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For the common forms of
heart failure -
those due to damaged heart muscle - no known cure exists. But
treatment for these forms may be quite successful. The treatment seeks
to improve patients' quality of life and length of survival through
lifestyle change and drug therapy.
Patients can minimize the effects of
heart failure by controlling the risk factors for heart disease.
Obvious steps include quitting smoking, losing weight if necessary,
abstaining from alcohol, and making dietary changes to reduce the
amount of salt and fat consumed. Regular, modest exercise is also
helpful for many patients, though the amount and intensity should be
carefully monitored by a physician.
But, even with lifestyle changes, most
heart failure patients must take medication. Many patients
receive two or more drugs.
Several types of drugs have proven
useful in the treatment of heart failure:
- Diuretics help reduce the amount of
fluid in the body and are useful for patients with fluid retention
and hypertension.
- Digitalis increases the force of the
heart's contractions, helping to improve circulation.
- Results of recent studies have
placed more emphasis on the use of drugs known as angiotensin
converting enzyme (ACE) inhibitors. Several large studies have
indicated that ACE inhibitors improve survival among heart failure
patients and may slow, or perhaps even prevent, the loss of heart
pumping activity.
Originally developed as a treatment for
hypertension, ACE inhibitors help heart failure patients by, among
other things, decreasing the pressure inside blood vessels. As a
result, the heart does not have to work as hard to pump blood through
the vessels.
Patients who cannot take ACE inhibitors
may get a nitrate and/or a drug called hydralazine, each of which
helps relax tension in blood vessels to improve blood flow.
Sometimes, heart failure is
life-threatening. Usually, this happens when drug therapy and
lifestyle changes fail to control its symptoms. In such cases, a
heart transplant may be the only treatment option. However,
candidates for transplantation often have to wait months or even years
before a suitable donor heart is found. Recent studies indicate that
some transplant candidates improve during this waiting period through
drug treatment and other therapy, and can be removed from the
transplant list.
Transplant candidates who do not
improve sometimes need mechanical pumps, which are attached to
the heart. Called left ventricular assist devices (LVADs), the
machines take over part or virtually all of the heart's blood-pumping
activity. However, current LVADs are not permanent solutions for heart
failure but are considered bridges to transplantation.
An experimental surgical procedure
for severe heart failure is available at a few U.S. medical centers.
The procedure, called cardiomyoplasty, involves detaching one end of a
muscle in the back, wrapping it around the heart, and then suturing
the muscle to the heart. An implanted electric stimulator causes the
back muscle to contract, pumping blood from the heart.
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common heart failure
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