HEART FAILURE AND ITS TREATMENT
January 3rd, 2007 Posted by: Dr. Cox
If you’re new here, you may want to subscribe to my RSS feed.Thanks for visiting!
QUESTION:
What types of drugs are used to treat bean failure?
ANSWER:
Heart failure or congestive heart failure (CHF) affects nearly 5 million people in the U.S., with more than 400,000 new cases diagnosed every year. For people over age 65, heart failure is one of the most frequent causes of hospitalization. Furthermore, as the population ages CHF will become an even more common medical problem.
CHF is caused by an inefficient heart that cannot pump blood effectively out to the various body parts. This leads to a backup of blood flow and causes swelling of the arms, legs, or abdomen, decreased urination, fatigue, and shortness of breath. Some causes of heart failure include coronary heart disease, high blood pressure, heart muscle diseases, heart defects, severe anemia, and alcohol abuse.
If the cause of CHF is known and can be treated, then this is the first step in treating someone with heart failure. However, for most patients a combination of 3 or 4 different types of medications are used for the treatment of CHF. These include: a water tablet (diuretic) to remove excess fluid from the body; digoxin to increase the heart’s pumping ability; an ACE inhibitor which improves blood flow by expanding blood vessels; and a beta-blocker to prevent damage to heart cells caused by hormones. Sometimes other drugs can be used if a person cannot tolerate these medications or if other medical problems arc present. The use of these drugs can result in decreased mortality, fewer hospitalizations, and a general improvement in symptoms allowing for a better quality of life. Your doctor can determine which medication or combination of medications is best for you.
QUESTION:
I get short of breath and my ankles swell up now and then. I’m taking Celebrex for back pain and I wonder if this is OK?
ANSWER:
Shortness of breath and swollen ankles are signs of congestive heart failure and you should see a physician for an evaluation. Heart failure or congestive heart failure (CHF) affects nearly 5 million people in the U.S. For people over age 65, heart failure is one of the most frequent causes of hospitalization. As the population ages, CHF will become an even more common medical problem. This condition is caused by an inefficient heart that cannot pump blood effectively out to various body parts. This leads to a backup of blood flow and causes swelling of the arms, legs, or abdomen. It also causes decreased urination, fatigue, and shortness of breath. Some causes of heart failure include coronary heart disease, high blood pressure, heart muscle disease, heart defects, severe anemia, and alcohol abuse.
The drug Celebrex is a new medication that falls into the class of drugs known as nonsteroidal anti-inflammatory drugs or NSAIDs. NSAIDs arc useful agents to treat pain and inflammation but one of their side effects is fluid retention and edema. Because of this, caution must be used when using this medication in patients with heart failure, high blood pressure, or other conditions that can cause fluid retention. In fact, a recent study showed that the use of NSAIDs by elderly patients doubles the risk of being hospitalized for CHF, and for those with a history of heart disease it increases the risk by more than 10 times. The newer NSAIDs like Celebrex and Bextra were not included in this study, but until they can be proven to be more safe, they should be used with caution in the elderly. Patients taking NSAIDs should immediately contact their physician if they get short of breath. Other commonly used NSAIDs include Voltaren (diclofenac), Lodinc (ctod-olac), Nalfon (fenoprofen), Ansaid (flurbiprofen), Motrin or Advil (ibuprofen), Indocin (indomethacin), Orudis, Actron, or Oruvail (ketoprofen), Toradol (ketorolac), meclofcnamate, Relafcn, Naprosyn or Anaprox (naproxen), Daypro (oxaprozin), Fcldcnc (piroxicam), Cli-noril (sulindac), and Tolectin (tolmetin).
QUESTION:
I heard about a new drug on T.V. that is supposed to help people with heart failure. What can you tell me about it?
ANSWER:
The news you heard is really about an old drug called spironolactone or Aldactonc. As I discussed in an earlier column, heart failure or congestive heart failure (CHF) is a very common disorder, especially in the elderly. It is caused by an inefficient heart that cannot pump blood effectively out to various pars of the body. This leads to a backup of blood flow and causes swelling of the arms, legs, or abdomen; decreased urination; fatigue; and shortness of breath. Treatment of this medical problem usually includes a water tablet (diuretic) to remove excess fluid from the body; digoxin to increase the heart’s pumping ability; an ACE inhibitor to improve blood flow; and a beta-blocker to prevent damage to the heart caused by hormones. Recently a very important study showed that if a low dose of spironolactone was added to the therapy in patients with severe CHF, the risk of death or hospitalization was reduced by approximately 30%. In fact, this study was stopped before it was finished because of the excellent results. How spironolactone works in CHF is not exactly known, but it probably prevents progressive heart failure by blocking a hormone known as aldosterone. This appears to have a protective effect on the heart and also prevents sodium retention and potassium loss by the body.