Heart Failure

You probably will need to take a combination of medicines to treat heart failure, even if you do not have symptoms yet. Medicines do not cure heart failure. But they can help you manage your symptoms.

The goals of drug treatment are to relieve or control symptoms of heart failure, improve daily function and quality of life, slow the progression of the disease, and reduce the risk of complications, hospital stays, and premature death.

Medicines are used to treat the problems associated with heart failure, including:

• Fluid buildup, swelling, and water retention (edema).
• The reduced pumping ability of the heart.
• The effects of the body's attempt to compensate for heart failure.
• Other conditions that can lead to heart failure, such as coronary artery disease, high blood pressure, or diabetes.
• Prevention of complications, such as stroke.

It is extremely important that you take your medicines exactly as recommended by your doctor. If you don't, your heart failure may get worse or you may develop sudden heart failure. For more information, see:

Heart failure: Taking your medicines properly.

Medicine Choices

A combination of medicines is often needed to control symptoms and slow the progression of heart failure. Some medicines are used to treat pumping problems (systolic heart failure), and others are used to treat problems with filling (diastolic heart failure). The most commonly used and effective classes of medicines are as follows:

Medicines for pumping problems (systolic heart failure)

These include:

• ACE inhibitors (angiotensin-converting enzyme inhibitors). ACE inhibitors allow blood vessels to relax and widen (dilate), making it easier for blood to flow through the vessels.
• ARBs (angiotensin II receptor blockers). Like ACE inhibitors, ARBs allow blood vessels to relax and widen (dilate), making it easier for blood to flow through the vessels.
• Diuretics. Diuretics stimulate the kidneys to remove more water and salt (sodium) from the body.
• Aldosterone receptor antagonists. These medicines cause the kidneys to get rid of extra salt and fluid, and they help hold on to (retain) potassium by inhibiting the action of the hormone aldosterone.
• Digoxin. Digoxin slows and strengthens heart contractions, enabling the heart to pump more blood with each beat.
• Beta-blockers. Beta-blockers control symptoms of heart failure by either slowing the heart rate or making the blood vessels wider so blood flows more easily.
• Vasodilators. Vasodilators lower blood pressure and reduce the workload on the heart. Vasodilators like hydralazine are often used along with nitrates.

Medicines for filling problems (diastolic heart failure)

• Beta-blockers
• Diuretics
• ACE inhibitors
• ARBs (angiotensin II receptor blockers)
• Calcium channel blockers
• Direct renin inhibitors

If your heart failure is related to another condition, such as irregular rapid heartbeats (arrhythmias), impaired blood flow to the heart muscle (ischemia), or high blood pressure, you may take specific drugs for these conditions.

• Anticoagulants thin the blood and make it less likely to clot. These drugs may help prevent strokes.
• Antiarrhythmics prevent rapid and sometimes irregular heart rhythms.
• Antianginals control chest pain (angina) caused by impaired blood flow to the heart muscle.
• Antihypertensives lower blood pressure.

If you take the anticoagulant warfarin, don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:

Anticoagulants: Vitamin K and your diet.

What to Think About

Taking medicines used only to treat diastolic dysfunction may be harmful if you have systolic dysfunction, and vice versa.

Different people will take different medicines depending on the cause of heart failure and other related conditions.

Medicines for arthritis can cause sodium and water retention and can make heart failure worse. Ask your doctor before taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin), naproxen (Aleve), or cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex). For more information, see:

Heart failure: Avoiding medicines that make symptoms worse.

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