different path
We will introduce treatments by category. First, there is the category of lifestyle changes. Next is the pharmaceutical category. In particular, we use the term “guideline medical therapy” to describe drugs that have been clearly shown to improve survival rates, increase longevity, and reduce the likelihood of hospitalization. In fact, doctors adhere to certain standards when prescribing these drugs, and here’s why: There is a reason why medicines are effective.
More advanced treatments are then given to prevent arrhythmias and irregular heart rhythms. These include things like defibrillators and pacemakers. And there’s a new device that wasn’t available 20 years ago that can improve symptoms in people with weak hearts who have a particular type of heart disease called left bundle branch cardiomyopathy.
Our hospital also offers advanced treatments such as:
- heart transplant
- Left ventricular assist device (LVAD)
- Intravenous drug therapy. Certain IV medications we can administer that seem to improve symptoms.
Sometimes they are done as a bridge to a transplant, and sometimes as so-called destination therapy (if you are not a candidate for a transplant). In order to improve your physical condition, you may be fitted with these devices or given an IV drip at home.
But it all starts with lifestyle.
change in way of life
Food is very important. Of course, salt intake is also important. We have a general limit of 1,500 milligrams of sodium that we want people to consume. Reducing salt intake reduces the amount of water retained in the body, lowering blood pressure and making it easier for the heart to pump blood.
Then, of course, there’s exercise.
You may be wondering, “How is exercise effective?” Now, when you think about heart failure, it’s a supply and demand imbalance. The heart cannot pump enough blood that the body needs. But if you can make your body more efficient, you can get by with less.
It’s no different than when you downsized your car. Even if he puts a four-cylinder engine in a big, old Cadillac, he can’t expect enough power. If his heart beats at half power, it’s the equivalent of running his four-cylinder engine in his 1960s big car. It doesn’t work very well. Therefore, the more activities you engage in, the more efficient you become and the more you can make great progress there.
After talking about the lifestyle first, let’s look at what you need to do every day as follows:
- watch your weight
- Look for signs and symptoms of leg swelling
- wake up every day
- Pissing
- Step on the scale and measure your weight. Many people decide whether to take additional diuretics based on their weight and symptoms. They don’t talk to me about it anymore. That is wonderful.
find the right medicine
There are different types of drugs that doctors use to treat heart failure, including:
- ACE (angiotensin converting enzyme) inhibitor
- ARB (angiotensin receptor blocker)
- beta blocker
- Mineralocorticoid receptor agonist (MRA)
- SGLT2 inhibitor
- diuretic
- vasodilator
- Ivabradine
- Vericiguat
- digoxin
Diuretics help eliminate salt and water from the body. It probably won’t help you much when it comes to survival. They are there to treat your symptoms and make you feel better. However, other drugs are often given to strengthen the heart, and diuretics do not need to be given as much.
There are many other drugs that have brought about dramatic changes. When I was a medical student 35 years before him, we would never give beta blockers to people with heart failure. I never have. They were thought to weaken the heart. Well, it turns out that it blocks adrenaline. This is how beta blockers work. Improve Survival. Blocking adrenaline calms the heart, making it stronger.
Years ago, a drug called carvedilol was introduced, and it was truly life-changing when it came to heart failure. I vividly remember administering such drugs in the early 90’s thinking, “This doesn’t make any sense.” Eventually, it became the standard of care.
We consider only three beta blockers to be guideline treatments. they work. Each has been shown to independently improve survival rates, make people live longer, feel better, and reduce readmission rates.
- Carvedilol (Coreg)
- Metoprolol (Toprol)
- Bisoprolol (Zebeta)
ACE inhibitors and their sister ARBs lower blood pressure, making it easier for the heart to pump blood forward. We call it “unburdening the mind.” We’ve known for probably 30 years that these drugs can increase your survival rate, make you live longer, and actually reduce the size of your heart and prevent it from getting worse.
These drugs led to new drugs called neprilysin inhibitors. It lowers blood pressure and really improves the work of the heart. That’s pretty impressive.
We see some additional benefits. But these are the pillars of treatment.
Also remember that not all drugs are the same. There is actually another series of drug combinations that can be used instead of ACE inhibitors, called hydralazine and nitrates. They seem to have a good chemistry with African Americans. In many cases, depending on the person, we basically tailor the medical therapy to that person.
surgical options
When we’re talking about treatment, if the cause of heart failure is a defective or blocked valve, then of course we’ll treat that as well. In that case, surgery such as valve replacement or angioplasty may be helpful.
A pacemaker may be inserted to control irregular heart rhythms. That’s helpful. Implantable cardioverter defibrillators are mostly there to prevent sudden death. It can monitor irregular heartbeats and deliver electric shocks to correct them. But they don’t actually make your heart stronger. Biventricular pacemaker defibrillators (BiVICDs, or biventricular implantable cardiac defibrillators), a type of defibrillator currently in use, are used for certain types of heart failure and improve sudden mortality rates. And in some cases, it can improve heart function.
When you move on to the next step, an LVAD (left ventricular assist device), it becomes a big deal. You have to go into the heart or open the chest. But again, for those for whom all else fails, it is an option before transplant.
Hope for heart failure patients
Just in the past 30 years, there has been a fundamental change in the way we approach heart failure, especially with regard to beta-blockers. When we see our heart working better… In the past, when we saw a really bad ejection fraction (a measurement of how well the heart is working) of 5% or 10%, we I was surprised. Afterwards, the patient was given these medicines, and when the test was repeated 6 months later, the results were normal. That’s very cool. And my heart also shrinks. It starts big and gets smaller. It gets better.
oh.
There are so many great things we can do to help people feel better and live longer. And I think that’s important. That means people shouldn’t give up hope. That’s totally encouraging.