Treatment of congestive heart failure #medicine,device,surgery


Treatment-of-congestive-heart-failure
treatment of congestive heart failure

Congestive heart failure means “unable to the proper functioning of heart due to various causes”. Mainly this all causes reduced cardiac output and decreases blood flow in the body. When blood flow decrease, doesn’t meet their actual requirement of the body.

First of all understand the treatment of congestive heart failure, understand basic introduction, symptoms, causes, and other details of CHF.

Basically, mainly two types of congestive heart failure.

Systolic dysfunction ➞ abnormality in heart systole.
Diastolic dysfunction ➞ abnormality in heart diastole.

Heart failure causes are mainly affecting the left ventricle of the heart.

If contraction of heart muscle (myocardium) decreases, leads to decrease cardiac output. If cardiac output decreases, do not proper blood flow in the body, and finally, the body does not meet their oxygen, salt, and nutrient requirement.
(if you understand cardiac output and stroke volume relation visit this article. Cardiac output)

Why congestive? Congestive means “accumulation of blood or fluid in the body”. In CHF, reabsorption of salt and water increase leads to increase fluid in body. So, retention of salt and water in the body and produce a toxic effect in our body.

Various causes of CHF include myocardium ischemic, myocardium infraction, hypertension, coronary artery etc.

Various symptoms seen in CHF patients include Chest pain, shortness of breath, jugular vein distention, fluid retention, rapid weight gain, ankle inflammation, irregular heartbeat and weakness. (if you learn CHF pathophysiology in details visit this article CHF pathophysiology)


In the USA, approximately 50 lakhs new cases diagnosed each year. It is shown in younger, elder, and child. But, Most of the cases shown in elder patients. But, in minor stages (starting phase) consult your consultant or doctor. If proper medication and treatment have taken don’t worry its curable.

(Don’t take any medication and treatment of your own decision. Self-medication is dangerous. If you suffering any disease consult your health consultant or doctor. Here, I will provide some details for information and boost your knowledge, not our motive to promote self-medication)

So, let’s start congestive heart failure treatment

Treatment of congestive heart failure


Here, I will discuss three types of treatment that cure CHF           

➣ Congestive heart failure Treatment through medication

➣ Congestive heart failure treatment through heart devices

➣ Congestive heart failure treatment through surgeries

Medication therapy beneficial for minor heart failure conditions or first stage condition. If a problem arises and converts major heart failure to treat with some heart devices. If condition extreme critical to required replacement of heart, valve, artery, etc via surgery.

➣ Congestive heart failure Treatment through medication


To minor congestive heart failure is treated with some medication. The various medication available in the market that cures congestive heart failure. But, why medication required. what’s our motive to take this medication.

Let’s discuss it

Our main motive to cure congestive heart failure by the following mechanism,

 ✔️ If contraction of heart muscle decrease, its increase.

 ✔️ If increase blood pressure (hypertension), decrease it.

 ✔️ If salt and water retention to our body, restrict to it.

 ✔️ If cardiac output and stroke volume reduced, just increase it. (normal level)

 ✔️ If blood flow decreases, increase the flow of blood.

 ✔️ If heart the rate increase, decrease it. (in normal condition)

following this all condition rises in CHF. Here, some following medication that cures this condition with different medications.

Let’s understand congestive heart failure medication in detail.

➙ ACE inhibitors drugss
➙ Beta blocker drugs
➙ Diuretic drugs
➙ Cardiac glycoside drugs

Above all type of medication is beneficial in CHF condition. Most of the cases ACE inhibitors are used in CHF condition. Here, I will discuss step by step each class in detail.

⇨ ACE inhibitors drugs

Example of ACE inhibitors,

Captopril (Vasotec)
Lisinopril (Zestril)
Fosinopril (Monopril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Rimipril (Altace)
Trandolapril (Mavik)

Aim of ACE inhibitors is to reduce hypertension and venous constriction. Let’s see how?

ACE inhibitors are one of the most useable drugs in the treatment of congestive heart failure.

Treatment-of-congestive-heart-failure
CHF treatment


As per this the image in CHF condition, kidney release renin. Renin and angiotensin both stimulate the angiotensin 1. After with the use of angiotensin-converting enzyme angiotensin 1 converted angiotensin 2.

Angiotensin 2 are responsible for increase venous constriction. Also, increase blood pressure (hypertension). these drugs are relaxed the venous tone and reduced blood pressure.

