Congestive Heart Failure Treatment

A Varied Approach For Congestive Heart Failure Treatment

There are a number of options for congestive heart failure treatment. However in treating CHF it is important to treat the underlying cause or causes in order to stop the progression of the disease. 

Congestive heart failure is the result of long-term heart and cardiovascular damage. After years of strain and being overworked the heart simply can not adequately pump blood to the body. 

Treatments can be classified into two categories. There are a number of natural options for congestive heart failure treatment. This section is concerned only with conventional treatments.

Medications For Congestive Heart Failure Treatment

There are a variety of medications that are used in treating CHF and its underlying causes. These are of course only to be prescribed by a doctor. A sampling of these medications follows. 

One primary cause of CHF is hypertension. Long-term high blood pressure forces the heart to overwork. It also damages the blood vessels. After years of fighting against increased blood pressure the heart simply is not able to function properly. 

Doctors do not always know what causes high blood pressure. But there are a number of medications that can help. By reducing blood pressure these medications can help relieve the workload on the heart and, therefore, relieve some of the symptoms associated with CHF.

ACE inhibitors are becoming increasingly popular for the treatment of hypertension. These drugs inhibit angiotensin-converting enzyme. This enzyme joins with angiotensin I (an inactive compound) to form angiotensin II.

Angiotensin II causes contraction of the smooth muscles lining the blood vessel walls.

This hyper-contraction in turn causes an increase in blood pressure. By reducing the amount of angiotensin-converting enzyme in the system, angiotensin II levels are also reduced thereby lowering blood pressure. 

Caution should be exercised in using ACE inhibitors under certain conditions. Some allergies can cause negative reactions in the patient. Also the use of ACE inhibitors during pregnancy can lower blood pressure too much, cause kidney failure and even result in the death of the baby.

Another congestive heart failure treatment used against hypertension includes the beta blockers. This class of drugs works to block adrenaline. Adrenaline increases stress to the heart. By blocking the nerve impulses to adrenaline the heart is relieved of some of its workload thereby requiring less oxygen and blood flow (especially in the left ventricle). 

Additionally beta blockers can slow the heart rate, help the heart beat more regularly and relieve angina (chest pain) in heart attack patients. 

Diuretics like Thiazide are also prescribed for treating hypertension (though not exclusively) to lessen the heart’s workload. However, instead of controlling adrenaline or enzymes, diuretics work to reduce the amount of fluids in the body by increasing urine flow. 

It is important to talk to your doctor about special allergies you have before taking any of the thiazide diuretics. As always it is a good idea to show caution when taking drugs during pregnancy. 

Some possible side effects are…

  • Jaundice
  • Low potassium levels
  • Blood problems in newborns

Further, thiazide diuretics pass through with breast milk and can reduce breast milk flow. Diuretics can have a negative effect on potassium and magnesium levels making it necessary to replace these minerals with dietary supplements. 

Digitalis medicines are used to…

  • Improve heart strength
  • Improve heart efficiency
  • Control heart rhythm and rate

This leads to better blood circulation. Interestingly these medications come from a plant known as the foxglove (digitalis) which is considered highly toxic because it contains cardiac glycosides. These substances increase the force of cardiac contraction but are destructive in high dosages. Digitalis poisoning causes…

  • Dizziness
  • Vomiting
  • Delirium
  • Hallucinations
  • Cardiac arrhythmias
Nitrates are used in congestive heart failure treatment to…
  • Relax the smooth muscles of blood vessels (like ACE inhibitors)
  • Dilate veins
  • Reduce left ventricle filling pressure
  • Decrease the heart’s oxygen demand
  • Lower vascular resistance
  • Improve blood flow through the coronary arteries
… thereby decreasing the amount of work the heart has to perform. 

One example of a nitrate is nitroglycerin. It gets its name from the action of nitric acid (a corrosive compound) on glycerin. It is highly unstable and, in case you were wondering, it is the same compound used in explosives. Fortunately the pharmacist dilutes it a bit.

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Surgery For Congestive Heart Failure Treatment

In many cases the best congestive heart failure treatment is surgery. Because of the diverse causes of CHF the surgical treatments are also diverse. A sampling of methods follows. 

