What treatments are available to cure congestive heart failure?
The treatment of congestive heart failure focused on treating the symptoms and signs of congestive heart failure and preventing the progression of disease. If there is a reversible cause of the heart failure (ie: infection, anemia, thyrotoxicosis, arrhythmia, or hypertension), that should be addressed as well.
Treating the signs and symptoms of congestive heart failure involves maintaining a euvolemic state (normal fluid level in the circulatory system). This is done with the judicious use of diuretic agents, vasodilator agents, and positive inotropes. Certain subgroups may benefit from Bi-ventricular pacemaker placement or surgical remodelling of the heart. While these treatment modalities may make the patient symptomatically better, either they have not been shown to improve survival in large clinical studies or those studies have not been performed.
In the recently completed COMPANION trial, cardiac resynchronization therapy (pacing both the left ventricle as well as the right ventricle) has been shown to improve mortality in individuals with NYHA class III or IV heart failure with a widened QRS complex on EKG.
Delaying the progression of heart failure involves the use of ACE inhibitors, beta blockers, and aldosterone inhibitors. These agents have been proven to improve survival in individuals with CHF. While the mechanism of improving is not entirely clear, it appears that these agents prevent remodelling of the heart and therefore prevent progression of dilatation of the left ventricle. If there is a underlying cause of congestive heart failure, it is corrected. For example, infections can be treated with antibiotics, surgery can correct malfunctioning heart valves and remove blockages from coronary arteries, and drugs can correct problems with the thyroid gland and control high blood pressure and cholesterol levels. There are also contributing factors that can be corrected, including diet and lifestyle changes such as reducing salt and fat intake, controlling weight, eliminating cigarette smoking, and reducing alcohol consumption. Next, your doctor will try to improve the flow of blood and oxygen through your body. There are many drugs that are prescribed for this purpose. For example, digitalis drugs slow the heart rate and improve its pumping ability. Vasodilators are drugs that dilate the blood vessels. A class of vasodilators called ACE inhibitors is used to treat high blood pressure. These drugs reduce the force required to move blood through the body by lowering blood pressure, which reduces the heart's workload and prolongs the patient's life. Patients who cannot tolerate ACE inhibitors are prescribed angiotensin II receptor blockers, which affect the blood vessels in the same way as ACE inhibitors.
Patients who experience swelling in the feet, ankles, legs, and abdomen are given drugs called diuretics. Diuretics stimulate the kidneys to increase urine production and remove sodium and water from the body. Reducing fluid retention also helps relieve shortness of breath. However, patients taking diuretics may also need to take a potassium supplement because the body loses large amounts of that mineral due to frequent urination. A diuretic called spironolactone has been shown to have the added benefit of preserving the body's potassium levels. Patients with severe heart failure and lowered kidney function may need to be hospitalized and given diuretics intravenously until their condition is stable. Patients with pulmonary edema are hospitalized and given high concentrations of oxygen through a face mask or a tube inserted through the windpipe (trachea). A number of medications, including diuretics and vasodilators, can help remove fluids from the lungs and improve heart function. Morphine may also be given to help reduce the anxiety caused by breathing difficulties associated with pulmonary edema.
For long-term care, doctors recommend alternating periods of rest with gentle exercise, such as walking. Cardiac rehabilitation programs can provide medically supervised exercise programs for people with congestive heart failure. Heart transplants are only considered for patients with severe congestive heart failure. A procedure called an intra-aortic balloon pump (IABP) can be used as a short-term treatment for patients who need a heart transplant. An IABP consists of a balloon attached to the end of a long, thin tube called a catheter. The catheter is inserted is through an artery in the groin where it is guided to the heart's aorta. A bedside pump, attached to the catheter, inflates the balloon immediately after the heart contracts. The inflated balloon blocks the aorta and forces some blood into the coronary arteries. Right before the heart beats again, the balloon deflates. This creates a vacuum in the arteries that makes it easier for the heart to push oxygen-rich blood out to the body. An IABP can be used for only a few days, and the patient must remain in the hospital, lying flat. Patients with weakened left ventricles can be helped by a left ventricular assist device (LVAD). This device is a small pump that is implanted in the upper part of the abdomen. A tube leading from the left ventricle pulls blood into the pump, which then forces the blood into the aorta. A second tube protrudes outside of the body, through the abdominal wall, and is attached a pump control system. The LVAD takes over the work of the left ventricle by letting blood flow bypass it altogether. Like the IABP, the LVAD can extend the life of patients with severe congestive heart failure. The LVAD, however, shows promise as a longer-term treatment device.