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Heart Failure

Heart Failure Treatment

In addition to their family doctor, people with heart disease are often treated by a cardiology specialist. Cardiology is the medical discipline that specializes in heart disease. Cardiology specialists include:

  • Cardiologists
    Cardioloists have special training and skills in diagnosing, treating, and preventing diseases of the heart and blood vessels in adults.
  • Pediatric cardiologists
    Pediatric cardiologists work with infants, children, and teenagers.
  • Cardiac surgeons
    Cardiac surgeons have special training and skills to operate on the heart, blood vessels, and lungs.
  • Electrophysiologists
    Electrophysiologists are cardiologists who specialize in arrhythmias.

Additional members of the healthcare team may include:

  • Counselors or psychologists
  • Dietitians
  • Exercise specialists
  • Family doctor
  • Nurses
  • Occupational therapists
  • Physical therapists

Common heart disease treatments include:

Lifestyle changes

Several lifestyle changes can help people lower their heart disease risk factors. When lifestyle changes aren't sufficient, medications, and sometimes procedures and surgery may be required.

Eating a Healthy Diet

The following heart-healthy dietary modifications are recommended by the American Heart Association and the National Heart, Lung, and Blood Institute:

  • Total fat
    • Total fat should be no more than 25 to 35% of the daily calories.
    • Foods containing monounsaturated fats and polyunsaturated fats are a better choice than foods containing saturated fats and trans fatty acids.
  • Saturated fat
    • Saturated fat should be less than 7% of the total daily calories.
    • Foods containing saturated fats include certain vegetable oils (coconut oil, cottonseed oil, and palm oil), dairy products (butter and cheese), and meat.
  • Trans fatty acids
    • Trans fatty acids (trans fat) should be less than 1% of the total daily calories.
    • Foods that list "hydrogenated oils" or "partially hydrogenated oils" on the label contain trans fatty acids.
  • Monosaturated fats
    • Monosaturated fats should be less than 20% of the total daily calories.
    • Foods containing monosaturated fats include nuts, avocados, and certain vegetable oils (canola oil, flaxseed oil, olive oil, and peanut oil).
  • Polyunsaturated fats
    • Polyunsaturated fats should be less than 10% of the total daily calories.
    • Foods containing polyunsaturated fat include certain vegetable oils (corn oil, safflower oil, soybean oil), fatty fish (bass, halibut, herring, mackerel, salmon, sardines, trout, and tuna), and soybeans.
  • Total cholesterol
    • Total cholesterol should be less than 200 milligrams per day
  • Total carbohydrates
    • To lower triglyceride levels, total carbohydrate consumption should be less than 50% of the total daily calories. Simple sugars (such as sucrose) and alcohol should be avoided.
  • Soluble plant fiber
    • Soluble plant fiber should be increased 10 to 25 grams per day
    • Foods containing soluble plant fiber include leafy vegetables, legumes, whole grains, and whole fruits.
  • Salt
    • Salt (sodium chloride) can increase a person's blood pressure. Moreover, salt-sensitive people have a heightened blood pressure response to salt.
    • People should check all labels of packaged food carefully for sodium content, replace salt with salt substitutes and herbs, and increase dietary potassium (such as fruits and vegetables).
  • Fluids
    • Heart failure may cause people to gain weight suddenly due to a fluid build up in their bodies.
    • People should limit the amount of fluids they drink, weigh themselves daily, and notify their doctor immediately if they gain weight suddenly.
  • Healthy foods
    • Fish, lean meats, and skinless chicken or turkey
    • Fruits and vegetables
    • Legumes (dry peas or beans)
    • Low-fat dairy
    • Whole grains
  • FDA-approved low-calorie sweeteners
    • Saccharin (Sweet N Low, Sugar Twin)
    • Aspartame (NutraSweet, Equal)
    • Acesulfame potassium (Sweet One, Swiss Sweet, Sunett)
    • Sucralose (SPLENDA)

Exercising

  • In 2007, the American Heart Association and the American College of Sports Medicine issued new exercise guidelines. Their new recommendation is for healthy adults to engage in moderate-intensity aerobic physical activity for at least 30 minutes five days each week, or vigorous-intensity aerobic exercise for at least 20 minutes three days a week. In addition, the guidelines add that exercise above the recommended minimum amounts provides even greater health benefits.
    • Moderate-intensity aerobic activity is any exercise that noticeably accelerates the heart rate, such as a brisk walk or light jogging.
    • Vigorous-intensity exercise is any exercise that causes rapid breathing and a substantial increase in heart rate, such as jogging.
  • People with angina should take rest breaks if exercise causes their angina.
  • It's important for people to discuss all exercise modifications in advance with their healthcare provider.