When ACE inhibitor drugs are given it inhibits the angiotensin-converting enzyme and relaxes the contraction of venous tone. These drugs decrease preload and afterload. Also, increase stroke volume and cardiac output of the heart.

ACE inhibitors are mostly beneficial to increase ejection blood flow. it indicates used with diuretics, B  – blocker, digoxin, and aldosterone.  

Other agents angiotensin receptor blockers are also beneficial for venous constriction. These agents block the angiotensin receptor to bind the venous muscle and block the contraction of the blood vessels.

Also, angiotensin 2 are responsible for the secretion of aldosterone from the adrenal gland. These aldosterone increases the salt and water retention in the body and ultimately increases blood pressure. ACE inhibitor drugs inhibit aldosterone and decrease blood pressure.

Some adverse effect produced include postural hypotension, hyperkalemia, renal insufficiency, angioedema, and dry cough.

Drugs do not take with ACE inhibitors drugs,

➞ ACE inhibitors with thiazide diuretics additionally decrease blood pressure.

➞ Such NSAIDs drugs (naproxen, ibuprofen, and aspirin) reduce ACE inhibitor effect on blood pressure. (because retention of water and salt)

➞ ACE inhibitors taken with potassium-sparing diuretics leads to potassium buildup and imbalance in heart rhythm.

Warning. ACE inhibitor drugs and angiotensin receptor blockers doesn’t use in pregnancy. Because generate teratogenic effect and harmful for the fetus.  

⇨ Diuretics drugs

Example of diuretics

Thiazide diuretics.
Hydrochlorothiazide (hydrodiuril)
Chlorthalidone (hygroton)
Metolazone (zaroxolyn)
Indapamide (lozol)
Chlorothiazide (diuril)

Loop diuretics.
Bumetanide (bumex)
Torsemide (demadex)
Furosemide (Lasix)

Potassium-sparing diuretics.
Amiloride (midamor)
Triamterene (dyrenium)
Eplerenone (aldoctone)
Spironolactone (Aldactone)

Aim of Diuretics drugs is to decrease pulmonary and peripheral edema. Let’s see how?

In CHF condition, pulmonary and peripheral edema are produced. These diuretics drugs decrease the reabsorption of venous tubules. When reabsorption decrease leads to increase excretion of urine and relieves both types of edema.

increase elimination of salt and water leads to decrease blood pressure and venous pressure. So, this medication also relieves hypertension.  

Diuretics are decrease the volume overload symptoms and preload.

Adverse effect of diuretic include weakness or tiredness, loss of appetite, nausea & vomiting, dehydration, confusion, restlessness and etc.

Drugs do not take with a diuretic,

➞ Diuretic given with some ACE inhibitors, anxiolytic, hypnotics, beta-blocker. Cause low blood pressure.

➞ Also, diuretic given with some NSAIDs drugs include naproxen, ibuprofen and aspirin causes a liver toxicity.

⇨ Beta blocker

Example of beta-blocker,

Acebutolol (Sectral)
Metoprolol (Lopressor)
Nadolol (Corgard)
Bisoprolol (Zebeta)
Atenolol (Tenormin)
Esmolol (Brevibloc)

Aim of Beta-blocker is to increase systolic function and relieve myocardial hypertrophy (size of heart muscle). Let’s seen how?

Generally, CHF has produced two types of dysfunction. Systolic and diastolic. systolic dysfunction means Heart doesn’t properly systole. And that’s why to reduce the cardiac output of the heart. So, beta-blocker increases systolic function and again balanced heart rhythmicity as well as its cardiac output.

If sometimes cardiac muscle (myocardium) produce hypertrophy. In hypertrophy, condition heart doesn’t work properly (contraction and relaxation). So, beta-blocker drugs normalize hypertrophy of myocardium. This condition called remodeling of muscle.

In fear and fight condition, heart rate increases. It’s one of the important causes of congestive heart failure. If heart rate increase, less blood filling time provide for the heart. If blood felling time less, reduced blood flow. So,  Beta-blocker drugs normalized heart rate and increase blood flow.

Also, beta blocker inhibits the release of renin in blood. As understand in ACE inhibitor drug renin are one of the important parts in salt & water retention. So, beta-blocker is directly inhibiting the renin release.

Adverse effect of beta-blocker include tiredness, dizziness, slow heart rate, don’t proper sleep, inflammation in legs.

Drugs do not take with beta-blocker,

➞ Beta blocker with arrhythmic medication (amiodarone), decrease heart rate, and blood pressure.

