Heart failure is a chronic progressive condition where the heart is no longer able to keep up with the demands of pumping adequate amounts of blood. As a result, the heart is unable to maintain vital supplies of oxygen and nutrients to the tissues of the body. The Centers for Disease Control and Prevention (CDC) estimate that approximately 6 million people in the United States live with heart failure and that the condition contributes to nearly 300,000 deaths each year. According to the American Heart Association (AHA), congestive heart failure happens when the tissues get congested with blood because of decreased blood flow through the heart. Medications are used to improve the performance of the heart and prevent complications. They are of various types and are usually used in combination.
Angiotensin Converting Enzyme (ACE) Inhibitors
These drugs stop the body from making angiotensin, a powerful agent that narrows the blood vessels and raises blood pressure. The drugs lower blood pressure and reduce the workload on the heart. According to the AHA in 2009, ACE inhibitors are considered the first choice of drugs in heart failure and the cornerstone of treatment. They have been proven to slow the progression of the disease.
ACE inhibitors prescribed in congestive heart failure include enalapril (Vasotec), fosinopril (Monopril), lisinopril (Zestril, Prinivil), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), benazepril (Lotensin) and captopril (Capoten).
Diuretics
Also called water pills, these make you urinate a lot and reduce the collection of fluids in the tissues in congestive heart failure. They also reduce the workload on the heart by reducing the amount of fluid returning to the heart. Diuretics include hydrochlorothiazide or HCTZ (HydroDiuril), chlorothiazide (Diuril), furosemide (Lasix), bumetanide (Bumex), triamterene (Dyrenium), metolazone (Zaroxolyn), torsemide, indapamide (Lozol), polythiazide, amiloride (Midamor) and a combination preparation called Dyazide (HCTZ and triamterene).
Spironolactone (Aldactone) and eplerenone (Inspra), both diuretics, block the effects of the hormone aldosterone. According to the Mayo Clinic, these two diuretics could slow the progress of the disease and reverse some of the scarring in the heart.
Vasodilators
These drugs widen the blood vessels, reducing the workload of the heart. According to the AHA, they are preferred in patients who do not tolerate ACE inhibitors.
Vasodilators used in congestive cardiac failure include isosorbide dinitrate (Isordil), nesiritide (Natrecor), hydralazine (Apresoline), nitrates/nitroglycerin and minoxidil (Loniten).
Digitalis Preparations
These drugs increase the force of contraction of the heart and slow the heart down. According to the AHA, they are useful in patients who are not responding to ACE inhibitors and diuretics. The preparations include digoxin (Lanoxin) and digitoxin.
Beta Blockers
Beta blockers lower blood pressure and reduce the drive on the heart to beat faster, relieving the strain on the heart. The AHA notes that they are usually prescribed with other medications in congestive cardiac failure, such as ACE inhibitors, diuretics and digoxin. Beta blockers used in congestive heart failure include carvedilol (Coreg), acebutolol (Sectral), propanolol (Inderal), pindolol, labetalol, timolol (Blocadren), atenolol (Tenormin), bisoprolol (Zebeta), esmolol (Brevibloc), metoprolol (Toprol XL, Lopressor), sotalol (Betapace), penbutolol, nadolol (Corgard) and betaxolol (Kerlone).
Angiotensin II Receptor Blockers (ARBs)
These block the effects of already released angiotensin II on the blood vessels. They also cause dilation of the blood vessels. ARBs include candesartan (Atacand), eprosartan mesylate (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis), valsartan (Diovan) and olmesartan.
Other Drugs
Other medications that can be used in congestive heart failure include potassium supplements to offset the loss of potassium that may occur with the use of diuretics.
The calcium channel blocker, amlodipine (Norvasc) can also be used.
According to the AHA, a significant complication of congestive heart failure is blood clots forming in the heart and the vessels of the legs and lungs. Blood thinners, such as heparin and warfarin (Coumadin), are prescribed in congestive heart failure to prevent this complication.