Enhanced Counterpulsation (ECP) is a non-invasive congestive heart failure treatment that helps relieve the discomfort of angina. Angina is basically chest pains that are a result of inadequate oxygen supply to the heart muscle. When the heart becomes weak it cannot adequately pull the blood back into itself. So while supplying the rest of the body with oxygen the heart itself is deprived. 

A series of one to two hour sessions are performed over several weeks at which time pressure cuffs are placed on the legs and inflated to compress the blood vessels. As a result blood is forced back to the heart providing it with needed oxygen. This serves not only to feed the heart but it also reduces the circulatory pressure against which the heart must pump. 

Blood pressure is increased while the heart is at rest. The heart is fed while at the same time reducing its workload. In addition to relieving angina the patient is able to exercise more and often able to reduce medications. 

Heart Valve Surgery becomes a necessary congestive heart failure treatment when a heart valve ceases to open and close properly. Mild cases can be treated with medications. More severe cases require surgical repair or replacement. 

The valve is designed to allow blood to flow in only one direction like a door that opens when the wind blows in one direction then slams shut when the wind shifts. When the valve does not close properly the heart must fight against backup pressure thereby increasing its workload. 

There are four valves in the heart. However, most valve surgery is performed on the left side of the heart, which is the harder working side, controlling blood flow from the lungs to the rest of the body. 

The two valves on the left side of the heart are the mitral valve (which divides the left atrium and the left ventricle); and the aortic valve (which divides the left ventricle and the aorta). When the left atrium contracts, the mitral valve opens to allow blood to flow into the left ventricle (the muscular chamber of the heart which accepts blood from the left atrium and ejects it into the aorta). Upon closure, the mitral valve prohibits the back flow of blood into the left atrium. 

The aortic valve divides the left ventricle and the aorta. The aortic valve opens during left ventricular contraction and then closes to prohibit the backwash of oxygenated blood from the aorta into the ventricle. 

Heart valve surgery can be broken into two categories, repair and replacement. Valve repair can take several forms: 

A Commissurotomy is performed when the leaflets of a narrow valve become thickened or stuck together. The valve leaflets are severed at the point where they join. 

Decalcification becomes necessary when calcium builds up on the valve leaflets making it impossible for the valve to close properly. Once the calcium is removed the valve normally functions properly. 

Reshaping valve leaflets is necessitated by valve deformation that hinders proper closing. A section of a leaflet is removed to allow for better fit. 

Structural support repair involves the replacing or shortening of the thread-like cords (chordae tendineae) that support the valves. Once the cords are the proper length the valves will close. 

Sometimes valve leaflets close properly but leak through holes or tears. The surgeon patches these tears with a tissue patch. 

Valvuloplasty is a congestive heart failure treatment used to widen a narrowed or stiff heart valve. A small catheter is guided into the valve where a balloon is inflated to enlarge the valve opening. The restored valve…

  • Provides for better blood flow
  • Improves valve closing
  • Reduces the workload on the heart

This congestive heart failure treatment has become popular for children and adolescents with congenital stenotic (narrowed) valves. It is also useful for the elderly and other high-risk patients unsuitable for more invasive surgery. 

Valve replacement is necessitated by seriously damaged valves and comes in two forms. Mechanical valves can be made from metal, carbon or plastic. They have the advantage of being durable and strong. They have the disadvantage of facilitating blood clots making it necessary for the patient to take blood thinners. Biological valves are made from animate tissue. Sometimes the material comes from animals (xenograft) and sometimes from human subjects (homograft). 

If the patient’s own tissue is used it is called an autograft. The advantage to biological grafts is the patient does not need to use blood thinners. However, biological grafts do not last as long as the mechanical variety and must be replaced every ten years or so which is less of a problem for the elderly. 

Needless to say valve replacement is the most invasive congestive heart failure treatment and is classified as open heart surgery. During replacement the breastbone is divided and the heart is stopped. The blood must be circulated using a heart-lung machine. 

Life after replacement also has its difficulties. Patients with a mechanical replacement must stay on blood thinners the rest of their lives increasing the risk of bleeding. Other patients may suffer through further surgeries to replace worn or defective valves. Bacteria can enter the body through other surgeries or dental work. Bacteria can seriously affect the replaced valve. Therefore antibiotics should be taken in conjunction with any surgeries. 

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