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Treatment of congestive heart failure (CHF) depends on the severity of the disease. In
general, CHF is the result of a weakening of the heart over a long period of time, and
consequently, there is usually no "cure" for the condition. Treatment typically
focuses on relieve the symptoms of CHF and treating diseases or conditions that may be
causing CHF.
Drug Therapy for CHF
The following chart summarizes the drugs that may be used to help treat CHF. Brand
names of drugs are shown in parentheses.
| Drug Type |
Function |
Examples |
| ACE Inhibitors |
prevent blood vessel constriction and increase
blood flow to body |
benazepril (Lotensin), lisinopril (Prinivil),
captopril (Capoten), ramipril (Altace), fosinopril (Monopril), moexipril (Univasc) |
| Diuretics |
removes excess fluid, decreasing congestion in
lungs |
hydrochlorothiazide (HydroDIURIL), chlorothiazide
(Diuril), furosemide (Lasix), bumetanide (Bumex), spironolactone (Aldactone), triamterene
(Dyrenium), metolazone (Zaroxolyn) |
| Beta blockers |
reduce heart’s workload |
nadolol (Corgard), metoprolol (Lopressor, Toprol
XL), pindolol (Visken), bisoprolol (Zebeta), acebutolol (Sectral) |
| Calcium channel blockers |
increase blood flow through heart and help
prevent blood vessel constriction by blocking calcium ions |
verapamil (Calan, Isoptin, Verelan), diltiazem
(Cardizem, Tiamate, etc.) and nifedipine (Adalat) |
| Blood thinners |
may be used to prevent blood clots |
warfarin (Coumadin) |
| Cardiotonics |
strengthen heart’s ability to pump blood |
digoxin (Lanoxin), adenosine (Adenocard,
Adenoscan) |
Medical Procedures to Help Treat CHF
In addition to drug therapy, surgery may be necessary in select cases to correct
problems that may be causing CHF. For example, coronary angioplasty or coronary artery
bypass graft may be performed on patients who have CHF as a result of coronary artery disease. The type of surgery a patient
receives will depend on his or her specific heart problems. Surgical options for CHF
include:
- Coronary angioplasty: Performed in a cardiac catheterization laboratory, this
procedure involves placing a catheter with a small balloon on its tip into the
patient’s narrowed artery under angiographic guidance.
When properly positioned, the balloon is inflated and deflated, moving the plaque build-up
further against the artery wall and thereby improving the flow of blood. This procedure
may also be called percutaneous transluminal coronary angioplasty (PCTA), coronary artery
balloon dilation or balloon angioplasty. Coronary angioplasty may be followed by stenting,
a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the
artery to keep it open and restore normal blood flow.
- Coronary artery bypass graft: Involves grafting the ends of a healthy blood vessel
(often taken from the chest or leg) above and below a narrowed artery, bypassing the flow
of blood around the narrowed artery. Bypass surgery can relieve symptoms of CAD, such as
dyspnea or angina and may help prevent a myocardial infarction
(heart attack).
- Valve replacement: Valve replacement involves removing a defective heart valve and
replacing it with one made from metal, human tissue, or donated by another person. Methods
of valve replacement include valvotomy (open-heart surgery) or percutaneous balloon
valvuloplasty, where a catheter is fed up to the heart valve under angiographic guidance
and a balloon at the end of the catheter inflates to widen the valve. Newer minimally
invasive procedures show promise in reducing some of the surgical risks associated with
valvotomy.
- Pacemaker implantation: An artificial pacemaker can be surgically implanted to help
correct bradycardia (slow heartbeat), a condition that can worsen CHF. The surgery
involves implanting an artificial pacemaker into the patient’s chest, which uses
batteries to deliver an electrical impulse when an irregularity of the heart rhythm is detected. Many pacemakers have sophisticated
sensory systems which allow them to function only when necessary.
- Cardioverter defibrillator implantation:This procedure involves implanting
leads on the heart’s surface, which are connected to a pulse generator implanted
under the skin near the chest or abdomen. The device delivers electrical shocks to the
heart to help restore a normal rhythm. Like pacemakers, implantable cardioverter
defibrillators have sophisticated sensory systems that allow them to record activity and
adjust electrical pulses based on the heart’s activity.
- Left ventricular assist device (LVAD):An LVAD may be used in some cases to
help the heart pump blood to the rest of the body. An LVAD consists of a tube that is
inserted in the left ventricle, which draws blood into a pump and sends it to the aorta,
in effect bypassing the weakened ventricle. LVADs are sometimes used while a patient waits
for a heart to become available for transplant.
- Aneurysm surgery:In some cases, surgery may be performed on patients with
CHF to repair an aneurysm, a bulging out of a blood vessel wall,
associated with the build-up of plaque. Surgery may include placing stent grafts
(expandable wire mesh tubes) to bypass the aneurysm (one above the aneurysm and one
below). The stents will divert the flow of blood around the aneurysm instead of through
it.
- Heart transplant: In severe cases of CHF, a heart transplant may be necessary
to prolong life. This open-heart surgery consists of replacing the diseased heart with
either an artificial heart or a donor heart. Patients seeking heart transplants will be
put on a waiting list until a heart becomes available.
Updated: August 2006
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