Managing weight

  • People should eat sufficient calories to maintain a healthy weight as determined by their healthcare provider.
  • A healthcare provider can also recommend an appropriate diet and physical activity program for people who are overweight.
  • The American Heart Association recommends using waist circumference and body mass index (BMI) to estimate body fat.
    • A high-risk waistline is 35 inches or higher for women and 40 inches or higher for men.
    • To calculate BMI, multiply weight in pounds by 703, divide by height in inches, then divide again by height in inches.
    • Overweight is defined as a BMI of 25.0 to less than 30.0, obesity is defined as a BMI of 30.0 or greater, and extreme obesity is defined as a BMI of 40 or greater.
    • Note that although BMI is useful for most people, it is not precise for the elderly, pregnant women, or very muscular athletes.

Measuring blood cholesterol at home

Some people use home kits to test their blood cholesterol levels at home. Simple kits only test total cholesterol or LDL cholesterol levels. More sophisticated kits provide complete lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides).

Cholesterol kits require people to prick a finger, put a drop of blood on a treated paper, and wait for the test results. The test results are obtained by:

  • Comparing the color of the treated paper to a chart.
  • Reading the test results on the display screen of an electronic device.
  • Or, mailing the test strips to a certified laboratory.

A doctor is the best judge of treatment decisions based on cholesterol test results.

Measuring blood pressure at home

Home blood pressure monitors help people check that their blood pressure medication is working and warn them if their blood pressure is getting too high. The devices are available without prescription.

Measuring blood sugar levels at home

People with diabetes can help manage their condition by testing their blood sugar levels regularly. A doctor typically recommends how often people should test their blood sugar, and sets the target fasting and before-meal blood sugar ranges. People should keep a record of their blood sugar readings and bring the record to all doctor visits.

Reducing alcohol consumption

  • Alcohol has been shown to raise blood pressure in some people. Moreover, regular or excessive alcohol use may raise LDL cholesterol and triglyceride levels.
  • Men should limit their alcohol to no more than two alcoholic beverages a day and women should limit their alcohol to no more than one alcoholic beverage a day.
  • Because alcohol is high in calories and low in nutrients, it should be avoided by people who are trying to lose weight.

Reducing stress

  • Emotional stress causes a temporary rise in blood pressure and may cause susceptible people to develop high blood pressure.
  • Some people develop angina due to emotional stress.
  • People should get sufficient rest and sleep, exercise regularly, avoid stressful situations, and try using a relaxation technique (such as deep breathing and self-hypnosis).

Smoking cessation

  • According to the Centers for Disease Control and Prevention (CDC):
    • Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers.
    • Cigarette smoking approximately doubles a person’s risk of having a stroke.
  • According to the American Heart Association:
    • The health benefits of smoking cessation start almost immediately.
    • Within a few years of quitting, a person's risk of coronary artery disease and stroke are similar to non-smokers.

Support groups

Heart disease support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.

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Medications

Medications are used when lifestyle changes don't sufficiently lower a person's heart disease risk factors or the heart failure symptoms worsen. Some people with heart failure may require hospitalization. During their hospital stay, they may be given their medications intravenously with supplemental oxygen provided for people who have trouble breathing.

The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. A doctor should be notified if any severe reactions occur. It's important not to stop taking medications without notifying a doctor in advance.

People should ask their doctor or pharmacist in advance for possible drug side effects or interactions. They should also inform their doctor or pharmacist of all prescription and over-the-counter medicines they are taking.

Heart failure medications include:

Aldosterone antagonists

Aldosterone antagonists are used in combination with other heart failure drugs. They work by blocking the action of aldosterone, a substance naturally in the body that raises blood pressure. Examples include:

Digoxin
Digoxin (digitalis) slows the electrical activity of the heart, increases the force of heart muscle contractions, and improves circulation. It is especially helpful when ACE inhibitors and diuretics don't work.

