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Treatment of Congestive heart failure

Congestive heart failure is not curable, but the condition can be managed with medication and a number of lifestyle changes that can help prevent it worsening.

There are a number of effective drugs, which when used regularly, help improve the function of the heart and reduce the symptoms of heart failure. It may take some time to get the right combination and amount of medication as many of the drugs have side effects, which your GP or specialist will discuss with you. A typical combination of drugs is ACE inhibitors, vasodilators and beta-blockers.

Medication:

  • ACE (Angiotensin Converting Enzyme) inhibitors are the most widely used medication for congestive heart failure. They prevent a build up of fluid by interfering with the enzyme 'angiotensin' (a body chemical). They relax the blood vessels and reduce the workload of the heart. They have a protective effect on the heart and cause a drop in blood pressure. Blood pressure monitoring is carried out after beginning ACE inhibitors. Blood tests are done regularly to check the function of the kidneys, which may be affected by the ACE inhibitors.  A dry cough is a common side effect.
  • Angiotensin II receptor antagonists have similar effects to ACE inhibitors. Unlike ACE inhibitors, they do not cause a dry cough so may be prescribed for people who have a strong reaction to ACE inhibitors.
  • Vasodilators relax and dilate the blood vessels and lower blood pressure.
  • Diuretics (water tablets) remove excess fluid and salt from the body, but mean that the body produces extra urine. They can reduce ankle swelling and breathlessness and may increase life expectancy. They are usually taken in addition to ACE inhibitors.
  • Cardiac glycosides (such as digoxin) strengthen and slow the heartbeat and are usually only taken in addition to other medication.
  • Beta blockers can be used to protect the heart muscle. They slow the heartbeat, improve the blood flow and help the heart pump effectively. They are usually taken in small doses in conjunction with ACE inhibitors and diuretics. Beta blockers are not suitable for people with respiratory problems such as asthma.
  • Intravenous medication is taken through a catheter inserted in the arm to strengthen the heart. It can be taken at home by having a ‘port’ inserted in the arm.
  • Cholesterol lowering medication (lipid lowering drugs) and aspirin may also be prescribed.

One the patients is stable, a long-term exercise programme will be discussed.

Surgery and other procedures:

Opening or bypassing the blocked arteries (using an artery from the chest wall or veins from the leg) can help. This is often carried out on patients who have angina. This is a major operation and may take 2-3 months to recover from.

A coronary angioplasty (where a balloon is inflated in the narrowed blood vessels) is a non-surgical procedure carried out under local anaesthetic. The blocked arteries are opened so that they are able to deliver oxygen and nutrients to the heart muscle.

A heart transplant may be necessary in a small number of some cases, where medication is not effectively controlling the condition or the heart is severely damaged. Not all patients are suitable for a heart transplant, and it may take several months to find a suitable donor.