Treatment for systolic heart failure typically includes medications and lifestyle changes.
The multidisciplinary team at UK HealthCare is made up of interventional cardiologists, advanced cardiac imagers and cardiothoracic surgeons who will evaluate each patient together to determine which treatment option is best.
If there are other causes of your heart failure, such as blocked arteries or leaky valves, then a procedure may be needed to improve your symptoms.
A heart transplant may be needed in severe cases of systolic heart failure.
The initial treatment for heart failure is usually a combination of medications. Taking all of your heart failure medications ordered by your team will improve your heart failure symptoms and quality of life.
There are four kinds of medications your team may prescribe:
- Beta blockers: These medications lower your heart rate and blood pressure. They help your heart work better and will reduce symptoms of heart failure. Examples include carvedilol and metoprolol.
- Angiotensin receptor plus neprilysin inhibitors (ARNIs): This medicine is a combination of two medicines (sacubitril and valsartan). It works to lower your blood pressure.
- Mineralocorticoid receptor antagonists (MRAs): These medicines block the effects of a hormone produced by your adrenal glands. Blocking this hormone can prevent your heart failure from worsening. The medicines will lower blood pressure and reduce fluid build-up. Examples include spironolactone and eplerenone.
- SGLT2 (sodium glucose cotransporter 2) inhibitors: These medicines are used to treat diabetes by lowering blood sugar, but they are also shown to prolong life and improve symptoms in heart failure patients. Examples include canagliflozin, dapagliflozin and empagliflozin.
Other medicines your team may prescribe include:
- Diuretics: Diuretics help remove extra water and sodium from your body, which reduces swelling and can make it easier to breathe. Examples include furosemide and bumetanide. Certain diuretics may lower your potassium and magnesium. Your team may prescribe supplements if this occurs.
- ACE inhibitors: These medications can decrease your blood pressure and support the continued health of your heart. ACE inhibitors are especially effective for people who experience diastolic dysfunction, which may be brought on by underlying conditions like hypertension, obesity and cardiac ischemia.
- Angiotensin II receptor blockers (ARBs): These medicines have many of the same benefits as ACE inhibitors. They may be an option for people who can't tolerate ACE inhibitors. Examples include losartan, valsartan and candesartan.
- Digoxin (Lanoxin): This medicine helps your heart squeeze better to pump blood. It may also slow your heart rate. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
- Positive inotropes: These medicines may be given by IV to people with certain types of severe heart failure. Positive inotropes can help your heart pump blood better and maintain blood pressure. In certain cases, your team may want to consider long-term use of these medications after you leave the hospital. An example is milrinone.
Living a healthy lifestyle and following these tips may help slow the progression of your heart disease:
- Eating a heart-healthy diet that is low in sodium, fat and cholesterol.
- Getting plenty of exercise (if your doctor says it’s OK). Aim for 150 minutes of moderate-intensity exercise each week.
- Losing weight if you are overweight.
- Managing any medical conditions that can damage the heart, such as diabetes, kidney disease or sleep apnea.
- Managing stress.
- Quitting smoking and limiting alcohol.
- Taking any daily medications recommended by your doctor.
- Working with your primary care provider to lower your blood pressure, blood sugar and cholesterol.
Depending on the cause of your heart failure, you may be a candidate for one of the following procedures:
Coronary artery bypass grafting (CABG)
A coronary artery bypass grafting (CABG) procedure, also known as a heart bypass, is an open-heart surgical procedure used to bypass, or replace, arteries blocked by plaque.
During a CABG procedure, a patient is placed under general anesthesia and a heart/lung bypass machine takes over the function of these organs.
A cardiothoracic surgeon begins the procedure by surgically opening the chest and breaking the sternum to access the heart. From there, a blood vessel from another part of the body, often the leg, is placed into the heart and used to bypass an artery blocked by plaque buildup. A single bypass procedure may be used to bypass multiple blocked arteries at one time.
Once the procedure is complete, the sternum is closed back up and wired together for stability. Then, the chest is stitched closed.
Following a heart bypass, the patient will be closely monitored in a cardiovascular intensive care setting for a day or two. They will then be moved to a regular room for additional monitoring and recovery. Most patients can be discharged from the hospital within a few days to a week.
Recovery at home after a CABG procedure can take several months to a year, and careful precautions are needed as the sternum heals.
Ventricular assist device (VAD)
A ventricular assist device (VAD), a surgically implanted pump, helps pump blood from the heart to your lungs and the rest of your body. If you are awaiting a heart transplant, a VAD is a valuable tool to improve your symptoms and quality of life. A VAD may also be used if you do not meet the criteria for, or do not want, a heart transplant. The goal of a VAD is to improve your blood flow, cardiac output, organ function and ability to be active.
A surgeon will place your VAD in the left or the right ventricle of your heart, depending on your needs. The VAD will take the demand off the side of the heart where it is placed. The operation typically takes six to 10 hours, and you will recover in the cardiovascular intensive care unit (CICU) for several days.
Cardiac resynchronization therapy (CRT)
A cardiac resynchronization therapy (CRT) device is a small, implantable machine that helps both sides of your heart stay in sync.
An implantable cardioverter defibrillator (ICD) is implanted in your chest. It can detect a dangerous arrythmia, such as ventricular fibrillation or ventricular tachycardia, when it occurs. It will provide an electric shock to send your heart into a normal rhythm.
MitraClip
MitraClip is an implant smaller than a dime that restores heart function and eases strain on your heart. During a minimally invasive procedure, the MitraClip implant is guided via catheter from a needle puncture in your leg to the mitral valve. There, it is deployed to hold part of the damaged valve together, helping it close more completely and improving the mitral valve regurgitation. The procedure takes one to three hours, and patients return home from the hospital in one to three days.
MitraClip offers patients an alternative to open-heart surgery, but not everyone is a good candidate.
