• 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.

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.

Listed below are some of the medications prescribed for heart failure. Not all medications are suitable for all patients, and more than one drug may be needed.

ACE Inhibitors
These prevent the production of a chemical that causes blood vessels to narrow. As a result, blood pressure drops and the heart does not have to work as hard to pump blood. Side effects may include coughing, skin rashes, fluid retention, excess potassium in the bloodstream, kidney problems, and an altered or lost sense of taste.

Digitalis
Increases the force of the heart’s contractions. It also slows certain fast heart rhythms. As a result, the heart beats less frequently but more effectively, and more blood is pumped into the arteries. Side effects may include nausea, vomiting, loss of appetite, diarrhea, confusion, and new heartbeat irregularities.

Diuretics
These decrease the body’s retention of salt and so of water. Diuretics are commonly prescribed to reduce high blood pressure. Diuretics come in many types, with different periods of effectiveness. Side effects may include loss of too much potassium, weakness, muscle cramps, joint pains, and impotence.

Hydralazine
This drug widens blood vessels, easing blood flow. Side effects may include headaches, rapid heartbeat, and joint pain.

Nitrates
This drug is used mostly for chest pain, but may also help diminish heart failure symptoms. It is a smooth–muscle relaxer and widens blood vessels. It acts to lower primarily systolic blood pressure.

Side effects may include headaches.
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.

Can a person live with heart failure?

Heart failure is one of the most serious symptoms of heart disease. About half of all patients die within 5 years of diagnosis. However, half live beyond 5 years, many well into old age. The outlook for an individual patient depends on the patient’s age, severity of heart failure, overall health, and a number of other factors.

As heart failure progresses, the effects can become quite severe, and patients often lose the ability to perform even modest physical activity. Eventually, the heart’s reduced pumping capacity may interfere with routine functions, and patients may become unable to care for themselves. The loss in functional ability can occur quickly if the heart is further weakened by heart attacks or the worsening of other conditions that affect heart failure, such as diabetes and coronary heart disease.

Heart failure patients also have an increased risk of sudden death, or cardiac arrest, caused by an irregular heartbeat.

• To improve the chances of surviving with heart failure, patients must take care of themselves. Patients must.
• See their physician regularly.
• Closely follow all of their physician’s instructions.
• Take any medication according to instructions.

Immediately inform their physician of any significant change in their condition, such as an intensified shortness of breath or swollen feet.

• Patients with heart failure also should:
• Control their weight.
• Watch what they eat.
• Not smoke cigarettes or use other tobacco products.
• Abstain from or strictly limit alcohol consumption.

Even with the best care, heart failure can worsen, but patients who don’t take care of themselves are almost writing themselves a prescription for poor health.

The best defense against heart failure is the prevention of heart disease. Almost all of the major coronary risk factors can be controlled or eliminated: smoking, high cholesterol, high blood pressure, diabetes, and obesity.