Living with heart failure requires knowledge and the right care

ON CALL

August 09, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: I had a mild heart attack six months ago and was doing fine until the past few weeks, when I noted some shortness of breath when walking a few blocks. My doctor said that my problem is heart failure, and he started me on digitalis pills.

Are there any other ways to treat heart failure?

A: Clinical Practice Guidelines, developed for the management of patients with heart failure by a multidisciplinary panel sponsored by the Agency for Health Care Policy and Research, was published in June. The major recommendations of this panel are as follows:

* Patients with symptoms highly suggestive of heart failure should undergo a specialized test, such as echocardiography, to determine their ejection fraction (a measure of the ability of the left lower chamber of the heart, the ventricle, to pump blood to the rest of the body; a low ejection fraction indicates poor left ventricular function) as a way to guide therapy based on the severity of the heart failure.

* Most patients with heart failure due to poor function of the left ventricle should be treated with drugs called ACE inhibitors, unless there is some reason the patient can't take them.

* Diuretics should be started at once when patients with heart failure exhibit signs of fluid overload, such as swelling of the feet and ankles (edema).

* Digitalis is no longer the first choice of drugs in the treatment of heart failure. It should be used in those with severe heart failure or when symptoms persist despite appropriate doses of ACE inhibitors and diuretics.

* In patients with angina or a history of a prior heart attack, evaluations should be carried out to determine whether coronary artery bypass or angioplasty might be beneficial.

* Patients and their families should be counseled about the serious nature of heart failure and the importance of complying with lifestyle measures and taking prescribed medications. (Noncompliance with drug treatment is a major reason for recurrent hospitalizations for heart failure.)

* Dietary sodium should be limited to two grams a day.

* Regular exercise is encouraged for all patients with stable heart failure.

* Alcohol consumption should be limited to no more than one drink per day containing one ounce of alcohol or less.

* Patients should contact their doctor if their weight changes by more than 3 to 5 pounds since their last visit. Weight gain may indicate fluid retention.

A booklet containing a consumer version of the guideline, "Living with Heart Disease: Is It Heart Failure? A Patient and Family Guide," can be obtained by writing to: AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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