Heart failure requires monitoring of the condition by the health care provider. The first step is usually to identify and treat any underlying disorders and precipitating factors. This may require a thorough diagnostic work-up, medications or certain medical procedures (catheter procedures or surgery).
The goals of treatment in heart failure include reduction of the heart's workload, control of excess salt and water retention (swelling, decreased urinary output) and improvement of heart function. In advanced cases or when the heart failure occurs suddenly (acute heart failure), bed rest or reduced physical activity are recommended to minimize the heart's workload.
If salt and fluid intake have been reduced and swelling persists or there are signs of severe systemic (body) or pulmonary (lung) congestion, it may be necessary to use diuretics (water pills). Diuretics include loop diuretics (e.g., furosemide, bumetanide) for moderate symptoms; thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone, chlorothiazide) for mild symptoms; and diuretics in combination. Potassium-sparing diuretics (spironolactone, triamterene) are frequently used to prevent excessive potassium losses.
Digoxin may also be given, especially if the heart rhythm is irregular due to atrial fibrillation.
Medications used to reduce the heart's workload include angiotensin converting enzyme (ACE) inhibitors such as captopril and enalapril, and angiotensin receptor blockers such as losartan and candesartan. Other medications frequently used are vasodilators such as hydralazine and long-acting nitrates.
Some patients, particularly those with a history of coronary artery disease, may benefit from low doses of beta-blockers.
Weight loss may be recommended for overweight patients. Eliminate smoking and excessive alcohol consumption (which decrease the pumping efficiency of the heart).
If symptoms are very limiting and minimal activity causes difficulty breathing, or if there is no response to the initial treatment, hospitalization may be required. Hospitalized patients may receive oxygen and intravenous medications such as vasodilators and diuretics.
The heart's ability to pump blood can be directly increased by medications called inotropic agents. These include dobutamine and milrinone, which are given intravenously.
Unstable patients receiving several medications usually need also hemodynamic monitoring with Swan-Ganz catheterization.
Severe cases require more drastic measures. For example, excess fluid can be removed through dialysis, and circulatory assistance can be provided by implanted devices such as the intra-aortic balloon pump (IABP) and the left ventricular assist device (LVAD). These devices can be life-saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.
