Congestive Heart Failure: A Patient Guide

Some medications are reserved for in-hospital use only or during cases of severe, decompensated heart failure. These medications, which include intravenous vasodilators (e.g., nesiritide, nitrates) and intravenous inotropics (e.g., milrinone, dobutamine), are usually only prescribed by physicians specially trained in heart failure management. Physicians may also temporarily discontinue some orally prescribed medications during severe cases of symptomatic heart failure. Again, only a physician trained in heart failure management should advise the discontinuation of these medications. Often, treatment of the underlying cause will result in cessation of symptoms and prolongation of life. This is quite frequent when the cause is valvular and can be treated surgically. Some problems are self-limited as well.

Newer therapies also are available in specialized heart failure clinics. These may in some instances include special pacemakers for resynchronizing the heart or for changing heart rhythm. When necessary, there are also devices for heart assistance called left ventricular assist devices and in certain cases transplantation can be considered.

Hospitalization

Hospitalization might be required if your symptoms are too severe or if you do not respond to initial forms of treatment. Surgery may be indicated for some patients.

Lifestyle changes

Lifestyle changes are important in the treatment of CHF. They include dietary restriction of sodium (salt), smoking cessation, limiting the consumption of alcohol and fluids, exercise and weight control. All lifestyle modifications must be monitored by appropriate medical personnel.

Relief and prevention

There are many therapeutic measures you can follow each day to help relieve and prevent the progression of CHF. Some of these are:

• Regularly follow a doctor-prescribed exercise program.
• Avoid significant physical labor and emotional stress.
• Avoid fatigue by planning rest periods and gradually increasing daily activities.
• Avoid extremes in temperature.
• Take medication(s) exactly as prescribed and call your physician if one or several do not agree with you.
• Weigh yourself daily to detect increased fluid retention (do this at the same time each day).
• Familiarize yourself regularly with your blood pressure and heart rate.
• Restrict fluids if ordered by your physician.

Know the signs and symptoms of CHF and immediately report any to your physician: edema, increased shortness of breath, distended neck veins, weight gain (as defined by your physician), persistent cough, and increased urination at night.

CHF is a disorder that can lead to serious complications and death. For this reason, it is important to know CHF warning signs and to follow your physician's plan of care. Symptoms can be controlled with appropriate treatment and the correction of underlying health problems.