Treatment for Heart failure
The management of heart failure depends on its cause and clinical course, therefore an individualized approach to the treatment is mandatory.
Diuretics and angiotensin converting enzyme (ACE) inhibitors, when combined with nonpharmacological measures, remain the basis of treatment in patients with heart failure.
Pharmacological Management
The pharmacologic treatment tackles four specific management goals:
- Optimization of the treatment of etiologic conditions=
- Treatment of fluid retention symptoms
- Prevention of disease progression
The following pharmacological agents are used for symptomatic improvement:
- Angiotensin receptor blockers (ARBs)—losartan and candesartan
- Positive inotropes—digoxin
For improvement in survival
- Vasodilators—oral nitrates in combination with hydralazine
Diuretic therapy is indicated for relief of congestive symptoms. The ACE inhibitors, when added to diuretics, improve the symptoms, exercise tolerance and reduce hospital admission rates in chronic heart failure. The primaryaction of beta-blockers is to counteract the unfavorable effectsof the sympathetic nervous system that are activated during heart failure. The beneficial effects of beta-blockers includeimprovement in the heart remodeling and ejection fraction,the rate of hospitalization, survival, quality of life and the incidenceof sudden death.1
The ARBs should be used only in patients who cannot tolerate ACE inhibitors because of severe cough or angioedema (rapid swelling of the skin, mucosa and submucosal tissues). In patients who remain symptomatic despite diuretic and beta-blocker therapy, treatment with the vasodilator combination of hydralazine and isosorbide dinitratemay be an alternative.7 Once used as first-line therapy, digoxin is now reserved for the control of ventricular rhythm in patients with atrial fibrillation or where adequate control is not achieved with an ACE inhibitor, beta-blocker or a diuretic.
Nonpharmacological Measures
Various nonpharmacological measures to improve symptoms and prognosis of HF include the following:2
- Aregularly scheduled exercise program, for selected patients.
- Weight reduction and weight monitoring.
- Fluid restriction, limited to 1.5 L daily.
- Avoidanceof nonsteroidal antiinflammatory drugs (NSAIDs).
- Abstain from or limit alcohol consumption.
Revascularization and Surgical Therapy
As CAD is the primary etiology in two-thirdsof all cases of HF, practice guidelines and recent studies recommendcoronary revascularization for patients with HF andCAD.3 Patients with severe CAD and symptomatic left ventricular systolic dysfunction had been observed to have poor outcomes, when treated medically, despite the advances in medical therapy over the past decade.
Revascularization either by coronary artery bypass graft surgery or by percutaneous coronary intervention may improve the long-term outcomes in patients with left ventricular dysfunction and myocardial ischemia, and reduces the risk of sudden death.4
Next page: Causes of Heart failure
Written by: Healthplus24 team
Date last updated: April 15, 2012