Blood pressure medications

Several types of high blood pressure medications help lower a person's heart rate and the heart's oxygen use, which reduces the strain on the heart and improves the blood supply to the heart. Additional high blood pressure medications (antihypertensives) are prescribed for people with high blood pressure when lifestyle changes, such as a healthy diet and physical activity, are unable to lower their blood pressure to normal levels.

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by preventing the body from converting angiotensin I to angiotensin II, which is a natural hormone that causes blood vessels to constrict (narrow). ACE inhibitors cause the blood vessels to dilate (widen), which lowers blood pressure, improves blood flow to the heart, and reduces the strain on the heart. Examples include:

Angiotensin II receptor blockers (or inhibitors)

Angiotensin II receptor blockers (ARBs) are a newer medication that prevents angiotensin II from tightening blood vessels. The blood vessels relax, which lowers blood pressure, improves blood flow to the heart, and reduces the strain on the heart. ARBs provide an alternative medication for people who are unable to tolerate ACE inhibitors. Examples include:

Beta-blockers

Beta-blockers alter the response of the heart muscle's beta receptors to nervous system impulses. This decreases the force and rate of the heart's contractions, which lowers blood pressure and reduces the heart's need for oxygen. Examples include:

Diuretics

Diuretics (water pills) lower blood pressure. They also rid the body of excess fluids and sodium, which helps reduce swelling (edema) in the legs, ankles, and feet. Diuretics are often the first medication used to reduce high blood pressure. They work by helping the kidneys remove excess fluids and sodium from the body. If a person's blood pressure remains above normal, diuretics are used in addition to other medications, sometimes in a combination pill. Examples include:

Additional high blood pressure medications

There are several classes of high blood pressure medications. People are often prescribed two or more medications from different classes of drugs. Different medications are often tried until the appropriate regimen is identified.

Calcium channel blockers

Blood vessels and heart muscle cells need calcium to contract. By blocking the action of calcium on the blood vessels, calcium channel blockers dilate (widen) the blood vessels, which increases the supply of oxygen-rich blood to the heart and decreases blood pressure. By blocking the action of calcium on the heart muscle cells, they also relax the heart muscle, which slows the rate of heart contractions. Examples include:

Direct renin inhibitors

Early in 2007 the FDA approved the first direct renin inhibitor for the treatment of high blood pressure. Direct renin inhibitors lower blood pressure by inhibiting renin, which is a kidney enzyme associated with the regulation of blood pressure. The approved drug is:

  • aliskiren (Tekturna)

Tekturna may be combined with hydrochlorothiazide (a diuretic) to reduce blood pressure levels even further.

Beta-blocker + diuretic

ACE inhibitor + diuretic

Angiotensin II receptor antagonist + diuretic

ACE inihibitor + calcium channel blocker

Alpha blockers

Alpha blockers lower blood pressure by reducing nerve impulses that constrict blood vessels and slow the heartbeat. Examples include:

Alpha-beta blockers

Alpha-beta blockers lower blood pressure by both reducing nerve impulses to the blood vessels (alpha blocker component) and slowing the heartbeat (beta-blocker component). Examples include:

Central-acting agents (central alpha agonists)

Central-acting agents lower blood pressure by preventing signals to the nervous system that increase heart rate and narrow blood vessels. Examples include:

Vasodilators

Vasodilators lower blood pressure by preventing the blood vessel muscles from constricting (narrowing). Examples include:

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Procedures and surgery

Medical procedures and surgery are used if lifestyle changes and medications have not:

  • Reduced a person's heart disease risk factors.
  • Improved a person's heart disease symptoms or the symptoms are getting worse.
Heart failure procedures and surgery include:

Left ventricular assist device

A left ventricular assist device (LVAD or heart pump) helps a weak heart pump blood to the rest of body. LVAD is often used by people who are waiting for a donor heart to become available for heart transplant surgery.

Permanent LVADs have recently been used to help people who are not healthy enough to undergo heart transplantation.

Heart valve surgery

Heart valves control the direction that blood flows within the heart. Heart valve surgery repairs or replaces diseased heart valves. A heart-lung bypass machine is used to oxygenate and circulate the blood during the surgery.

Artificial valves are most commonly used, which require life-long anti-clotting medication. Sometimes a valve from animal tissue (usually pig's aortic valve) or human organ donor is used. Animal or human donor valves rarely require antirejection drugs.

