Medications
PROMISING DEVELOPMENTS
Heart transplants are usually reserved for those with severe disease, marked by discomfort with any physical exertion and overt symptoms even at rest. A candidate for a transplant should generally have no other major illness and be younger than age 60 (although success has been achieved in older persons). With surgical advances, 85 percent of transplant recipients are now live after one year, and 65 to 75 percent survive past five years.
DRUGS TO AVOID IN CHF
Some heart failure patients with very slow pulse rates may need a pacemaker inserted. The new bi-ventricular pacemaker is designed for the up to 50 percent or so of CHF sufferers whose hearts do not beat in synchrony. The small device is implanted under the shoulder, with wire leads that deliver electrical signals to both sides of the heart. Patients who receive such devices generally show improved quality of life, can walk further and spend half the number of days in the hospital as those without a pacemaker. There is also growing interest in the implantable cardioverter-defibrillator as a treatment for potentially fatal heart rhythms in those with heart failure.
Despite complications, including bleeding, blood clots and infections,these and other devices are increasingly becoming and treatments in themselves, making a transplant unnecessary.
>How do I Know if my CHF drugs are working?
You'll actually start feeling better in a matter of hours. Diuretics ('water pills') quickly move excess fluid out through your kidneys---so expect a lot of visits to the bathroom in the first 24 hours. You'll also soon notice that your breathing is easier. Then, a few days later, the swelling in your feet should nearly be gone. Some other medications, such as ACE inhibitors and digoxin, take a little longer to achieve their maximum benefit.
>Can I still have sex?
Sexual activity is likely to be safe if you can climb two flights of stairs without stopping due to chest pain, shortness of breath or dizziness. Also, if you are a man who takes one of the impotence drugs (Viagra, Cialis or Levitra), you shouldn't continue to use it if you are taking nitrates for your heart condition. It's a good idea to discuss the topic of sex openly with your doctor.
Lifestyle changes
Simple lifestyle measures can improve your quality of life and help to keep you away from the hospital.
A few small studies indicate that the amino acids taurine (500 mg L-taurine twice a day) or arginine (1000 mg twice a day) may offer some therapeutic benefits for those with heart failure. Along with coenzyme Q10 (100 mg twice a day) other supplements have also been proposed for treatment. Research has also shown that heart failure can be associated with high blood levels of homocysteine. There have been some suggestions that homocysteine is not only toxic to arteries but may also damage heart muscle directly. It has not yet been proven that you can lower your homocysteine levels by simply increasing your folate intake.
Diuretics are usually given along with angiotensin---converting enzyme (ACE) inhibitors, such as captopril (Capoten), ramiprill (Ramace, Tritace) or lisinpril (Privinil, Zestril). By opening up blood vessels, these drugs lower your blood pressure and reduce strain on your heart. Unfortunately, studies show ACE inbitors are under-prescribed, in part because of worries about side effects, including the infamous ACE inhibitors, you may experience similar benefits from the angiotensin II receptor antagonists, such as losartan (Cozaar) and irbesartan (Karvea), which have fewer side effects, or from vasodilators such as hydralazine or nitrates.
Once you've stabilised on diuretics and ACE inhibitors, beta-blockers, which slow the heart down and make the pumping action easier, may prove a useful addition to the mix. Researchers are finding that beta-blockers, which also lower blood pressure and normalise rhythm, can be quite beneficial in strengthing the heart at the same time they lessen symptoms and help prolong survival in people with heart failure. Studies show these drugs reduce the chance of rehospitalisation and even death from heart failure. Commonly prescribed beta-blockers include carvedilol (Dilatrend) and metoprolol (Lopresor). Initially, your doctor will have to monitor you closely, because in rare cases these drugs may actually worsen your heart failure or produce annoying side effects, such as nightmares, depression or fatigue.
Digitalis drugs, such as digoxin (Lanoxin), also called cardiac glycosides, might be useful for those who don't respond to other medications. These drugs strenghten the heartbeat and increase blood flow to the kidneys, promoting fluid removal. Your doctor will check regularly for harmful side effects, such as irregular heart-beats digestive upset and visual disturbances.
A variety of other drugs are used for heart failure as well, including injectable vasodilators for emergency situations, amiodarone (Coradarone) for irregular heartbeats, and lung-strengthening ashtma drugs. Many more drugs are currently under investigation as well.
