This is an abbreviated version of the complete article.*
Congestive heart failure (CHF) is the buildup of blood in the lungs because of inadequate pumping action of the heart.
CHF has many causes, and CHF therapy focuses on eliminating the cause, reducing symptoms, and preventing a further progressive decrease in the heart's pumping function.
Depending on the cause of heart failure, the treatment may be surgical or medical. Both strategies aim to relieve symptoms and to increase the heart's ability to pump.
Medications that treat CHF rid the body of excess fluid, reduce the blood vessels' resistance to ejection of blood, and combat the production of hormones that increase the heart's workload.
The goal of heart failure therapy is to lessen the effect of heart failure symptoms and to keep people with the condition out of the hospital. Heart failure caused by valve disease, toxins such as drugs used in chemotherapy, or congenital heart defects is often reversible. People with heart failure caused by permanently damaged or weakened heart muscle, however, require long-term lifestyle modification and medication.
Heart failure therapy requires lifestyle changes, such as losing weight, quitting smoking, limiting alcohol consumption, and reducing salt and fluid in the diet. These changes can improve the heart's ability to function and may help people with weakened hearts feel stronger.
Additionally, most people will need to take medications to manage the symptoms of living with a weakened hear-for the rest of their lives. Physicians recommend that people take their medications at the same time each day and keep a record that includes the name of the medication, the dosage, the number of times per day the medication is taken, and the symptom or condition the medication is intended to treat.
WHAT TO EXPECT
Commonly prescribed medications for heart failure include diuretics, Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), digitalis, beta-blockers, nitrates, and vasodilators. The types and doses of these medications may be adjusted in people with liver and kidney disease.
Diuretics. Diuretics reduce fluid retention, a common symptom of heart failure, by stimulating the kidneys to remove excess sodium and fluid from the body. The fluid is flushed out through urination. Diuretics usually take effect within 2 hours and act for 6 to 12 hours.
Angiotensin converting enzyme (ACE) inhibitors. Angiotensin is a substance in the body that causes blood vessels to constrict, increasing the pressure against which the heart must pump. ACE inhibitors prevent the body from making Angiotensin. Blocking the production of Angiotensin dilates, or opens, blood vessels, decreasing the heart's workload.
Angiotensin II receptor blockers (ARBs). ARBs block cell receptors that bind angiotensin, which means ARBs prevent angiotensin from entering cells of the heart. ARBs usually take effect within 1 to 4 hours and act for about 24 hours. People who have liver and kidney disease should use ARBs with caution.
Digitalis. Digitalis regulates the heart's rate and rhythm and strengthens the force of heart contractions, which can improve circulation. Digitalis medications take effect in 30 minutes to 2 hours and act for about 3 to 4 days.
Beta-blockers. Beta-blockers block the effect of adrenaline and related compounds and are effective in slowing the progression of heart failure. Beta-blockers also slow the heart rate, lower blood pressure, and reduce the force of cardiac contractions. Depending on the dose, beta-blockers take effect in 15 minutes to 1 hour and act for 12 to 24 hours.
Nitrates. Nitrates cause blood vessels to dilate. This decreases the volume of blood returning to the heart and reduces the resistance against which the heart must work, allowing the heart to pump blood more efficiently. Nitrates may cause dizziness, lightheadedness, or headaches. Nitrates can take effect in as little as 2 minutes up to 45 minutes, and can last from 30 minutes to 24 hours.
Direct-acting vasodilators. These medications relax the walls of the blood vessels and are used occasionally. Unlike ACE inhibitors and ARBs, vasodilators work directly on the muscles in the walls of blood vessels. Relaxing these muscles in turn allows more blood to flow through the vessels, decreasing the resistance against which the heart must pump.
BiDil: A medication that combines hydralazine and isosorbide dinitrate (BiDil), is a drug approved for the treatment of heart failure in African Americans. Used in addition to standard medications, this drug works by expanding and relaxing the blood vessels.
Surgical treatments. Surgical procedures that may improve heart failure include valve replacement surgery, coronary artery bypass surgery (when heart failure is caused by insufficient blood supply to the heart muscle), correction of congenital heart defects, cardiac resynchronization therapy, and ventricular assist devices.
Medical Review Date: July 29, 2009
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