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 What is CHF?
CHF stands for congestive heart failure. CHF is not a kind of heart disease. Heart disease is called cardiomyopathy and it's cardiomyopathy that causes heart failure. Heart failure is the set of symptoms that hit you when your heart can't pump enough blood to meet your body's needs. It's called congestive because fluid settles in your lungs, "congesting" you. Honestly, I usually think of CHF as meaning Chronic Heart Failure.
 
your heart - so misunderstoodSo now you have a weak heart, probably enlarged. You may have "episodes" of heart failure, meaning sometimes you have the symptoms and sometimes you don't. Or you may have symptoms all the time. Either way, you "have" CHF. However, you are only "in" CHF if you are having symptoms right now. The symptoms include shortness of breath, fatigue, lightheadedness, swelling, insomnia, and the other fun stuff described in the section called Expect These Symptoms.
 
If you don't usually have symptoms, you are called "well compensated." This means meds and life style changes are compensating for your weak heart function. If you are in CHF, meaning that you have all or some of those symptoms, you are called "decompensated." With good treatment your CHF (symptoms) may go away, but that doesn't mean you're cured. You should be kept on certain drugs even if all your symptoms go away - to keep them away.

 What's happening to my heart?
Your lungs take the oxygen you breathe in and put it into your blood. Your heart pumps that oxygen-rich blood out of your lungs into the rest of your body. Your other organs and tissues get a good drink of oxygen-rich blood and then it goes back through your lungs, picking up oxygen again. The heart pumps it out again and again and again - we hope.
 
CardiomyopicA weakened heart can't pump hard enough to keep up with this cycle. It receives more blood from the lungs than it can pump out into the body with each heart beat. The blood it can't handle backs up, spilling over into the lungs and other tissues. Cells get waterlogged. This causes swelling called edema.
 
This swelling often happens in the ankles and legs first. That's because gravity pulls the backed-up, "loose" fluid straight down. The fluid also backs up into your lungs, which makes it hard to breathe. When you're lying down, gravity isn't pulling the fluid out of your lungs down into your feet, so it is even harder to breathe. Your heart can fail in two basic ways: 

 
*  Systolic dysfunction is when the heart can't pump out enough blood. Most CHFers have this problem
*  Diastolic dysfunction is when enough blood cannot get into the heart because the heart muscle refuses to properly relax. Because the heart doesn't relax, there isn't enough room inside it for all the blood. With diastolic dysfunction, your heart may be normal size and you may have a normal ejection fraction

 Do I really have heart failure?
Your heart does not just stop if you go into heart failure. Usually you get heart failure over a period of time - maybe even years - before it is diagnosed. Heart failure causes shortness of breath, swelling of legs, feet and maybe your stomach. You can get a feeling of fullness in your stomach that makes it hard to breathe. Sleeping can be difficult. Wheezing and extreme fatigue are common.
 
diagnosingHeart failure is often misdiagnosed as respiratory infection, bronchitis, asthma or gallstones. Certain tests can identify heart failure in different ways. A chest x-ray can show if your heart is enlarged. An echocardiogram can measure how well your heart is pumping. A new 20-minute blood test called the Triage BNP test can confirm a CHF diagnosis. Some common causes of congestive heart failure are listed here.

 Am I going to die tomorrow?
With proper treatment, you may live a long time with heart failure. Of course, some adjustments have to be made. That's why you should read the rest of this page. It will tell you in plain English what to expect, what to do, and what not to do. If you doubt anything you read here, please discuss it with your doctor, whom I hope is a CHF specialist.
 
It is said that up to 40% of people with heart failure will die from SCD (sudden cardiac death) but I would personally guess 15% or less. This is more likely in people with arrhythmia - an unstable heart rhythm.uh oh! The longer or more often you are in heart failure, the more likely you are to develop an unstable heart rhythm. That's because as your heart enlarges, the electrical pathways in the heart get stretched out and no longer work quite right. The subtances in your body that control "electricity" also get out of whack. In end-stage CHF, your lungs may fill with fluid, drowning you. I don't want to depress you, but my pages are honest and accurate. I won't yank your chain. Inotropes can relieve a lot of symptoms in people with end-stage heart failure.

