An in-depth report on the causes, diagnosis, treatment, and prevention of heart failure.
Cardiomyopathy; Congestive heart failure
Heart failure is a condition in which the heart does not pump enough blood to meet the needs of the body's tissues. It can have a number of causes. Heart failure can develop slowly over time as the result of other conditions (such as high blood pressure and coronary artery disease) that weaken the heart. It can also occur suddenly as the result of damage to the heart muscle or an acute valve problem.
Common signs and symptoms of heart failure include:
- Shortness of breath
- Wheezing or cough
- Fluid retention and weight gain
- Loss of appetite
- Abnormally fast or slow heart rate
Treatment for heart failure depends on its severity. All patients need dietary salt restriction and other lifestyle adjustments, medication, and monitoring. People with severe heart failure may need implanted devices (such as pacemakers, implantable cardiac defibrillators, or devices that help the heart pump blood) or surgery, including heart transplantation.
Doctors usually treat heart failure, and the underlying conditions that cause it, with a combination of medications. Some of these medications include:
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs)
- Beta blockers
- Diuretics (water pills)
- Aldosterone blockers
- Hydralazine and isosorbide dinitrate
Not all patients will be placed on all these medications. But most of them will be prescribed at least for some of the patients.
Two newer drugs are now available for select patients with heart failure:
- Ivabradine (Corlanor) works to decrease the heart rate.
- Sacubitril-valsartan (Entresto) is called a angiotensin-neprilysin inhibitor. This drug may be used in place of an ARB or ACE inhibitor under certain circumstances.
Decision Making in Advanced Heart Failure
For patients with advanced heart failure, symptom relief, quality of life, and personal values are as important to consider as survival, advises the American Heart Association (AHA). The AHA notes that while technology has increased the treatment options for advanced heart failure, "doing everything is not always the right thing." AHA guidelines emphasize a patient-centered approach to treatment and the importance of patients discussing with their doctors their preferences, expectations, and goals.