➞ Beta blocker with antipsychotics drugs (thioridazine), causes blood pressure.

➞ Beta blocker with clonidine increase blood pressure.

⇨ Cardiac glycoside drugs

Example of cardiac glycoside,

Digoxin
Digitalis
Dobutamine

Aim of Cardiac glycoside is to increase cardiac muscle contractility. Let’s see how?

Cardiac glycoside is responsible for increase cytoplasmic intracellular calcium ion in cells. It inhibits the Na+ – K+ channel. When Na+ – K+ channel block, decrease efflux of sodium and calcium ion. Accumulate calcium level in the cytoplasmic level.

If calcium ion increase inside the cell. it’s responsible for increase cardiac muscle contraction and increase stroke volume. Also, Cardiac muscle contraction leads to an increase the cardiac output of the heart.

Its mostly indicate in only left ventricle systolic function. And it's not indicated in diastolic and right-sided heart failure.

Various cardiac glycoside is used in the treatment of congestive heart failure but, a cardiac glycoside is dose-dependent. If doses of cardiac glycoside slightly increase it’s very toxic and dangerous for our health.

Adverse effect of cardiac glycoside include tachycardiac, decrease intracellular potassium ion, anorexia, headache, confusion, blur vision, nausea, and vomiting.

Drugs do not take with cardiac glycoside,

➞ Quinidine and verapamil is taken with cardiac glycoside increase digoxin toxicity.

➞ Antacid and neomycin are decreasing the absorption of digoxin.

➞ Rifampicin and phenobarbitone is increasing the metabolism of digoxin.

➣ Congestive heart failure treatment through heart devices


Various type of heart failure devices are available in the market, here discuss most popular devices

➙ Implantable cardioverter defibrillator (ICD)
➙ Cardiac resynchronization therapy (CRT)
➙ Left ventricular assist devices (LVAD)

This all devices not used in mild congestive heart failure condition. These are used in severe conditions or irregular heartbeat conditions. The main motive of these devices if our heart rate increases or decrease sometimes, these devices generate a pulse and regulate it.

Let’s discuss details in

⇨ Implantable cardiovascular defibrillator (ICD)

it’s battery-powered devices. This device is placed under the chest & abdominal skin, Below the collarbone. ICD install through blood vessels. It eliminates via open chest surgery.

ICD tract the heartbeat and regulate it

If heart rate increase ➞ sends signals to decrease it. (defibrillator shock)
If heart rate decrease ➞ sends signals to increase it. (pacemaker signal)

This device tract abnormality of heart rate, detect and deliver an electric shock to restore condition.

Which condition patients go for ICD. Ventricular tachycardiac, sudden heart attack, sudden cardiac arrest, long QT & Brugada syndrome.

Benefits of ICD. prevent the ventricular tachycardiac or fibrillation. It also prevents sudden cardiac arrest in severe congestive heart failure.

Before patients going to ICD, your doctor restore some causes like infarction, ischemia, irregular blood flow, and imbalance of electrolyte in the body.    

view animation of ICD treatment - click here


⇨ cardiac resynchronization therapy (CRT)

As per heart.Org CRT is a half-dollar sized pacemaker. It’s implanted below the collarbone. Leads (3 wires) are connected devices to monitor and detect the heart rhythm.

ICD is mostly beneficial who have heart failure with arrhythmic. It regulates the heartbeat and rhythmicity of the heart via an electric signal.

Which condition patients go for CRT. CRT not for any mild congestive heart failure patients. Usually,  it is only for the left and the right chamber of the heart does not work properly. If this condition not correct with medication. Your doctor going for ICD.

Benefits of CRT. It’s improve blood flow of heart as well as the efficacy of the heart. It prevents some heart failure causes like shortness of breath, cardiac arrest, etc.

Before patients go for CRT, your doctor check your blood test, another medical history, age for best and safe treatment

view animation of CRT treatment - click here

⇨ Left ventricle assist device (LVAD)

Also called “bridge to transplant”

As per discuss, ventricles are the most valuable part of the heart. Ventricle pumping the blood through-out body. If the heart can’t work properly. This device implanted just the upper part of the abdomen. LVAD is pumping blood like a battery device.

LVAD is tube like structure that pulls the blood from ventricle to aorta.  

Which condition patient goes for LVAD. if the heart’s pumping ability sometimes declines to some reason. In this condition, the LVAD device maintains the pumping ability of the heart.

