Congestive heart failure is a condition in which the heart does not pump blood as efficiently as it should. This causes patients to become tired or fatigued more easily with exertion as well as fluid buildup in the legs and back. If severe, CHF can cause fluid buildup in the lung tissue, which can impair breathing. Treatments for CHF fall into several general categories. Certain medications improve the ability of the heart to contract. Other medications decrease the amount of pressure the heart has to pump against.
Lifestyle Modification
The cornerstone of treatment for heart-related disease is maintaining a healthy lifestyle. This includes weight reduction if overweight, salt restriction to reduce hypertension and smoking cessation. Losing weight and following a low-salt diet work to decrease the amount of pressure the heart needs to pump against to deliver blood to the tissues. Unusual weight gain can signal a worsening of heart failure; therefore frequent monitoring of body weight is recommended for patients with moderate to severe heart failure,.
Diuretics
Diuretics are medications that help remove fluid from the body. Fluid leaks out of capillaries and fills the space underneath the skin when the heart cannot push the blood around with enough force to return it to the heart through the venous system. In general, diuretics stimulate the kidneys to extract water from the bloodstream and excrete it as urine. These medications can cause changes in blood levels of sodium and potassium and require frequent monitoring of these levels.
ACE Inhibitors
Angiotensin converting enzyme inhibitors are a class of medications that work on the heart and on the blood vessels to improve the efficiency of each heartbeat. They work by decreasing blood pressure in the capillaries where fluid is likely to leak out. It also works as a weak diuretic, causing excess fluid to be excreted by the kidneys as urine. ACE inhibitors are a class of drug that has been proven to decrease the likelihood of death from heart failure and is used as a first-line medication for CHF.
Digoxin
Digoxin is a medication that works in two ways to help the heart pump more effectively. It first slows down the rate at which the heart pumps, allowing more blood to collect in the ventricle before it contracts again. It also increases the force with which the heart pumps out blood. Digoxin is a medication used in conjunction with ACE inhibitors and diuretics to improve leg swelling and fatigue associated with congestive heart failure, however it does not have any effect on the disease course.
Pacemaker/Defibrillator
People with long-standing heart failure are often at an increased risk for abnormal heart rhythms. Heart failure can cause dilation or abnormal growth of the heart's muscular wall, which changes how electricity is conducted from one area to another. These structural changes over time can lead to unpredictable changes in heart rhythm, some of which are fatal. Implanting a pacemaker and/or defibrillator in some patients with severe disease may be able to prevent death from these abnormal heart rhythms.
References
- Access Medicone: Current Diagnosis & Treatment in Cardiology; Chapter 18. Congestive Heart Failure; Prakash C. Deedwania, MD & Enrique V. Carbajal, MD; 2009
- "Journal of the American College of Cardiology"; ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults; Mariell Jessup, MD et al; 2009
- StafRef: AHFS DI Essentials; Digoxin; ACP PIER; 2010
- MD Consult: Heart Failure; Robert C Bahler, MD et al; February 13, 2010
