplant may be needed in severe cases of congestive heart failure in which medications and lifestyle and dietary changes do not improve heart function.

• Left ventricular assist device (LVAD) is a device that is connected to the heart. An LVAD helps to improve heart function and may be used as a bridge treatment while waiting for a heart transplant or as a treatment in itself.

• Pacemaker may be used in some cases to control abnormal heart rhythms.

• Valve surgery repair or replacement of damaged heart valves

Other treatments for congestive heart failure

Other treatments and therapies that may be recommended as part of a complete treatment program for congestive heart failure include:

• Cardiac rehabilitation and physical therapy can help strengthen the body, reduce complications, increase alertness, reduce fatigue, improve your overall health, and enhance your ability to function in everyday activities.

• Palliative care to improve the overall quality of life for families and patients with serious diseases

• Regular follow-up care to help monitor your treatment and progress and to address any problems or complications promptly

• Complementary or alternative treatments, such as acupuncture, massage therapy, and yoga to reduce stress and improve well-being. Complementary treatments are not meant to substitute for full medical care.

What are the possible complications of congestive heart failure?

Complications of congestive heart failure are life threatening. Complications include a rapid or severe buildup of fluid in the lungs (pulmonary edema), which can lead to respiratory failure, respiratory arrest, and death. Pulmonary edema also increases the risk of developing serious infections of the lungs, such as pneumonia.

Congestive heart failure also impacts the quality of life and can lead to serious and permanent disability. You can best help minimize the risk of serious complications of congestive heart failure by following the treatment plan you and your health care professional design specifically for you. Serious and life-threatening complications of congestive heart failure include:

• Cardiac arrest

• Cardiogenic shock

• Disability

• Pneumonia

• Pulmonary edema

• Serious or lethal cardiac arrhythmias (abnormalities in heart rhythm, such as atrial fibrillation, ventricular tachycardia, and ventricular fibrillation)