Although the treatment of heart failure is a field of modern pharmacotherapeutics, other proven conservative measures must also be exploited. These include hospitalization for bed rest, where supporting the patient in the sitting position is often sufficient in itself to produce marked improvement. Other measures, especially in patients with edema, are a low-salt diet (less than 3 g/day) and maintaining a fluid balance chart. Depending on severity and body weight, patients should not drink more than 1–1.5 litres daily. A long-term weight loss programme is essential in overweight patients.

Various drugs are available for treating chronic heart failure. Some have been shown to improve the prognosis, while others improve symptoms only.


Improve prognosis

• ACE inhibitors
  ACE inhibitors block the action of the endogenous protein ACE, which catalyses the formation of the hormone angiotensin-II (AT-II). AT-II constricts blood vessels and maintains blood pressure. Lowering AT-II concentrations in the body keeps blood vessels dilated and lowers blood pressure.
  The burden on the heart is relieved by having to work against lower resistance. ACE inhibitors may also slow pathological remodeling of the heart muscle. They improve the prognosis of heart failure and are well tolerated. Cough is a common but harmless side effect.
• Angiotensin receptor blockers (ARBs)
  These work in the same way as ACE inhibitors and are used in patients who fail to tolerate ACE inhibitors.
• Beta blockers
  Beta blockers reduce the effect of stress hormones (catecholamines) on the heart. Increased stress hormones are released in heart failure and may lead to cardiac arrhythmias. Beta blockers improve prognosis by preventing life-threatening cardiac arrhythmias.
• Diuretics
  Particular diuretics (aldosterone antagonists) improve prognosis in advanced disease. How they actually work remains unclear.

Relieving symptoms

• Diuretics
  By clearing retained excess fluid from the body, diuretics reduce the burden on the heart and blood vessels. They decrease breathlessness and ankle edema.
• Digitalis (glycosides)
  Digitalis (foxglove extract) is one of the oldest drugs. Although it has not been shown to prolong survival in patients with heart failure, it improves their quality of life and exercise tolerance. Digitalis also helps to control the heart rate in atrial fibrillation (a common cardiac arrhythmia).