What Happens in End Stage Heart Disease?
Heart failure from any cause is an end stage heart disease where the once powerful muscle which supplies all the organs of the body is unable to deliver blood and oxygen where they are needed. It may also be referred to as congestive heart failure (CHF) because the failure to pump blood forward to the circulation results in damming of fluids back to the lungs which becomes congested.
Medications used to save a deteriorating heart address the different problems causing the signs and symptoms of heart failure such as:
- Decreased heart muscle strength
- Disturbances in rate and rhythm of heart beats
- Reduced coronary blood supply to the muscles of the heart
- Congestion of fluids in the lungs
- Increased resistance to blood flow brought about by hypertension (high blood pressure)
- Blood thickening
- Abnormalities in electrolytes affecting electrical conduction in the heart
Medications for Congestive Heart Failure
These are some of the common end stage heart disease medications:
Angiotensin-converting-enzyme (ACE) inhibitors are the cornerstone of therapy in CHF. They have been found to slow down the progression of heart disease. Their main effects are to prevent increases in blood pressure which also reduces the workload of the heart. Examples of these are captopril (Capoten), enalapril (Vasotec), quinapril (Accupril) and ramipril (Altace).
Side effects include frequent coughing, dizziness and skin rashes.
Angiotensin II Receptor Blockers (ARBs)
Aside from ACE inhibitors these types of drugs block the effects of angiotensin II in increasing blood pressure. As a result the heart can pump blood more effectively with a decrease in resistance. Side effects are similar to other antihypertensives which are decreased blood pressure, dizziness, nausea and headaches. Examples of these are losartan (Cozaar), telmisartan (Micardis) and eprosartan (Teveten). Some of these types of drugs are still considered investigational.
Patients who are suffering from pulmonary congestion and edema of the legs and abdomen need to unload their excess fluid into the urine with the use of diuretics. The challenge with this therapy is finding the right balance in eliminating enough fluids without losing too much electrolytes (like potassium) that can aggravate heart problems. Diuretics usually give immediate relief of the symptoms of shortness of breath and edema but they can also cause sudden decrease in blood pressure and weakness. Common examples are furosemide (Lasix), spironolactone (Aldactone) and chlorothiazide (Diuril).
To prevent constriction of blood vessels and increase blood flow to the heart, vasodilators like isosorbide dinitrate (Isordil) and nitrates or nitroglycerin are given. These relieve symptoms of chest pains and may increase tolerance for exercise. Side effects like sudden drop in blood pressure, dizziness and fainting may occur.
Digoxin (Lanoxin) and digitoxin are drugs that increase the force of the heart’s contraction and may regulate the rate of its beating. The result is improved pumping function which helps in decreasing congestive symptoms and weakness. However, dosage and effects must be closely monitored because slight increases in blood levels can lead to toxicity and side effects that can aggravate heart failure.
These drugs block beta receptors in the heart that are responsible for increased heart rate. This is an important aspect of therapy because a slower heart rate decreases the work of the heart, decreases oxygen demand and allows proper filling of the ventricles for adequate pumping of blood. They also decrease blood pressure so that a patient must be careful not to exert too much during work or exercise which may lead to weakness, dizziness and headache. Examples of these drugs are metoprolol (Lopressor), propranolol (Inderal), carvedilol (Coreg) and atenolol (Tenormin).
To prevent the formation of blood clots that put the patient at risk for stroke, blood thinners are given to patients with CHF. Heparin and warfarin are the usual drugs used. Complications from these drugs include internal bleeding such as gastric ulcers and easy bruising.
Calcium Channel Blockers
Calcium antagonists like amlodipine (Norvasc) decrease blood pressure by preventing blood vessel constriction. Side effects are similar to other antihypertensive agents.
Medications for heart failure are usually taken with each other in therapy to achieve a combination of effects like increasing heart muscle contraction, decreasing blood pressure, eliminating excess fluids and preventing stroke from blood clots. Although necessary, complications may arise from compounded effects of the drugs. Medical supervision is therefore essential in monitoring the effects of therapy.
AHA, “Medications Commonly Used to Treat Heart Failure" accessed 2/24/11
NHLBI, “How Is Heart Failure Treated?" accessed 2/24/11