Treatment Strategies

Treatment of heart failure usually involves a combination of medications, diet modification, fluid limitations and some lifestyle changes. In some cases, a biventricular pacemaker or internal cardiac defibrillator (ICD) or cardiac transplant may be recommended. Your doctor will discuss treatment options and determine the method most appropriate for your condition.

Common Heart Failure Medications

Angiotensin enzyme (ACE) inhibitors – ACE inhibitors are medications that dilate (widen) the blood vessels, decrease the blood pressure and make it easier for the heart to pump blood through the vessels. Some ACE inhibitors:

• captropril (Capoten)
• fosinopril (Monopril)
• ramipril (Altace)
• enalopril (Vasotec)
• quinapril (Accupril)
• lisinopril (Prinivil, Zestril)
• benazepril (Lotensin)
• perindopril (Aceon)
• trandolapril (Mavik)

Angiotensin II blockers – Other drugs used to relax the blood vessels, frequently used if ACE inhibitors cause coughing. Some angiotensin II blockers are:

• losartan (Cozaar)
• irbesartan (Avapro)
• valsartan (Diovan)
• candesartan (Atacand)

Vasodilators – May also be used to relax the blood vessels when a person cannot take ACE inhibitors. Some vasodilators are:

• hydralazine (Apresoline)
• isosorbide dinitrate (Isordil, Sorbitrate)
• nitroglycerin (Nitrodur, Transderm)
• isosorbide mononitrate (Imdur)

Beta-blockers – These drugs reduce heart rhythm problems and may cause the heart to become smaller and stronger.

• carvedilol (Coreg)
• metoprolol (Lopressor, Toprol-XL)
• bisoprolol (Zebeta)

Digoxin – May improve symptoms through a variety of mechanisms.

Diuretics – Commonly referred to as “water pills” because they help the kidneys to rid excess water and salt from the body through the urine.

• furosemide (Lasix)
• chlorothiazide (Diuril)
• bumetanide (Bumex
• metolazone (Zaroxolyn)
• torsemide (Demadex)
• spirnolactone (Aldactone)
• hydrochlorothiazide (HydroDiuril)

Potassium – Important electrolyte in the body that is often lost with increased urine output. Potassium supplements are frequently needed when taking diuretics.

Inotropic therapy – Intravenous drugs used in end stage heart failure to stimulate the weakened heart to pump more effectively to send blood through the body. These drugs increase the force of the heart's contractions and relax the blood vessels.

• dobutamine (Dobutrex)
• milrinone (Primacor)

Nutritional Guidelines

One of the most important actions that you can take to improve your symptoms of heart failure is to limit your sodium (salt) and fluid intake. Sodium attracts water, and too much sodium causes extra fluid to build up in the body. This extra fluid creates more work for the heart and worsens the heart failure. In addition, you should follow the recommended American Heart Association Diet: Low Fat (less than 30 grams per day), and Low Cholesterol (less than 300 mg per day).

Limit Your Sodium

It is very important that you limit your sodium intake to 2000-3000 mg (2-3 grams) per day to avoid extra build up of fluid in the body. Sodium is found in many foods and they don't all taste salty, so it is important to know how much sodium a food contains before you eat it. Salt is very high in sodium so do not cook with salt nor add salt to your food. Use alternative spices to add flavor to your food. Most canned meats, salted canned vegetables, canned soups, sausages, peanut butter, sauces, prepared mixes (pancake, muffins, etc.), and “fast foods” contain a lot of sodium. Some of the foods low in sodium are: fresh or frozen vegetables, fruits, chicken, turkey, fresh or frozen fish, dried beans, cooked cereals (oatmeal, cream of wheat), rice, and graham crackers. Learning how to read food labels will help you choose foods that are low in sodium. Talk with your dietitian to learn about the food contents and how to prepare a well-balanced meal that is low in sodium, fat and cholesterol.

Limit Your Fluid Intake

Your doctor may recommend that you limit your fluid intake to 2 quarts or 8 cups per day. Measure the fluids that you drink and record the amounts so that you do not exceed the recommended amount of fluids each day. Be sure to include all fluids including water, drinks, coffee, jello, ice cream, yogurt, puddings, juices, milk, ice, soups, etc. Avoid alcoholic beverages (beer, wine or liquor).

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