Congestive Heart Failure

Treatment

Congestive heart failure treatments can significantly improve symptoms and help a weakened heart work as efficiently as possible. Treatment options at Mayo Clinic comprise:

• Lifestyle changes
• Medications
• Surgery and Medical Devices

Lifestyle changes

Lifestyle changes can often help relieve symptoms of congestive heart failure and prevent the disease from worsening. Among the most important and beneficial changes are:

• Quit smoking
• If overweight, lose weight
• Avoid or limit alcohol consumption to one drink two or three times a week
• Avoid or limit caffeine
• Eat a low-fat, low-sodium diet
• Exercise individually or in a structured rehabilitation program (under a physician's guidance)
• Reduce stress

Medications

Doctors usually treat congestive heart failure with medications. Most patients are prescribed two or more medications to treat congestive heart failure. Along with heart failure medications, a physician may also prescribe nitrates for chest pain, calcium channel blockers to lower blood pressure and improve circulation, or blood thinners to help prevent blood clots.

Several types of drugs are useful in the treatment of heart failure if a person is experiencing reduced ejection fraction (the percentage of blood pumped out of a filled ventricle with each heartbeat). They include:

Angiotensin-converting enzyme (ACE) inhibitors
These drugs — the mainstay treatment for congestive heart failure — help people with congestive heart failure live longer and feel better. Examples include enalapril, lisinopril and captopril. ACE inhibitors lower blood pressure and decrease the heart's workload. They also blunt some effects of hormones that promote salt and water retention.

Angiotensin II (A-II) receptor blockers
This group of drugs has many of the beneficial effects of ACE inhibitors, without the potential side effect of persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors. However, A-II receptor blockers — for example, losartan and valsartan — haven't been studied extensively in people with congestive heart failure.

Beta blockers
This class of drug slows the heart rate and lowers blood pressure. These medicines also lessen the risk of some abnormal heart rhythms. Beta blockers may reduce signs and symptoms of congestive heart failure and improve heart function and survival.

Diuretics
Often called water pills, diuretics cause frequent urination, to prevent fluid from collecting in the body. Commonly prescribed diuretics for congestive heart failure include bumetanide and furosemide. These drugs also decrease fluid in the lungs, making breathing easier. Because diuretics cause the body to lose potassium and magnesium, doctors may prescribe these minerals as supplements.

Spironolactone
This potassium-sparing diuretic may improve survival for people with severe congestive heart failure. Unlike some other diuretics, spironolactone can raise potassium levels in the blood.

Digoxin
This drug, also referred to as digitalis, increases the strength of heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves a person's ability to live with the condition.

Nesiritide
Nesiritide, which is administered intravenously, is a synthetic version of B-type natriuretic peptide (BNP), a naturally occurring hormone in the body. BNP is secreted in high levels by the heart when it becomes overloaded with pressure and its volume expands. BNP causes the body to excrete excess fluid, helping to counter the effects of congestive heart failure.

Nesiritide may benefit people who have severe congestive heart failure. Sometimes symptoms of congestive heart failure become severe enough to require hospitalization and monitoring for a few days. While in the hospital, patients may take medications that work quickly to help the heart pump better and relieve symptoms. Supplemental oxygen through a mask or small tubes placed in the nose may be necessary. In cases of severe congestive heart failure that doesn't respond to treatment, supplemental oxygen may be needed over the longer term.

Surgery and Medical Devices

Heart valve repair or replacement

In some cases, doctors recommend surgery to treat the underlying problem that led to congestive heart failure. For example, a damaged heart valve may be repaired or, if necessary, replaced with an artificial one.

Coronary Bypass Surgery

Sometimes doctors recommend coronary bypass surgery to treat congestive heart failure if the disease is related to severely narrowed coronary arteries.

Heart Transplant

Some people have such severe congestive heart failure that medications or surgery don't provide adequate help. They may need to have their diseased heart replaced with a healthy donor heart.

About 2,000 Americans each year undergo a heart transplant. The procedure has dramatically improved the survival and quality of life of people with severe congestive heart failure. However, candidates for transplantation often have to wait years before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment and other therapy and can be removed from the transplant waiting list.

A left ventricular assist device helps a failing heart pump blood.

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Heart Pumps

When a weakened heart needs help pumping blood, a ventricular assist device (VAD) can be implanted into the abdomen and attached to the heart. These mechanical heart pumps can be used either as a "bridge" to cardiac transplantation or permanent therapy for patients who aren't eligible for heart transplant. This new therapy offers hope to many patients who previously had no options for improving quality and quantity of life. The Advanced Heart Failure Clinic at Mayo's campus in Rochester specifically evaluates patients who may need a VAD.

Biventricular Cardiac Pacemaker

Biventricular cardiac heart pacemakers send specifically timed electrical impulses to the heart's lower chambers to treat moderate to severe congestive heart failure. Approximately 30 percent to 50 percent of people with congestive heart failure have abnormalities in their heart's electrical system which cause their already weakened heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's energy and may cause heart failure to worsen.

A biventricular cardiac pacemaker consists of a pulse generator that's implanted in the chest and connected to the heart by three wires (leads) that deliver electrical impulses. One wire is placed in the upper-right chamber (right atrium), one wire in the lower-right ventricle, and the third is used to stimulate the lower-left ventricle.

Defibrillators

Patients with heart failure are at high risk of fast rhythms which are life threatening. Some patients need internal cardiac defibrillators (ICD) and medicines to prevent sudden death.

Myectomy

Myectomy is the surgical removal of part of the overgrown heart muscle in hypertrophic cardiomyopathy to decrease the obstruction to blood flow. It is used when medication has become ineffective at relieving symptoms.