In addition to treating the underlying cause, there are other options available that minimize the symptoms of heart failure, help the heart work better and improve survival.
Drugs
Diuretics Diuretics, or "water pills," are a mainstay of therapy for patients with heart failure. These drugs increase the elimination of water through the kidneys, and reduce the fluid retention that occurs in heart failure. They help rid the lungs of the excess fluids that cause shortness of breath, and also reduce leg swelling. Most patients who have experienced an episode of heart failure are placed on daily therapy with diuretics - and most will notice worsening symptoms rather quickly if they stop taking their diuretics. Commonly used diuretics include Lasix (furosemide) and Bumex (bumetanide. Their chief side effect is that they can cause low potassium levels, which can lead to cardiac arrhythmias.
Beta blockers Beta blockers reduce the excess stress on the failing heart, and have been proven to significantly improve the survival of patients with heart failure. Virtually all patients with heart failure should be on a beta blocker. The generic names for beta blockers all end in "lol:" Carvedilol (Coreg), metoprolol (Toprol) and bisoprolol (Ziac) are the most commonly used beta blockers in heart failure. Beta blockers can cause some fatigue when they are first started. For this reason, a very low dose is used initially, and the dose is gradually built up over weeks or months to a "target" dose. Once the body body adjusts, not only are these drugs well-tolerated, but they also usually improve overall heart function, symptoms and survival.
ACE inhibitors ACE (angiotensin converting enzyme) inhibitors have proven to be very effective in improving both the symptoms and survival in patients with heart failure. Every patient with heart failure should be on an ACE inhibitor unless they are not tolerated (usually due to cough or low blood pressure). Commonly used ACE inhibitors include Vasotec (enalapril), Altace (ramipril), Accupril (quinapril), Lotensin (benazepril and Zeztril (lisinopril or Prinivil). If you are not taking a drug whose generic name ends in "pril," you need to talk to your doctor.
Angiotensin II receptor blockers (ARBS) are drugs that work similarly to ACE inhibitors. They can be used in patients with heart failure who cannot take ACE inhibitors. ARBS that have been approved for heart failure include Atacand (candesartan) and Diovan (valsartan).
Aldosterone antagonists Aldactone (spironolactone) and Inspra (eplerenone) are another class of drugs drugs that have been convincingly shown to improve survival in some patients with heart failure. These drugs are weak diuretics, and they also help to hold potassium in the body. In patients with reduced kidney function, these drugs can cause dangerously high levels of potassium, so they need to be used with great caution if kidney function is not normal.
Digoxin While in past decades digoxin (Lanoxin) was considered a mainstay in the treatment of heart failure, its actual benefits in treating dilated cardiomyopathy seem to be marginal, and many doctors now prescribe it only if the more effective medications do not appear to be adequate. Also, there is evidence that digoxin might actually be detrimental in women who have heart failure. Click here to read about the risks of digitalis in women with heart failure.
Implantable Defibrillators
Unfortunately, patients with moderate to severe dilated cardiomyopathy have an increased risk of sudden death from ventricular arrhythmias. The implantable defibrillator has been shown to significantly reduce mortality in certain subsets of patients with cardiomyopathy, particularly in those with prior heart attacks. Clinical trials have shown that patients with greatly reduced ejection fractions have a significantly improved survival when they receive implantable defibrillators.Cardiac Resynchronization Therapy (CRT)
CRT is a new form of treatment for some patients with dilated cardiomyopathy. CRT is a form of cardiac pacing that stimulates both ventricles (right and left) simultaneously. (Standard pacemakers stimulate only the right ventricle.) The purpose of CRT is to coordinate the contraction of the ventricles, which improves the efficiency of the heart, and increases the amount of blood pumped with each heart beat. Studies with CRT show that this therapy, in appropriately selected patients, results in substantial improvements in cardiac function and symptoms, reduces hospitalizations, and prolongs life. Any patient with dilated cardiomyopathy and a complete or partial bundle branch block should be considered for CRT. Click here to read more about CRT.Cardiac Transplantation
While heart transplantation techniques have improved remarkably over the last 20 years, this treatment is reserved for the sickest patients. With the treatments discussed above, patients with heart failure often do quite well for years, without ever needing to be considered for this "last resort" therapy.More on Dilated Cardiomyopathy
Causes of Dilated Cardiomyopathy
Symptoms and Diagnosis of Dilated Cardiomyopathy
Additional Links Related to Heart Failure
Source:
Massie, BM "Heart Failure" in: Goldman L and Ausiello D (Eds). Cecil Textbook of Medicine, WB Saunders, 2003.
