Treatment
Initial treatment of congestive heart failure
focuses on controlling acute symptoms. Bed rest
is prescribed to elevate the legs and discourage
fluid accumulation in the feet and ankles. Diuretics
("water pills") are administered to remove excess
body fluid by increasing urine output. Next, medications
are prescribed to help the heart beat more efficiently.
These medications may include one or more of the
following:
>
Digoxin to strengthen the heart's contractions
> Angiotensin-converting enzyme (ACE) inhibitors
to expand blood vessels, decrease the resistance
to blood flow and help prevent water retention
>
Beta-blockers to improve blood flow
Sometimes
anticoagulants (blood thinners) are also administered
to prevent blood clots, particularly if the patient
requires a long period of bed rest. Also, a large
study suggests that another medication known as
Aldactone (spironolactone) may have significant
benefits in selected patients with chronic congestive
heart failure. Once acute symptoms have been treated,
the underlying cause of congestive heart failure
is addressed. Treatment ranges from lifestyle changes
and medication for coronary heart disease to surgical
procedures to correct heart defects. Self-treatment
for congestive heart failure includes getting plenty
of rest, moderate exercise under a doctor's guidance,
a sodium-restricted diet to prevent edema, losing
weight if appropriate and avoiding alcohol.
When medications and self-treatment are no longer
helpful, a heart transplant may be considered.
This treatment option is currently limited by
a shortage of donor hearts and is generally reserved
for patients under age 65. An experimental procedure
called cardiomyoplasty is being performed at some
major medical centers. In this procedure, a muscle
from the patient's back is wrapped around the
heart, and a device is implanted that electrically
stimulates the muscle to contract. Other research
to improve the treatment of congestive heart failure
includes a procedure to replace damaged heart
cells with healthy ones, "combination" medications
that perform several tasks at once, improved medications
with fewer side effects than currently available
drugs, improvements in heart transplantation and
mechanical devices that help the failing heart
to pump.
Prognosis
The prognosis depends on the patient's age, the
severity of the heart failure, the severity of
the underlying heart disease and other factors.
When congestive heart failure develops suddenly
and has a treatable underlying cause, patients
can sometimes return to normal heart function
after treatment. With appropriate treatment, even
individuals who develop congestive heart failure
as a result of long- standing heart disease can
often enjoy many years of productive life.
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