Treatment of heart failure ?

There are many treatments for heart failure, and your doctor or health care provider may chose for you to take several medications and suggest other treatments.
These medications and treatments can:

  1. Improve symptoms and improve quality of life
  2. Decrease disease progression
  3. Decrease the risk of death; and
  4. Decrease the need for hospitalization

Important information about heart failure medications:

  1. Medications are often started in low doses, and doses are gradually increased over time. The medications are long-term and have long-term benefits. Some medications do not have an immediate effect so it is important to continue them.
  2. Do not use potassium supplements or salt substitutes that are high in potassium without talking with your nurse or doctor.
  3. Please do not start vitamin supplements or herbal remedies until you speak with your health care provider.
  4. It is important to take your medication every day. Take your medication even when your blood pressure comes down unless you are feeling bad.
  5. Do not stop taking your medicine until you consult with your healthcare provider.
  6. If you miss a dose, take it as soon as you remember—unless it's almost time for your next dose. If so, skip the missed dose. Do not take a double dose.
  7. Purchase pill boxes labeled with the days of the week. Fill the boxes at the start of the week with all of your daily drugs so that you do not miss any.
  8. Always carry a list of your current drugs AND their dose with you (in your wallet or purse). You may want to write the dose in pencil so that you can quickly change them after doctors' visits.
  9. Always take your drugs with you when you travel. You should also bring a few extra pills in case you are gone longer than planned. When you travel, pack your drugs in your carry-on baggage, never in your checked luggage.
  10. Never skip pills or cut your pills to save money. You should speak to your doctor or nurse first.
  11. When taking "water pills" think about the time you take them and how to still take them when you are away from home. Track how much you urinate after you take your normal dose of water pill. Plan you trips/errands after that time. If you take water pills twice a day, take your second dose late in the day but before dusk, to prevent from having to get up during the night while you are trying to sleep.
  12. You should speak with your doctor about your dose of water pills if you have been sick to your stomach for a few days, or if you get the flu. Be careful when going outside in very hot weather; you may feel faint or dizzy.

  • Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARBs) are drugs that block effects of stress hormones that can make HEART FAILURE worse. They can also be used to lower blood pressure. Research has shown that ACE-I significantly decrease death, hospitalization and symptoms of heart failure so you can feel better, and be more active.

    These medications are started a low doses and increased slowly over time as tolerated based on blood pressure, symptoms and lab results. The goal blood pressure varies for each person. The goal in heart failure management is to keep the blood pressure low to reduce the stress on the heart.

    Tip: Be sure to wait a minute or two before standing or walking if you have been lying or sitting down for a long time.
  • Examples of these medications include captopril (Capoten), lisinopril (Prinivil), enalapril (Vasotec), ramipril (Altace)/ candesartan (Atacand), losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan).ACE inhibitors usually end with a "pril", ARBs end with "sartan".
  • Side effects of these drugs can include a dry cough, getting dizzy due to low blood pressure, or metallic or salty taste, or decreased ability to taste. Tip: Consider taking your ace inhibitor or ARB at night to reduce side effects.

    These medications can also cause problems such as hurting your kidney function, causing high potassium, or swelling in your lips or throat. You will need to have blood tests after starting these pills or if the dose in increased, to check on your kidneys and potassium level. If you have signs of swelling in your lips or throat, call your health care provider.
  • Beta-blockers (Beta-adrenergic receptor blockers) are drugs that also block effects of stress hormones that can make heart failure worse. They can also be used to control high blood pressure and lower fast heart rates. Names of these drugs include atenolol (Tenormin), carvedilol (Coreg), metoprolol (Toprol), nadolol (Corgard), nebivolol (Bystolic).Beta blockers end in "lol". Side effects of these drugs can include feeling tired or dizzy. People who have asthma should take these drugs only under your health care providers close supervision because they can cause trouble breathing and/or wheezing. Be sure to talk to your doctor at once if you notice these problems.
  • Diuretics are drugs often known as "water pills". They help your body to get rid of excess fluid. This can help you breathe easier, and reduce or prevent swelling in your legs and/or abdomen. Some of these include hydrocholorthiazide (Dyazide), furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex).
  • Losing too much water is a side effect of these drugs with symptoms such as getting dizzy,feeling very thirsty, or very tired. These drugs can also cause your body to lose too much potassium. Ask your doctor if you need to replace it with potassium pills or eat more foods high in potassium.
  • Aldosterone antagonists are drugs that block effects of a hormone that can make heart failure worse. They also help the body hold potassium, which is often lost when a patient is taking a water pill. Some of these drugs include eplerenone (Inspra), and spironolactone (Aldactone).
  • Side effects include breast pain, breast growth (even in men), and higher potassium levels. Ask your doctor when you should have your potassium level drawn.
  • Isosorbide/hydralazine blend pills consist of 2 special medicines. The isosorbide portion supplies nitric oxide to the heart, which works to relax the blood vessels and decrease the work of the heart. The hydralazine portion helps to relax blood vessels and therefore, lowers blood pressure. Research shows that African Americans may produce low amounts of nitric oxide. These drugs can be given in one pill (Bidil) or as 2 separate pills. Side effects include being dizzy, having a sick stomach, or headaches.
  • Digoxin is a drug that helps heart function by causing the heart to beat stronger and may correct some hormonal effects that can make heart failure worse. Lanoxin, Digitek are some of the brand names of this drug. Side effects can be from an excessive amount of digoxin, and can include having a sick stomach, blurry vision, heartbeat that is too fast or slow, or passing out.
  • Medicines to Avoid: There are many medicines, both ordered by your healthcare provider and ones you can buy over-the-counter, that people with heart failure should avoid.
  • Non-steroidal anti-inflammatory drugs (NSAIDS) is one group of medicines if you have heart failure that you should not take. These include drugs such as ibuprofen, Advil, Motrin, Aleve, Toradol, and Celebrex. They can cause swelling, affect other heart failure drugs and/or worsen heart failure symptoms. These drugs can also harm kidney function.
  • Calcium Channel Blockers: Most of the time, doctors will not order some medicines that can lower the pumping of the heart such as Calcium-channel blockers. These include diltiazem (Cardizem, Cartia, Diltia) and verapamil (Calan, Verelan). These drugs can also cause the body to hold excess fluid.
  • Herbs and Supplements:There are hundreds of herbs and supplements on the market today. Many of them can cause problems with the current drugs that you are taking. Talk to your doctor about these before you begin taking them.