 Where can I learn about all this stuff?
Doctors often pass off cardiomyopathy and CHF as the same thing but as you've seen, they're not. Cardiomyopathy causes heart failure. See my Site Index for links to plain English pages about heart failure, ACE inhibitors, beta-blockers, drug trials, IV drugs, medical studies, CHF tests, implanted devices, low sodium diet and links to lots more. The Beat Goes On, the Me Too pages let you talk to other people living with heart failure. Jon's Place also offers support. If you prefer reading a book, the one I highly recommend is Success With Heart Failure by Dr. Marc Silver. It's worth reading cover to cover.

 Can I be cured?
You may live well for a long time if you do it right. Both support and information that you need to improve your life are offered here. It's time to accept the fact that you are sick - but don't dwell on it.
 
my heartThe two questions I hear most are, "How long do I have?" and "Can I be cured?" No one knows how long you have - not the doctors, not me, not anyone. Other health problems, the cause of your heart failure, your life style, genetics, and many other factors figure into it. Concentrate on living - not on dying. A positive outlook literally increases your chances of living longer.
 
Your cardiomyopathy may get cured, but your heart usually sustains some permanent damage before the underlying problem is fixed. This is one reason it's a question with no answer. It depends completely on your individual circumstances. Focus on getting back near-normal heart function instead of thinking "cure."
 
In studies, the highest number of CHFers to get back to truly normal was 27%. If you haven't gotten your heart function and energy back in the first year after diagnosis, you may not ever get it all back. You may get a whole lot better - just not fully "normal." Get with the program and know what to do and why - and then do it - and I believe most CHFers can indeed get much better. It was several years after my diagnosis that I really improved.

 How long do I have to take all these pills?
If you do get normal heart function back, your doc would be wise to keep you on an ACE inhibitor and a beta-blocker for life, since CHF can come back. Time and time again, I see CHFers come to my heart forum, regain heart function, go off their meds, and they're back in a year - back in serious heart failure! This is even stated in the official heart failure treatment guidelines.
 
For the other common question, "Can my enlarged heart shrink back to normal size?" I do have an answer. Yes, an enlarged heart can return to normal size. ACE inhibitors and beta-blockers are the best bet to reverse this heart remodeling. Now, let's explain those mysterious heart classes the docs always talk about - Class one, Class 3, whatever!  Jon.

 Heart Classes
Class I
No limitation; Ordinary physical activity does not cause excess fatigue, shortness of breath or palpitations.
Class II
Slight limitation of physical activity; Patients are comfortable at rest but ordinary physical activity results in fatigue, shortness of breath, palpitations, or angina.
Class III
Marked limitation of physical activity; Although patients are comfortable at rest, less than ordinary activity will lead to symptoms.
Class IV
Inability to carry on any physical activity without discomfort; Symptoms of congestive heart failure are present even at rest. With any physical activity, increased discomfort is experienced.

As of November 8, 2001, the American College of Cardiology and the American Heart Association have released a new class system for heart failure patients. This new system is meant to be used along with the functional class system described above. The new system classifies heart failure in "stages" A through D. Only stage C and D patients actually have CHF. The new guidelines can be found at www.acc.org and www.americanheart.org.

Stage A
patient is at high risk for developing CHF but has no structural disorder of the heart. Examples: patients at high risk for developing CHF because of high blood pressure, CAD, diabetes, history of drug or alcohol abuse, history of rheumatic fever, family history of cardiomyopathy, etc.
Stage B
patient has a structural disorder of the heart but has never developed CHF symptoms. Examples: patients with structural heart disease like left heart enlargement, heart fibrosis, valve disease, previous heart attack.
Stage C
patient with past or current CHF symptoms and underlying structural heart disease.
Stage D
patient with end-stage disease who is frequently hospitalized for CHF or who requires special treatments such as LVAD, artificial heart, inotropic infusions, heart transplant or hospice care.

NOTE
The new system is like cancer classes - even though treatment may make cancer disappear, the patient is still classified as a cancer patient. Patients who develop into stage C always remain in stage C even if they get better and their symptoms disappear. Their functional class would improve to class one but they would remain in stage C anyway.