Mostly, LVAD was available in the heart transplant center. If LVAD implanted patients also discharged from the hospital and wait to heart donor available.

➣ Congestive heart failure treatment through surgeries


Surgery is not use for all heart failure patients. If your doctor has shown correctness causes that develop heart failure. Then, your doctor goes for heart surgery. During this, all surgery patients connect to a heart-lung machine to supply proper blood and oxygen to the brain and body.

Here, I will discuss the most popular heart surgery.

➙ Heart transplantation
➙ Angioplasty
➙ Coronary artery Bypass
➙Valve replacement

Let’s discuss in details

⇨ Heart transplantation surgery

Heart transplantation is not used infrequently. Approx 2500 heart transplant per year. The ratio of transplantation is very rare.

Which condition heart transplantation required? If a patient's heart failure can’t cure with medicine, devices, and any condition or both type of heart chamber severely defective. In this condition heart transplantation is the last option.

How it works in the body? In the heart transplantation condition, your surgeon replaced disease or defective heart with a healthy heart (patients who declare brain dead). Not any kind of heart replace with any kind of heart. It takes a lot of time to find a perfect heart for patients. Before transplant heart, Your doctor matched tissue and other body condition and then after transfer the heart.

During the transplantation, your body connects with the heart-lung machine. Which provide same function of the heart. Then, the surgeon removed the diseased heart, transplant a healthy heart, and reconnect the blood vessel.

During transplantation gave some immunosuppression drugs to suppress immunity otherwise the body doesn’t accept foreign organs and reject it.

After the heart transplantation, your doctor regularly checks your blood reports, ECG, artery condition, etc. to check everything is fine. As per the ratio, 90 % of people survive more than one year.   

⇨ Angioplasty surgery (percutaneous coronary intervention)

Which condition angioplasty required? If heart failure develops due to blockage of the coronary artery and prevents the blood supply to the heart. And it’s not cured with medication. This time angioplasty is most beneficial.

Angioplasty remove the blockage and resolve the heart failure conditions. To again normalize blood supply to the heart.

How it works in the body?  Generally, angioplasty performs in a catheterization lab. A small tube-like catheter with a tiny deflated tube is placed in the artery via the groin. It pushed in the artery, at the blockage this tube inflated and removed the blockage. After completion of process tube-like structure removed from the body.

Also, stent implanted in body to consistently open your blood vessel.

Sometimes it’s slightly risky for patients (damage the artery). But it increases the patient's condition very well.

view animation of angioplasty treatment - click here

⇨ Coronary artery bypass surgery

Which condition bypass required? If any type of cause damage to the coronary artery, develop congestive heart failure and angiography doesn’t beneficial. In this condition bypass required.

How it works in the body?  In bypass surgery surgeon removed healthy blood vessels form the other part of your body (most cases are taken in chest or leg) and then surgically attached to the disease blood vessels. After attachment, blood flow through around the blockage section and sufficient blood provide as per normal condition

Bypass is helpful in if coronary artery damage due to any condition bypass surgery bypass the blood via another blood vessel.

Some the precaution was taken after bypass like not taken fat and cholesterol food. Because these substances make a plaque or clot in the artery. Also, the surgeon recommended doing some exercise to increase the strength of the myocardium.

view animation of bypass treatment - click here

⇨ Valve replacement

Which condition valve replacement required? if sometimes heart failure develops due to some disease and defective valve. In this condition, valve replacement is required.

Heart valve are regulated by the pumping of blood flow. if valve doesn’t work properly. In this condition valve problems cause congestive heart failure. In valve problem first step to correct it via treatment. If not cure with treatment then the second option is valve replacement surgery.

Different type of valve is available, like

Mechanical valve ➞ made by metal and plastic
Human valve ➞ made by human and animal tissue

How it works in the body? first, the patient connects with a heart-lung machine for oxygen and blood circulation. Then, the surgeon removed the bad and defected valve and placed a new valve in the heart. After replacement, the heart works fine.

After replacement your doctor has given some anti-clotting medicine to prevent the clot formation in a new valve.

Most of the cases of valve replacement surgery are a success.

view animation of valve replacement treatment - click here

Again, I a humble request to you any kind of medicine don’t take of your own decision. Sometimes self-medication is very dangerous to our health. If you suffering any health problem appoint your physician and doctor.

Conclusion: in this article, I will discuss the treatment of congestive heart failure, medication of CHF, heart devices, surgery. This article for just boost your knowledge. If you like our article, comment out.