Topic Overview

How do medicines relieve my symptoms?

Medicines for heart failure help relieve the symptoms of heart failure by:

• Removing excess fluid from the body. The class of medicines known as diuretics acts principally to rid the body of excess fluid.
• Improving the ability of the heart to pump more effectively. Another type of medicine, digoxin, works primarily by increasing the strength of the contraction of the heart.
• Preventing further injury to the heart. A class of medicines known as angiotensin-converting enzyme (ACE) inhibitors acts both by improving the efficiency of pumping and by preventing further damage to the heart.

How do medicines prolong my survival?

Several classes of medicines have been proven to increase the life span of people with heart failure. These include:

• ACE inhibitors.
• ARBs (angiotensin II receptor blockers).
• Beta-blockers.
• Spironolactone, a diuretic. (Other diuretics can improve symptoms but do not improve survival.)

The exact mechanism by which these medicines prolong survival is not entirely clear. Each medicine might have several beneficial effects for people with heart failure. In terms of prolonging survival, the most important effects may be the ability of these drugs to prevent both lethal abnormal heart rhythms and their ability to limit ongoing damage to the heart.

What types of medicines are used to treat heart failure?

There are many medicines that are designed to control symptoms of heart failure, improve heart function, and enhance chances of long-term survival. These medicines can be grouped together into classes of drugs that work in similar ways to treat heart failure. The three classes of medicines that have been proved to have the greatest benefit for people with heart failure are summarized in the following table.

Because there is very good evidence that ACE inhibitors, ARBs, beta-blockers, and spironolactone can prolong survival in people with heart failure, your doctor will aim to have you take these medicines, if appropriate.

Also, several other classes of medicines can be helpful in relieving symptoms of people with heart failure. There is less clear evidence that these medicines prolong survival, so your doctor will usually use these second-line medicines only if you are already taking each of the main classes of medicines or if you cannot tolerate one or more of the main medicines.

What types of medicines are used in the hospital?

If you go to the hospital because of sudden heart failure, also called a flare-up, your doctor will first try to stabilize your condition. The doctor will immediately prescribe drugs such as diuretics, nitrates, and/or morphine to help you breathe more easily and to control your pain or anxiety. These drugs should quickly relieve your symptoms.

Your doctor may also order an oxygen mask that fits over your nose and mouth. The oxygen helps make sure that your heart and the rest of your body are receiving plenty of oxygen. After your condition is stabilized, your doctor will try to find out what caused your flare-up and whether your heart has been damaged.

If these medicines do not help you enough, your doctor might try more aggressive medicines such as nesiritide (Natrecor) which helps relax certain blood vessels and gets rid of extra sodium and water from the body. Nesiritide is only used after trying other treatments. Your doctor will watch you closely for problems, because nesiritide can cause serious kidney problems, irregular heartbeats, and low blood pressure.