Treatment of mild heart failure usually starts with an ACE inhibitor, the most common vasodilator drug for heart failure patients. Studies have shown that ACE inhibitors are beneficial for treating heart failure symptoms and prolonging the life of patients with chronic heart failure. They also help increase the excretion of sodium and water, helping to reduce fluid overload.
One of the next steps is often the use of a type of negative inotropic drug called a beta-blocker. Studies have shown that beta-blockers can benefit heart failure patients by improving their symptoms and heart function, and, in some cases, the chance of survival.
In more severe heart failure, a diuretic is added. Even if diuretics alone controls a patient's symptoms, they should be used in combination with an ACE inhibitor and often a beta-blocker. A thiazide diuretic may be sufficient -- if not, a loop diuretic is used.
Diuretic drugs are used in most heart failure patients because heart failure leads to retention of sodium and water by the kidneys, which can lead to fluid overload. Congestion in the lungs can interfere with their ability to exchange oxygen from the air and can be life-threatening. Doctors prescribe diuretic drugs for all patients with heart failure who have evidence of fluid overload, such as lung congestion, raised jugular venous pressure or peripheral edema, and most heart failure patients are eventually placed on a diuretic drug.
Doctors usually start patients on a low dose of a diuretic and increase the dose until the effective range is reached. When the diuretic is working effectively, the patient will lose weight because of fluid loss. If a patient doesn't respond even to high doses of a diuretic, a doctor will often prescribe intravenous administration or more than one diuretic. Sometimes diuretics work better in combination. Patients are usually maintained on a diuretic, once it is working, to prevent episodes of fluid overload. Periodic adjustments may be needed in the dose, and care must be taken to prevent side effects like:
- Imbalances in electrolytes (small molecules in the fluids in our bodies, like sodium)
- Inappropriate activation of some hormonal systems
- Low blood pressure
- Increase in level of serum creatinine (a chemical in the blood that's used to measure kidney function)
- Symptoms of kidney failure
- Interactions with other drugs
If heart failure is so severe that a combination of an ACE inhibitor and a diuretic fails to relieve symptoms, digoxin, the most commonly prescribed positive inotropic drug, may be added. Studies have shown that digoxin can reduce the symptoms of patients who are already receiving diuretics and ACE inhibitors. The prolonged use of other positive inotropic drugs has been shown to increase the risk of death in some heart failure patients -- so they should only be used for acute or end-stage heart failure.
For more information about heart failure treatments and medications, take a look at the links on the next page.