How do Physicians Treat Congestive Heart Failure?
Heart failure occurs when the heart is unable to properly pump blood throughout the body; as a result, rather than distributing nutrients and oxygen to the tissues and then excreting the excess fluid into the urine the blood pools. This results in either a systemic or localized edema as fluid builds up in the veins and organs, causing swelling of the extremities as well as the organs themselves (this fluid accumulation is responsible for an excessive amount of stress on the heart as fluid accumulates in the pleural cavity as well as the dyspnea, or difficulty breathing, often symptomatic of heart failure). The swelling and lack of oxygen and nutrients will result in permanent damage to the organs if left untreated, providing a very poor prognosis for the patient.
The first stage of treatment generally consists of the administration of extra oxygen to attempt to return the oxygen levels in the tissues to normal. Once oxygen has been administered and a pulse oximeter reveals blood oxygen levels to be acceptable the focus will shift to attempting to treat the fluid build-up in the body. Diuretics will be administered to assist the excess fluid on its path out of the body via the urinary tract, and nitrates are administered to cause the vessels to dilate, allowing blood to flow more freely without the heart having to work quite as hard. Treatment with diuretics is often accompanied by supplemental potassium, as the body will excrete potassium in the urine and long term hypokalemia may result in muscle weakness or paralysis, as well as an increased risk of fatal cardiac arrhythmia.
Patients will often be sent home from the hospital with diuretics, as well as a medication known as an ACE inhibitor (an angiotensin-converting enzyme inhibitor) which prevents the body from creating angiotensin, a substance which raises blood pressure and causes the blood vessels to constrict. An angiotensin II receptor blocker may also be administered if the patient continues to produce angiotensin. Patients may also be treated with vasodilators other than ACE inhibitors, particularly if they have responded poorly to treatments with ACE inhibitors in the past. Nitroglycerin is a common example of this type of medication.
Digitalis, or Digoxin, may be prescribed to strengthen the force of the heart's contractions, aiding it to push blood throughout the body. Treatment with a beta blocker is also beneficial in cases of heart failure, preventing the heart from beating more rapidly in an attempt to compensate for the poor movement of the blood in the body and placing more stress on the weakened muscle.
Blood thinners are used to prevent the formation of clots in the body that may be caused by the decreased movement of the blood in the vessels. Coumadin and heparin are the most commonly prescribed blood thinners in use today; however, due to an increased risk of bleeding patients taking these medications should undergo coagulation testing regularly.
Lifestyle changes are just as important as medications in the long term treatment of heart failure. Patients should consult with their doctor to establish an appropriate (low sodium) diet and exercise program, and should do at least some moderate exercise daily. Equally important is taking sufficient time to rest every day. The heart pumps more easily when the body is at rest, which is vital to an already overstressed muscle. The nicotine from cigarettes causes an increase in heart rate, blood pressure, and the tendency for clumping in the blood vessels; patients with heart failure should abstain from smoking. Flu or pneumonia can be very difficult for hearts that are failing as they attempt to compensate for the lack of oxygen in the bloodstream being carried to the organs. It is very important that patients receive an annual influenza vaccine, as well as a dose of the pneumococcal vaccine, which will protect them from the pneumococcal bacteria that cause over eighty percent of cases of bacterial pneumonia. Wearing non-constrictive clothing will assist in preventing blood clots and facilitating blood flow to the extremeties, and in cases of extremely warm or extremely cold temperatures it is important that the patient take all precautions necessary to keep the body at an appropriate temperature..
Researchers are still seeking to find a cure for congestive heart failure; however, until that day comes it is extremely important that patients suffering from heart failure follow the treatment plan outlined by their physician. With careful attention to maintaining their condition, the prognosis associated with heart failure increases dramatically.
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