Monday, October 3, 2022

Medicines For Congestive Heart Failure

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Medications For Congestive Heart Failure

Drugs in Congestive Heart Failure – CRASH! Medical Review Series

Many people assume heart failure is when the heart stops working completely. And with the way the condition is named, we wouldnt blame them. People also use heart failure interchangeably with congestive heart failure. But while the two are somewhat synonymous, they are actually slightly different. We focus on the condition itself and medications for congestive heart failure in this article.

What Are The Complications Of Heart Failure

Some of the complications from heart failure include:

  • Irregular heartbeat.
  • History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but youve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. This category includes people who have heart failure and reduced EF due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

  • Shortness of breath.
  • Need to urinate while resting at night.
  • Rapid or irregular heartbeats .
  • A dry, hacking cough.
  • A full or hard stomach, loss of appetite or upset stomach .

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.Its important to let your doctor know if you have new symptoms or if your symptoms get worse.

Stages Of Heart Failure

In 2001, the American Heart Association and American College of Cardiology described the “Stages of Heart Failure.” These stages, which were updated in 2005, will help you understand that heart failure is often a progressive condition and can worsen over time. They will also help you understand why a new medication was added to your treatment plan and may help you understand why lifestyle changes and other treatments are needed.

The stages classified by the AHA and ACC are different than the New York Heart Association clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

Check the table below to see if your therapy matches what the AHA and ACC recommend. Note that you cannot go backward in stage, only forward.

The table below outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.

The New York Heart Association clinical classifications of heart failure rank people as class I-II-III-IV, according to the degree of symptoms or functional limits. You can ask your doctor if you want to know what stage of heart failure youâre in.

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Left Ventricular Assist Devices

Left ventricular assist devices are mechanical pumps that can help if your left ventricle isn’t working properly and medication alone isn’t helping.

They may be used as a permanent treatment if you can’t have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

Read more about LVADs on the British Heart Foundation website.

What Are The Common Side Effects Of Congestive Heart Failure Medications

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Most heart failure patients will be prescribed a diuretic and one or more blood pressure medications, so the most common side effects experienced will be low blood pressure, dizziness, lightheadedness, and fainting. Other heart failure medications have different side effects, so consult with a healthcare professional if you have any questions or concerns about side effects.

Diuretics reduce the amount of water and salt in the body, so the most common side effects are dehydration and low blood pressure.

Both ACE inhibitors and angiotensin receptor blockers are blood pressure medications, so the most common side effects are low blood pressure and its results, such as dizziness, lightheadedness, and fainting. The most serious side effects of ACE inhibitors and ARBs are high potassium levels and kidney damage. Patients who are unable to handle ACE inhibitors will be moved to angiotensin receptor blockers.

Beta-blockers block epinephrine , so side effects include slow heartbeat, low blood pressure, cold hands, weakness, and fatigue.

The neprilysin inhibitor sacubitril is always combined with an angiotensin receptor blocker, valsartan, so side effects are similar to ARB side effects: low blood pressure, high blood potassium, and kidney problems.

Vasodilators rapidly lower blood pressure by widening blood vessels. As a result, both nitrates and hydralazine are well-known for causing severe headaches, flushing, and low blood pressure.

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What Medications Should I Avoid If I Have Heart Failure

There are several different types of medications that are best avoided in those with heart failure including:

  • Nonsteroidal anti-inflammatory medications such as Motrin or Aleve. For relief of aches, pains, or fever take Tylenol instead.
  • Most calcium channel blockers
  • Some nutritional supplements, such as salt substitutes, and growth hormone therapies
  • Antacids that contain sodium

If youâre taking any of these drugs, discuss them with your doctor.

Itâs important to know the names of your medications, what theyâre used for, and how often and at what times you take them. Keep a list of your medications and bring them with you to each of your doctor visits. Never stop taking your medications without discussing it with your doctor. Even if you have no symptoms, your medications decrease the work of your heart so that it can pump more effectively.

