HeartFailure

What treatments are available?

Heart failure caused by an excessive workload is curable by treating the primary disease, such as anemia or thyrotoxicosis. Also curable are forms caused by anatomical problems, such as a heart valve defect. These defects can be surgically corrected.

However, for the common forms of heart failure--those due to damaged heart muscle--no known cure exists. But treatment for these forms may be quite successful. The treatment seeks to improve patients' quality of life and length of survival through lifestyle change and drug therapy.

Patients can minimize the effects of heart failure by controlling the risk factors for heart disease. Obvious steps include quitting smoking, losing weight if necessary, abstaining from alcohol, and making dietary changes to reduce the amount of salt and fat consumed. Regular, modest exercise is also helpful for many patients, though the amount and intensity should be carefully monitored by a physician.

But, even with lifestyle changes, most heart failure patients must take medication. Many patients receive two or more drugs.

Several types of drugs have proven useful in the treatment of heart failure:

• Diuretics help reduce the amount of fluid in the body and are useful for patients with fluid retention and hypertension.

• Digitalis increases the force of the heart's contractions, helping to improve circulation.

• Results of recent studies have placed more emphasis on the use of drugs known as angiotensin converting enzyme (ACE) inhibitors. Several large studies have indicated that ACE inhibitors improve survival among heart failure patients and may slow, or perhaps even prevent, the loss of heart pumping activity.

Originally developed as a treatment for hypertension, ACE inhibitors help heart failure patients by, among other things, decreasing the pressure inside blood vessels. As a result, the heart does not have to work as hard to pump blood through the vessels.

Patients who cannot take ACE inhibitors may get a nitrate and/or a drug called hydralazine, each of which helps relax tension in blood vessels to improve blood flow.

Sometimes, heart failure is life-threatening. Usually, this happens when drug therapy and lifestyle changes fail to control its symptoms. In such cases, a heart transplant may be the only treatment option. However, candidates for transplantation often have to wait months or even years before a suitable donor heart is found. Recent studies indicate that some transplant candidates improve during this waiting period through drug treatment and other therapy, and can be removed from the transplant list.

Transplant candidates who do not improve sometimes need mechanical pumps, which are attached to the heart. Called left ventricular assist devices (LVADs), the machines take over part or virtually all of the heart's blood-pumping activity. However, current LVADs are not permanent solutions for heart failure but are considered bridges to transplantation.

An experimental surgical procedure for severe heart failure is available at a few U.S. medical centers. The procedure, called cardiomyoplasty, involves detaching one end of a muscle in the back, wrapping it around the heart, and then suturing the muscle to the heart. An implanted electric stimulator causes the back muscle to contract, pumping blood from the heart.

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Sources:
National Institutes of Health