American Medical Association Family Medical Guide - American Medical Association [330]
Your doctor is likely to prescribe medication to help relieve your symptoms. Diuretic drugs will help your body eliminate excess fluid and sodium, thereby decreasing blood volume and lowering your blood pressure. Because diuretic drugs increase the body’s output of urine, always take them in the morning to avoid having to get up during the night to urinate.
Other medications frequently prescribed to treat heart failure include digitalis drugs (usually digoxin) and vasodilators such as ACE (angiotensin-converting enzyme) inhibitors. Digitalis drugs slow the heart rate while increasing the strength of the heartbeat and the heart’s output of blood. ACE inhibitors widen both small arteries and veins and counteract some of the substances produced by the kidneys that can narrow small arteries and cause the body to retain fluid. ACE inhibitors reduce the heart’s workload and significantly prolong life in many people. They are powerful drugs, and you and your doctor may need to work together to find the appropriate dosage for you. If you cannot take ACE inhibitors, your doctor may prescribe a nitrate drug or hydralazine, both of which relax smooth muscle to widen blood vessels and improve blood flow. Doctors often prescribe beta blockers (see page 562) to treat heart failure. Like ACE inhibitors, they can relieve symptoms and prolong life in people who have heart failure.
If your doctor prescribes a long period of bed rest, he or she may also prescribe an anticoagulant medication to help prevent the formation of blood clots. If your doctor prescribes an anticoagulant, he or she will carefully monitor the effect of the drug in your blood to help prevent possible complications such as bleeding in the intestines, skin, brain, or other organs.
Drug treatment should relieve your shortness of breath and swelling. By following a low-sodium diet and taking your medication as prescribed, you can expect to lead an active life. However, if your heart failure does not respond to treatment with rest, lifestyle changes, and medication, you may need to have a heart transplant (see next page). Heart transplantation has a high success rate. However, because of a severe shortage of donor hearts, the availability of this option is limited. Most people who need a heart transplant are placed on a waiting list until a donor heart becomes available.
Some people with severe heart failure who are waiting for a heart transplant are able to use a small mechanical pump called a left ventricular assist device (LVAD). An LVAD is attached to the heart to help the heart pump blood. In many people who have heart failure, an LVAD improves the heart’s ability to pump blood, eliminating the need for a heart transplant. Research continues on longer-term use of these devices.
Left ventricular assist device
A left ventricular assist device consists of an air-driven pump, a control mechanism, a power source, and connective tubing. The pump and tubing are surgically implanted in the body and attached to the heart. The control mechanism and power source are worn outside the body and are connected by wires to the pump. A tube inserted into the left ventricle draws blood into the pump (inflow). The blood is then pumped out to the tissues through a tube inserted into the aorta (outflow).
How a Heart Transplant Is Done
In heart transplant operations, surgeons remove the entire damaged heart, except for the back walls of the upper chambers (the atria). Most of the connections to the major blood vessels are left intact, making