Can Surgery Be Used To Treat Heart Failure

In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart’s function. Procedures used include:

  • Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is . Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.
  • Heart valve surgery. Diseased heart valves can be treated both surgically and non-surgically .
  • Implantable left ventricular assist device . The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.
  • Heart transplant. A heart transplant is considered when heart failure is so severe that it doesn’t respond to all other therapies, but the person’s health is otherwise good.

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What Is The Outlook With Heart Failure

With the right care, congestive heart failure wont stop you from doing the things you enjoy. Your prognosis, or outlook for the future, will depend on:

  • How well your heart muscle is working.
  • Your symptoms.
  • How well you respond to your treatment plan.
  • How well you follow your treatment plan.

One study says that people with heart failure have a life span 10 years shorter than those who dont have heart failure. Another study showed that the survival rates of people with chronic heart failure were 80% to 90% for one year, but that dropped to 50% to 60% for year five and down to 30% for 10 years.

A different study found that people who had heart failure and were discharged from the hospital had expected life spans ranging from three to 20 years, depending on various factors like age and gender. Its important to look at your specific situation when considering your prognosis.

Life Expectancy With Congestive Heart Failure

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The life expectancy of someone with congestive heart failure depends on the type of heart failure, the cause, the stage of the disease, and how effective treatment is.

When heart failure results from cardiomyopathy or coronary artery disease, a person typically has a less positive outlook than someone with heart failure in its earliest stage.

Also Check: Classes Of Heart Failure

How Does Heart Failure Affect The Quality Of Life And Lifestyle

With the right care and treatment plan, many adults still enjoy life even though heart failure limits their activities. How well you feel depends on:

  • How well your heart muscle is working.
  • Your symptoms.
  • How well you respond to your treatment plan.
  • How well you follow your treatment plan.

This includes caring for yourself by:

  • Taking your medications.
  • Tracking and reporting new or worsening symptoms to your provider.
  • Keeping regular follow-up appointments with your healthcare provider.

Because heart failure is a chronic, long-term illness, talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know what you want. A living will details the treatments you do or dont want to prolong your life. Its a good idea to prepare a living will while you are well in case you arent able to make these decisions at a later time.

A note from Cleveland Clinic

If you have heart failure, you can take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments and track your symptoms. Talk to your healthcare provider about questions or concerns you have about your medications, lifestyle changes or any other part of your treatment plan.

References

Trials Of Digoxin In Heart Failure

The role of digitalis in the treatment of heart failure has continued to be controversial and has been studied in clinical trials over the years. This role was recently addressed by the Digitalis Investigation Group 17 in a large multicenter trial sponsored by the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs. The trial involved patients in 302 centers in the United States and Canada.

Over the past decade, randomized double-blind, placebo-controlled trials and other new findings, such as the successful use of lower dosages, have revived interest in the use of digoxin in the treatment of heart failure. One study18 demonstrated that compared with placebo, digoxin improved signs and lessened symptoms in patients with heart failure who had normal sinus rhythm and were receiving maintenance diuretic therapy. The benefits of digoxin were greatest in patients with more severe heart failure, a third heart sound gallop, left ventricular enlargement and a depressed left ventricular ejection fraction.

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

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Isosorbide Dinitrate And Hydralazine

Action:

  • Dilate blood vessels to improve the amount of blood the heart pumps to the body.
  • Combination may be particularly beneficial in African American patients.
  • Effective for heart failure even in patients without high blood pressure.

Side effects:

  • Headache. Common after this combination is started can take Tylenol® to control. Should become less intense with time.
  • Low blood pressure. Check your blood pressure at home.
  • Medications for erectile dysfunction interact with isosorbide dinitrate, and should be avoided.
  • Dizziness. Take separately from other medications that cause dizziness.
  • Get up more slowly from lying or seated position.
  • Nausea. May take with small frequent meals.

Classes Of Medications For Heart Failure

Adherence and Medications to Avoid in Heart Failure

Doctors use a variety of medicines to manage heart failure. This includes drugs that reduce the hearts workload, help the heart pump more blood, and reduce fluid buildup in the body. Your doctor may also recommend drugs to prevent blood clots and reduce cholesterol. Most people with heart failure take more than one medication.

