Heart Disease - Treating Congestive Heart Failure (CHF)
Treatment of congestive heart failure (CHF) depends on the severity of the disease. In general, CHF is the result of a weakening of the heart over a long period of time, and consequently, there is usually no "cure" for the condition. Treatment typically focuses on relieve the symptoms of CHF and treating diseases or conditions that may be causing CHF.
The following chart summarizes the drugs that may be used to help treat CHF. Brand names of drugs are shown in parentheses.
|ACE Inhibitors||prevent blood vessel constriction and increase blood flow to body||benazepril (Lotensin), lisinopril (Prinivil), captopril (Capoten), ramipril (Altace), fosinopril (Monopril), moexipril (Univasc)|
|Diuretics||removes excess fluid, decreasing congestion in lungs||hydrochlorothiazide (HydroDIURIL), chlorothiazide (Diuril), furosemide (Lasix), bumetanide (Bumex), spironolactone (Aldactone), triamterene (Dyrenium), metolazone (Zaroxolyn)|
|Beta blockers||reduce heart’s workload||nadolol (Corgard), metoprolol (Lopressor, Toprol XL), pindolol (Visken), bisoprolol (Zebeta), acebutolol (Sectral)|
|Calcium channel blockers||increase blood flow through heart and help prevent blood vessel constriction by blocking calcium ions||verapamil (Calan, Isoptin, Verelan), diltiazem
(Cardizem, Tiamate, etc.) and nifedipine (Adalat)
|Blood thinners||may be used to prevent blood clots||warfarin (Coumadin)|
|Cardiotonics||strengthen heart’s ability to pump blood||digoxin (Lanoxin), adenosine (Adenocard, Adenoscan)|
In addition to drug therapy, surgery may be necessary in select cases to correct problems that may be causing CHF. For example, coronary angioplasty or coronary artery bypass graft may be performed on patients who have CHF as a result of coronary artery disease. The type of surgery a patient receives will depend on his or her specific heart problems. Surgical options for CHF include:
- Coronary angioplasty: Performed in a cardiac catheterization laboratory, this procedure involves placing a catheter with a small balloon on its tip into the patient’s narrowed artery under angiographic guidance. When properly positioned, the balloon is inflated and deflated, moving the plaque build-up further against the artery wall and thereby improving the flow of blood. This procedure may also be called percutaneous transluminal coronary angioplasty (PCTA), coronary artery balloon dilation or balloon angioplasty. Coronary angioplasty may be followed by stenting, a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the artery to keep it open and restore normal blood flow.
- Coronary artery bypass graft: Involves grafting the ends of a healthy blood vessel (often taken from the chest or leg) above and below a narrowed artery, bypassing the flow of blood around the narrowed artery. Bypass surgery can relieve symptoms of CAD, such as dyspnea or angina and may help prevent a myocardial infarction (heart attack).
- Valve replacement: Valve replacement involves removing a defective heart valve and replacing it with one made from metal, human tissue, or donated by another person. Methods of valve replacement include valvotomy (open-heart surgery) or percutaneous balloon valvuloplasty, where a catheter is fed up to the heart valve under angiographic guidance and a balloon at the end of the catheter inflates to widen the valve. Newer minimally invasive procedures show promise in reducing some of the surgical risks associated with valvotomy.
- Pacemaker implantation: An artificial pacemaker can be surgically implanted to help correct bradycardia (slow heartbeat), a condition that can worsen CHF. The surgery involves implanting an artificial pacemaker into the patient’s chest, which uses batteries to deliver an electrical impulse when an irregularity of the heart rhythm is detected. Many pacemakers have sophisticated sensory systems which allow them to function only when necessary.
- Cardioverter defibrillator implantation:This procedure involves implanting leads on the heart’s surface, which are connected to a pulse generator implanted under the skin near the chest or abdomen. The device delivers electrical shocks to the heart to help restore a normal rhythm. Like pacemakers, implantable cardioverter defibrillators have sophisticated sensory systems that allow them to record activity and adjust electrical pulses based on the heart’s activity.
- Left ventricular assist device (LVAD):An LVAD may be used in some cases to help the heart pump blood to the rest of the body. An LVAD consists of a tube that is inserted in the left ventricle, which draws blood into a pump and sends it to the aorta, in effect bypassing the weakened ventricle. LVADs are sometimes used while a patient waits for a heart to become available for transplant.
- Aneurysm surgery:In some cases, surgery may be performed on patients with CHF to repair an aneurysm, a bulging out of a blood vessel wall, associated with the build-up of plaque. Surgery may include placing stent grafts (expandable wire mesh tubes) to bypass the aneurysm (one above the aneurysm and one below). The stents will divert the flow of blood around the aneurysm instead of through it.
- Heart transplant: In severe cases of CHF, a heart transplant may be necessary to prolong life. This open-heart surgery consists of replacing the diseased heart with either an artificial heart or a donor heart. Patients seeking heart transplants will be put on a waiting list until a heart becomes available.
Updated: August 2006