What Medications Are Used To Manage Heart Failure? What Else Might Your Doctor Recommend?

The treatment plan for heart failure can include life style changes, medications, device implantation, and even surgery. You doctor will assess the degree of your heart failure with the help of diagnostic tests, and individualize your treatment accordingly. In most cases, a combination of approaches is used.

What is heart failure?

The heart is vital organ, a specialized muscle that will persistently contract throughout the life of its "owner". Its pumping action is responsible for bringing oxygenated blood to all tissues around the body.

The amount of blood that moves out of the heart in a minute is called cardiac output. In a healthy person, around five liters of blood leave the heart every minute, and that meets the needs of an average body’s requirements. If this amount lessens for any reason, and the heart fails to perform its function in a proper way, this is called heart failure.

What causes heart failure?

Heart failure is a general term used to describe a situation in which the heart cannot meet the body's demands. The cause can vary, and may include:

• Coronary artery disease
• High blood pressure
• Alcohol abuse
• Heart valve disorders

Symptoms include breathlessness, fatigue, lethargy and fluid accumulation in the body (edema). In severe cases, the patient can become very short of breath and may drop their blood pressure; this condition is a medical emergency and should be promptly treated by a doctor.

What medications are used to treat heart failure?

For the treatment of heart failure, the cardiologist provides medications based upon symptoms. Your treatment regime and dosage will also depend on the test results and the degree of heart failure. Most patients are started on a combination of two to three different medications. Heart failure is generally a lifelong condition, and therefore requires long-term treatment and medication. You will almost always be prescribed any of the following drug classes.

1. Angiotensin Converting Enzyme Inhibitors (ACEI)

These drugs act to dilate the blood vessels and hence reduce blood pressure. They also mold the heart's shape in such a way that improves its contractility. Examples include ramipril, enalapril and lisinopril. They are usually started at a lower dose and then gradually increased if the patient tolerates them well.

Common side effects include very low blood pressure, impaired kidney function, a dry cough, angioedema (swelling of lips and soft tissues around the mouth) and a dry mouth. The dry cough can sometimes be very distressing and you should talk to your doctor if you suffer from this adverse effect. You will be prescribed an alternative (most likely an ARB). Your doctor should also monitor your kidney function by arranging regular blood tests.

2. Angiotensin ll Receptor Blockers (ARB)

Common examples include losartan, telmisartan, and irbesartan. They function in more or less the same way as ACE inhibitors. ARBs are an alternative for people who are intolerant of ACE inhibitors, especially for those patients who developed dry cough or angioedema while taking an ACEI. You are less likely to get these side effects from an ARB.

3. Beta Blockers

This class of drugs functions not only to reduce the blood pressure and slow down your heart rate, but also reverses the some of the damage to your heart. Reducing the basal heart rate reduces the load on the heart muscle in the long run. Examples include bisoprolol, metoprolol, and carvedilol. These are very effective in slowing the progression of the disease, prolonging life expectancy, and reducing symptoms of heart failure patients. This drug is also started at a lower dose and gradually increased to a maximum tolerated dose.

Side effects include bradycardia (very slow heart rate), low blood pressure, wheeze, erectile dysfunction, and dizziness. If you develop any of these symptoms, please contact you doctor as soon as possible. Since they can cause wheezing, beta blockers should be used with caution in asthmatics.

4. Diuretics

These medications are also called "water tablets". They act on the kidneys and remove excess fluid from the body. Furosemide is the main medication in this class, and it helps control the symptoms of breathlessness and fluid accumulation. While these medications are mostly oral, diuretics can also be given in the vein in severe cases of fluid overload in a hospital setting. As opposed to the above-mentioned medications, this drug is usually started at a higher dose to achieve an adequate response, and then reduced to a maintenance dose to be taken in the long-term.

Adverse effects include dehydration, impaired kidney function, electrolyte disturbances and low blood pressure. You doctor will arrange regular blood tests to monitor your electrolytes and kidney function after starting you on diuretics.

5. Aldosterone Antagonists

These are specific diuretics that act on the kidneys and remove excess fluid from the body. They also help lower your blood pressure. Commonly prescribed medications from this class are spironolactone or eplerenone.

Spironolactone can cause gynecomastia (enlarged breasts) in males and breast pain and tenderness in females. It can also lead to very high potassium levels in your blood. Your doctor will do regular blood tests to monitor this.   

6. Digoxin

Also termed digitalis, this drug increases the heart muscle's contractility, and also slows the heartbeat. Both these actions improve the heart's pumping action. This medication is only reserved for the patients who do not respond well to ACEI and ARBs alone. Common side effects include diarrhea, blurred vision, vomiting and dizziness. If any of these symptoms are getting worse, contact your healthcare professional.

7. Newer medications

Newer drugs like ivabradine and Sacubatril-valsartan have recently been introduced and have shown promising results in clinical trials. They are only reserved for patients in which first line treatments have either been ineffective or not tolerated. Therefore, in these circumstances, your doctor might consider starting you on one of these novel medications.

In certain cases, you might be offered a device implantation or a surgery. It depends in your stage of heart failure and response to medications.

Lifestyle advice for heart failure patients

Clinical research has proved that certain lifestyle modifications can, alongside other treatments, make a big difference to your prognosis and quality of life. The following lifestyle changes are recommended:

• Stop smoking and using alcohol.
• Eat a healthy and balanced diet (think green). 
• Exercise. Focus on cardio and start under supervision.
• Limit fluids and salt. 
• Avoid a fat and lipid rich diet.
• Maintain a healthy weight.
• Reduce stress.
• Take steps to maximize your sleep quality. 

With adequate treatment and lifestyle changes, the symptoms of heart failure can be managed easily and the disease progression can be slowed down. The treatment regime is complex and should be started by your doctor following a series of tests.