Classes of heart failure drugs include:

To help doctors choose the best treatment, they follow expert guidelines and recommendations. Your doctor will consider your symptoms, test results, and stage of heart failure. After starting treatment, your doctor will monitor your response. It may be necessary to adjust your dose, change drugs, or add another drug for optimal treatment.

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Guidelines For Choosing Drugs In Chronic Heart Failure

In a recent article, Komajda and colleagues presented data gathered from the Medical Management of Chronic Heart Failure in Europe and its Related Costs survey in support of the view that adherence to guidelines in treating patients with chronic heart failure is a strong predictor of fewer cardiovascular hospitalizations in clinical practice.

Therefore, it should not be a surprise that the combination of the three would provide a clinical situation that could predispose the patient to a greater risk of manifesting an elevated level of serum potassium. Moreover, one reason that the five drug combination may not produce the same outcome is because of the fact that drugs such as thiazides and loop diuretics cause some degree of serum potassium depletion by the virtue of their pharmacological effects in the nephron. This action may prevent the rise in serum potassium to levels that precipitate the cardiovascular problems exhibited by the patients on the T3 drugs.

This hypothesis, of course, can easily be tested by examining electrolyte records of patients on these drugs admitted for cardiovascular problems. However, more importantly, the medical community must be made aware of the risk associated with this form of drug interaction and implement appropriate guidelines to prevent its occurrence in this patient population.

Surgery For Heart Failure

Your doctor may recommend surgery to implant a medical device that helps the heart function more effectively:

  • Pacemaker, which maintains a steady heart beat in people with a slow or irregular heartbeat
  • Implantable cardioverter defibrillator , which monitors the heart for fast rhythm and delivers an electrical shock to reset normal rhythm
  • Left ventricular assist device , which takes over the pumping action of the heart

People with advanced heart failure may be candidates for heart transplantation. A heart transplant replaces the diseased heart with a donated heart from a person who has died.

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Ace Inhibitors And Arbs

ACE inhibitors and ARBs work by opening blood vessels and lowering blood pressure. These medicines can:

  • Reduce the work your heart has to do
  • Help your heart muscle pump better
  • Keep your heart failure from getting worse

Common side effects of these drugs include:

  • Dry cough
  • Headache
  • Diarrhea

When you take these medicines, you will need to have blood tests to check how well your kidneys are working and to measure your potassium levels.

Most of the time, your provider will prescribe either an ACE inhibitor or an ARB.

Congestive Heart Failure Drugs

Treatment of Congestive Heart Failure (CHF)

There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.

ACE inhibitors

Angiotensin-converting enzyme inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cant tolerate ACE inhibitors.

You may be prescribed one of the following:

voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall.

ACE inhibitors shouldnt be taken with the following medications without consulting a doctor, because they may cause an adverse reaction:

  • Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene , eplerenone , and spironolactone .
  • Nonsteroidal anti-inflammatory drugs .NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitors effect on your blood pressure.

Beta-blockers

This may be achieved with:

Diuretics

Your doctor may recommend:

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Types Of Heart Failure

The main types of heart failure are named for where they occur in the heart:

  • Left-sided heart failure
  • Biventricular heart failure

Clinicians also may classify heart failure as:

  • Acute: You have active symptoms of heart failure, with either a new diagnosis or with long-term heart failure.
  • Chronic: You have a history of heart failure, but your condition is relatively stable with no symptoms or with manageable symptoms.

The Dangers Of Cardiovascular Damage Due To Drug Use

Asking can drug abuse cause congestive heart failure? is an important question with addiction rates on the rise nationally.1 Unfortunately, people using drugs regularly often mix these substances with alcohol to enhance the physical and psychological high.

The American College of Cardiology Journal has found that mixing drugs and alcohol increases the risk of a heart attack, irregular heart rate, and congestive heart failure.2 Its very common for those using drugs to experience a hike in blood pressure.

When a persons heart has to work harder to move blood throughout the body, it doesnt take long for issues with other organs to follow. Mixing drugs and alcohol only enhances the potential for damage to the heart.

Regular drug use can also cause damage to the tissues surrounding the heart and the vital blood vessels that transport blood throughout the body. When these blood vessels cant perform their job correctly, theres a risk that waste products can travel to the liver or kidney.

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