Treating Heart Failure
The appropriate treatment for heart failure depends on several factors, including the age and general health of the patient and the degree of loss of cardiac function. In some cases, lifestyle changes that include limiting salt intake, losing weight, quitting smoking, and exercising may be enough to restore adequate cardiac function. When the heart’s ability to pump deteriorates, other treatment options may be necessary.
Medications to Treat Heart Failure
Medications can be prescribed to assist cardiac function or to treat the symptoms of heart failure. Some types are:
- ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin receptor blockers) to relax blood vessels, lower blood pressure, and prevent kidney damage, and now ARNIs (angiotensin receptor blocker/neprilysin inhibitor), which are both used to lower the resistance against which the heart must pump
- Antihypertensive drugs to lower blood pressure
- Beta blockers to slow the heart rate and decrease blood pressure
- Diuretics to rid the body of excess salt and water through increased urination
Implanted Devices for Heart Failure Treatment
If medications do not sufficiently restore cardiac function, devices can be implanted to assist cardiac function or prevent further damage:
- Implantable defibrillators to protect against a life-threatening abnormal heart rhythm
- Pacemakers that help the ventricles contract and pump blood in a more normal rhythm
- Ventricular assist devices, which are surgically implanted devices that assist the heart in pumping blood
Circulatory support devices, such as the Impella heart pump, the CentriMag blood pump, and extracorporeal membrane oxygenation (ECMO), provide short-term mechanical support of both the right and left ventricles, as needed.
When the heart contracts, it pumps blood from the two ventricles; when the heart relaxes, the ventricles refill with blood. Ejection fraction refers to the percentage of blood that leaves the heart each time it contracts. Because the left ventricle is the heart’s main pumping chamber, ejection fraction is usually measured in the left ventricle, where typically between 55 and 70 percent of the blood is pumped out. An ejection fraction below 35 percent may indicate heart failure.
Heart failure surgery may be appropriate for select patients. The types of surgery that can be helpful for patients with heart failure include high-risk coronary artery bypass, left ventricular assist device implantation, valve repair procedures, and minimally invasive procedures such as transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR). These procedures offer an alternative to heart transplant surgery for some patients. Results are often good, and many patients have been able to avoid heart transplantation for many years.
Heart Transplant Surgery
If heart failure is severe and no longer responds sufficiently to other treatments, a heart transplant may be necessary. Before a patient is put on a list for a heart transplant, the program team and transplant surgeon will determine whether the patient is healthy enough for transplant surgery and will assess and confirm the need for a transplant. While a patient is awaiting a donor heart, the suitability of a heart is determined based on the patient’s body size and blood type.