Five million Americans suffer with heart failure, according to HeartFailure.org. Injury from a heart attack or viral infection causes ineffective pumping action of the heart. Congestive heart failure symptoms occur because of a weakened heart, inadequate blood flow and fluid collection. When heart failure decompensates, many patients need hospitalization for treatment. The goal of treatment for decompensated heart failure is to control symptoms, improve the quality of life and stabilize the disease process.
ACE Inhibitors
Lisinopril and quinapril are ACE inhibitors that act as vasodilators on the arterial system. By dilating the arteries, these medications effectively reduce the amount of pressure the heart has to pump against. This decreases the workload of the heart, making contractions more effective in moving blood through the circulatory system. According to the American Heart Association, ACE inhibitors slow the progression of the disease as well as decrease blood pressure. In decompensated heart failure, ACE inhibitors are the drugs of choice. They prevent angiotensin converting enzyme from forming, which causes the arteries to constrict.
One of the significant side effects of ACE inhibitors is the development of a dry cough. Some patients are unable to tolerate this drug. Isosorbide dinitrate, nitroglycerin and minoxidil are alternatives to ACE inhibitors in decompensated heart failure.
Water Pills
Diuretics, sometimes called "water pills," are the mainstay of decompensated heart failure. Congestive heart failure, an accumulation of excess fluid in the vascular system as a result of ineffective pumping of the heart, causes fluids to build up. Excess fluid then enters the lungs and causes swelling in the extremities. Fluid in the lungs causes congestion, and decompensated heart failure occurs when the lungs can't expand against the fluid buildup.
Diuretics put the kidneys in high gear and help to pull excess fluid from the system to be excreted, thereby eliminating the congestion in the lungs and the peripheral edema. Lasix or furosemide and spironolactone or Aldactone are diuretics that work on different areas of the kidneys to increase fluid loss. Decompensated heart failure patient's daily fluid intake and output are monitored closely as well as their daily weights in order to determine how much excess fluid is in the system.
Digitalis
In decompensated heart failure, it is necessary to control arrhythmias and to help the heart contract. Digoxin or digitalis increases the force of the heart's contractions so the heart pumps more blood through the system. Atrial fibrillation, a chaotic rhythm of the atrium, makes pumping ineffective. Digoxin, which controls this aberrant rhythm, can be toxic and requires daily blood levels in decompensated heart failure.