Heart transplant

A heart transplant is surgical procedure that removes and replaces a diseased heart with a healthy heart from a deceased donor. Heart transplantation is used when all other treatments for heart failure are unsuccessful. A heart transplant recipient must be sick enough to require a new heart but be healthy enough to survive the surgery.

During the heart transplant, a heart-lung bypass machine oxygenates and circulates the blood. After the transplant, antirejection (immunosuppressive) drugs are needed to prevent rejection of the transplanted heart. It's important for people need to watch for signs of infection (coughing, fever, sore throat; or incision inflammation, drainage, redness).

Cardiac rehabilitation

Cardiac rehabilitation (rehab) is often recommended for people with heart disease, especially after a heart procedure, heart surgery, or heart attack. Cardiac rehab programs are designed to help people improve their health and physical fitness, while reducing their symptoms and heart disease risk factors. A medical evaluation is used to create a personalized rehab program based on a person's individual abilities, interests, and needs.

Education, counseling, and training help people manage their heart condition, reduce their risk of future heart problems, and maintain a more active lifestyle when possible. People learn how to:

  • Cope with depression and stress.
  • Develop a healthy eating plan, exercise plan, and maintain a healthy weight.
  • Lower their blood pressure and cholesterol levels.
  • Resume some, if not all, of their normal activities.
  • Return to work if possible.
  • Stop smoking.

A personalized exercise plan helps people:

  • Exercise safely.
  • Gradually improve their strength, stamina, and exercise level.

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Complementary and Alternative Medicine

Alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Complementary medicine combines traditional and alternative treatments.

The following nontraditional therapies may help people with heart disease. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them.

Artichoke Leaf Extract

Artichoke leaf extract is made from the lower leaves of the artichoke plant Studies indicate that artichoke leaf extract may lower LDL cholesterol levels.

Biofeedback

Biofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns. Biofeedback techniques are able to produce a modest reduction in blood pressure.

Coenzyme Q10

Coenzyme Q10 (CoQ10 or ubiquinone) is a naturally occurring anti-oxidant compound and is used for energy production within cells. CoQ10 may help lower blood pressure.

Folate

Folate is a B vitamin that has been shown to reduce levels of homocysteine, a blood component that can damage blood vessels. Folate may also help relax the blood vessels, which helps lower blood pressure and improve circulation. People can obtain folate in their diets by eating citrus fruits and juices; dark, leafy green vegetables; and dried beans and peas. Folate is also available in pill form as folic acid.

Niacin (vitamin B3)

When taken at very high doses, niacin raises HDL cholesterol, and lowers LDL cholesterol and triglycerides. Although available as a dietary supplement, prescription niacin is preferred to the dietary supplement niacin. Dietary supplements are not regulated by the Food and Drug Administration (FDA), and may contain variable amounts of niacin and cause serious side effects.

Omega-3 fatty acids (DHA and EPA)

Omega-3 fatty acids are a group of polyunsaturated fatty acids (such as fish oil) that are not made by the body. Studies have found that omega-3 fatty acids may lower blood pressure, help people with cardiovascular disease, and slow the progression of atherosclerosis. Two types of omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). DHA and EPA have been shown to decrease triglycerides and may raise HDL (good) cholesterol.

Food sources of omega-3 fatty acids include fatty fish (bass, halibut, herring, mackerel, salmon, sardines, trout, and tuna) and vegetable sources (canola oil, soybean oil, flaxseeds, and walnuts). Fish oil pills are also available.

Plant Sterols and Stanols

Plant sterols and stanols lower LDL cholesterol levels in the blood by blocking the absorption of cholesterol. Small amounts of sterols and stanols are found in many fruits, grains, legumes, nuts, seeds, vegetables, and vegetable oils. Fortified foods with higher levels of sterols and stanols include margarine, salad dressings, and snack bars. Dietary supplements are also available.

Relaxation techniques

The following relaxation techniques are designed to relieve stress and may help lower blood pressure levels:

  • Acupuncture
    Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
  • Deep breathing
    Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
  • Qi gong
    Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
  • RESPeRATE Blood Pressure Lowering Device
    RESPeRATE is an FDA-approved portable electronic device that helps lower blood pressure naturally by helping people to master the technique of paced breathing.
  • Yoga
    Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.