DEAR DOCTOR K:
My father takes several medications for heart failure. Can you tell me what these drugs do?
Heart failure (also called congestive heart failure) is a condition in which the heart cannot pump efficiently enough to meet the body’s need for blood. Unlike a cardiac arrest, the heart is still pumping; it’s just not fully doing the job.
Heart failure often is the end stage of another form of heart disease. For example, coronary artery disease, high blood pressure and heart valve disorders often lead to heart failure. In some people with heart failure, the heart muscle becomes weaker and cannot pump as well. In others, the heart muscle stiffens. As a result, the heart cannot fill with enough blood between heartbeats. (See the illustration below.)
In diastolic heart failure, thickened and stiff heart walls prevent the heart from filling with enough blood. That means the heart does not have enough blood to pump around the body.
The heart’s inefficient pumping causes a backup of blood in the veins leading to the heart. That results in some fluid in the blood leaking out of the blood vessels into surrounding tissues, causing them to swell. You can see the swelling in the legs and ankles.
Oxygen-rich blood returning to the heart from the lungs also gets backed up into the lungs, which can cause breathlessness and wheezing. Since not enough blood is being pumped to the kidneys, they don’t remove as much salt and water from the blood as they are supposed to. This, too, causes swelling in the legs and ankles. Heart failure also causes fatigue.
As the condition worsens, all the symptoms worsen. For example, at first the shortness of breath and wheezing occur during exertion, but eventually they occur even at rest.
Treatment of heart failure focuses on:
- Lessening symptoms
- Decreasing hospitalizations
- Improving life expectancy
A low-salt diet to decrease water retention and medication are required to accomplish these goals. Heart failure medications can include:
- A diuretic to remove excess body fluid by stimulating the kidneys to produce more urine.
- An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) to help the heart work with less effort.
- A beta-blocker to help the heart work with less effort.
- Digoxin (Lanoxin) to strengthen the heart’s contractions.
- A potassium-sparing diuretic, which can increase life expectancy.
Sometimes blood thinners also are prescribed. That’s because during more serious heart failure, sluggish circulation makes it easier for blood clots to form in the heart and in the veins of the legs. The blood thinners help prevent blood clots in patients on extended bed rest. For some patients, losing weight or avoiding alcohol can dramatically improve symptoms.
It’s also important to identify and address the underlying cause of heart failure. Heart failure related to coronary artery disease, for example, may require additional medications, angioplasty or surgery.
With appropriate treatment, people who develop heart failure often can enjoy many years of productive life.