As a heart failure patient, you are likely taking many medications. Here are some tips that can help you to do well with your treatment:

  • Purchase pill boxes labeled with the days of the week. Fill the boxes at the start of the week with all of your daily drugs so that you do not miss any.
  • Always carry a list of your current drugs AND their dose with you (in your wallet or purse). You may want to write the dose in pencil so that you can quickly change them after doctors' visits.
  • Always take your drugs with you when you travel. You should also bring a few extra days worth in case you are gone longer than planned. When you travel, pack your drugs in your carry-on baggage, never in your checked luggage.
  • Never skip pills or cut your pills to save money. You should speak to your doctor or nurse first.

ps: When taking "water pills" think about  the time you take them and how to still take them when  you are away from home. Track how much you urinate after you take your normal dose of water pill. Plan you trips/errands after that time. If you take water pills twice a day, take your second dose late in the day but before dusk, to prevent from having to get up during the night while you are trying to sleep.

You should speak with your doctor about your dose of water pills if you have been sick to your stomach for a few days, or if you get the flu. Be careful when going outside in very hot weather; you may feel faint or dizzy.

Devices:Your doctor may suggest a special device to help treat your heart failure . This is because people with heart failure may have heart rhythms that are too fast or too slow. Heart rhythms that are not normal can make you feel bad, cause you to "black out" which in turn can threaten your life. Your doctor may suggest a device that can be placed to help treat your heart failure or one its harmful side effects. Some of these include implantable cardioverter defibrillators (ICD's), pacemakers, or bi-ventricular pacemakers or ICD's (Bi-V ICD's).

  • These are placed under the skin, most often on the upper left chest area. They have a battery with wires that connect to your heart. They must be checked often, and patients must still take their medications. Some devices check your heart rate and rhythm and only function when your heart needs it, while others work all of the time to pace your heart beats.
  • An ICD is a device that always watches the heart rhythm. It will deliver an electrical shock to treat unsafe heart rhythms (usually very fast heart rates that are hectic) that can occur in weak hearts. The shock restores a normal rhythm.
  • A Bi-V ICD helps the lower chambers of the heart to beat at the same time, and improve pumping. It involves placement of a special device under the skin with 3 wires attached, and the wires pace the heart so that both chambers contract at the same time. This device can also shock a hectic or unsafe rhythm.

Other procedures or surgeries that help some people with heart failure:

  • Some patients have blocked heart vessels that may be a cause of, or make heart failure worse. Plaque in heart vessels can decrease the blood supply to the heart and cause or worsen heart failure . Your doctor may decide that you need a percutaneous coronary intervention (PCI). In the cath lab, a special line with a tiny balloon on its end is placed into the blocked vessel. By blowing up the balloon, the plaque is pushed to the side and the vessel is opened up. Sometimes, a small metal spring-like device (a stent) is placed to keep the vessel open and restore good blood flow to the muscle.
  • Plaque in the vessels of the heart may not be able to be fixed with PCI. Bypass surgery may be required where the blood supply is moved around a blockage by using a vein or artery from somewhere else in the body. It is then attached to the blocked artery and brings good blood flow around the blockage to the heart muscle.
  • Some surgeries can help to treat heart problems that may be causing heart failure or make it worse. Sometimes, a heart valve needs to be repaired or replaced. New valves can be plastic, metal, or made from human or even cow or pig tissue. Patients may have to take blood thinners to prevent clots from forming on the valves.

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