PROMISING DEVELOPMENTS
- The first self-contained artificial heart gained worldwide prominence in 2001 when doctors at jewish Hospital in Lousiville, Kentucky, implanted it into 59-year-old Robert Tools. The 1 kg device, which is shaped like a yo-yo, is called the AbioCor, and is battery-powdered, grapefruit-sized and quiet. Tools and a handful of others who received the device, outlived all expectations. It's still a final option for the very sickest patients, but these encouraging results have paved the way for larger clinical trials.
- Scientists, reporting in an October 2002 issue of the The New England Journal of Medicine, say they've identified two altered genes that can put certain people at 10 times the risk for developing CHF. This will help counsellors alert people with these genetic mutations about the immediate need to reduce their CHF risk factors (high blood pressure, cholesterol, diabetes and obesity.) And eventually it may lead to drugs tailored to prevent or treat hear failure.
Procedures
If your CHF worsens and medications are no longer effective at relieving your symptoms, a heart transplant or other procedure may become necessary. Heart transplants are usually reserved for those with severe disease, marked by discomfort with any physical exertion and overt symptoms even at rest. A candidate for a transplant should generally have no other major illness and be younger than age 60 (although success has been achieved in older persons). With surgical advances, 85 percent of transplant recipients are now live after one year, and 65 to 75 percent survive past five years.
DRUGS TO AVOID IN CHF
- Drugs that affect heart rhythm, apart from beta-blockers and amiodarone.
- Calcium channel blockers, such as verapamil (Isoptin, Veracaps) and diltiazem (Cardizem)
- Tricyclic antidepressants
- NSAIDs and COX-2 inhibitors
Some heart failure patients with very slow pulse rates may need a pacemaker inserted. The new bi-ventricular pacemaker is designed for the up to 50 percent or so of CHF sufferers whose hearts do not beat in synchrony. The small device is implanted under the shoulder, with wire leads that deliver electrical signals to both sides of the heart. Patients who receive such devices generally show improved quality of life, can walk further and spend half the number of days in the hospital as those without a pacemaker. There is also growing interest in the implantable cardioverter-defibrillator as a treatment for potentially fatal heart rhythms in those with heart failure.
Despite complications, including bleeding, blood clots and infections,these and other devices are increasingly becoming and treatments in themselves, making a transplant unnecessary.
>How do I Know if my CHF drugs are working?
You'll actually start feeling better in a matter of hours. Diuretics ('water pills') quickly move excess fluid out through your kidneys---so expect a lot of visits to the bathroom in the first 24 hours. You'll also soon notice that your breathing is easier. Then, a few days later, the swelling in your feet should nearly be gone. Some other medications, such as ACE inhibitors and digoxin, take a little longer to achieve their maximum benefit.
>Can I still have sex?
Sexual activity is likely to be safe if you can climb two flights of stairs without stopping due to chest pain, shortness of breath or dizziness. Also, if you are a man who takes one of the impotence drugs (Viagra, Cialis or Levitra), you shouldn't continue to use it if you are taking nitrates for your heart condition. It's a good idea to discuss the topic of sex openly with your doctor.
Lifestyle changes
Simple lifestyle measures can improve your quality of life and help to keep you away from the hospital.
- Go easy on the salt. Aim for 2000 mg or less of sodium a day. Too much salt causes the body to retain fluids, raising your blood pressure; salt also causes small blood vessels to constrict.
- Exercise. Once actively discouraged for those with heart failure, a moderate exercise program has proven beneficial for many with CHF. A few minutes of walking or light weights two to five times a week may be all it takes. Be sure to consult your doctor before starting any type of exercise program.
- Seek support. People who are married or who have a strong social network generally fare much better than those who go it alone. Try to cultivate friendships and join a local support group.
- Practise stress-reduction techniques. Yoga, progressive muscle relaxation or meditation have all proved effective. They lower blood pressure and have other cardiac benefits as well.
A few small studies indicate that the amino acids taurine (500 mg L-taurine twice a day) or arginine (1000 mg twice a day) may offer some therapeutic benefits for those with heart failure. Along with coenzyme Q10 (100 mg twice a day) other supplements have also been proposed for treatment. Research has also shown that heart failure can be associated with high blood levels of homocysteine. There have been some suggestions that homocysteine is not only toxic to arteries but may also damage heart muscle directly. It has not yet been proven that you can lower your homocysteine levels by simply increasing your folate intake.
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