 Expected Symptoms

Shortness of Breath
dyspnea You run short on "wind" during and after almost any moderate or harder exertion. You may find yourself short of breath after mild exertion or even while at rest. Heart failure ain't much fun
Fatigue
tiredness Being tired is a way of life for us CHFers. You must learn to pace yourself so you don't give out halfway through the day. Do not over-do it on a day when you feel good because the "fatigue hangover" will clobber you 2 or even 3 days later. It's not worth it, believe me
Good Days/Bad Days
the see-saw You will have days when you feel good, maybe even normal. You will also have days when you feel like life isn't worth living. It is, though; really. This see-saw of physical and mental strength is "normal" for a CHFer. Pay attention to your body and when it says to do nothing but rest, do nothing but rest. When it says get active, be cautious <g>
Edema
swelling You may swell up at times. Some episodes will be mild. Other times, you may swell up like a balloon. This means you are retaining fluid in your body tissues. It can be very scary, especially the first time. Any part of your body can swell but the lower legs, ankles and feet are the most common. A few people will swell mainly in their abdomen, arms or even their face. Take an extra diuretic pill if that's okay with your doctor. If it's bad, head for the Emergency Room now, where they will give you IV diuretics to remove fluid the old fashioned way - making you pee like you won't believe
Lightheadedness
dizziness
poor sense of balance
It comes with CHF but Coreg and other beta-blockers may make it worse. ACE inhibitors can cause some lightheadedness too. Don't stand up suddenly and if you get it bad, please don't drive! If your diuretic dose is too high, you may get dehydrated and that will also make you lightheaded. One thing to try is to take your beta-blocker at a different time of day than your ACE inhibitor - but always with meals. In other words, "stagger" your meds. If your lightheadedness increases suddenly over a short period of time, call your doctor. It could be low blood pressure, dehydration, fall in heart function, or something else entirely
Memory Trouble
poor short-term
memory
Like it or not, your brain is not getting as much blood and therefore oxygen, as it wants. Between that and all the medications, you are going to have a lot of trouble remembering things - not "who am I?" but "what was I supposed to do next?" sort of things. Concentration comes hard and learning new things requires more effort
Strange Feelings
a swollen feeling
in your chest
and/or stomach
Most of us get this at least once. It feels like edema but there is no visible swelling. It may be nothing, but then again it could mean that your cardiac output is falling. This can also be caused by dehydration. Don't take any chances - see your doctor now. If a doctor tries to blow you off, tell him to check you out or he's fired. This is your life and he has no right to blow off any symptom you even think you have
Miscellaneous Goodies
dry cough Comes with CHF. ACE inhibitors can make it worse. If it is really bad you may need to switch from your ACE inhibitor to an ARB (ACE receptor blocker)
dry skin Comes from several CHF meds and lots of hand washing. Ask at The Beat Goes On for favorite brands of hand lotions and moisturizing creams
palpitations Being too aware of your heart beating. Your heart may seem to try jumping out of your chest with every beat or jump "into your throat." If you also feel a change in heart rate or rhythm, call the doc. If it happens when you're lying on your left side, roll over onto your right side 
discomfort Feels wrong to lie on your left side - this may cause palpitations or shortness of breath
numbness Sitting or sleeping in the wrong position causes your limbs to go numb. Tingling in arms or legs may occur during the day, especially if you stay in one position too long. Fidgeting regularly may help
can't lie flat May cause shortness of breath - lie on your right side on multiple pillows
nausea Happens in end-stage CHF, and can also be caused by some meds: Digoxin can cause nausea. You may get some unseen swelling inside your stomach from ACE inhibitors, causing nausea. Dehydration can also cause an upset stomach
loss of appetite Happens in end-stage CHF and can also be caused by too much digoxin or a too-low blood potassium level
difficulty sleeping Don't know why but it's fairly common. Getting to sleep may also be a big problem. Like we aren't already tired enough!
lower leg or foot pain Don't know why but lots of CHFers experience this (including me), often badly enough to need painkillers
feeling of physical
"wrongness"
This is impossible to describe but you'll know it when it happens to you, believe me. I get this only rarely but when I do, I am pretty sure I'm going to die, it makes me feel so "wrong." I have no idea what causes it and no doctor understands what I mean

 What Can I Do?

Read This Whole Site! There is an amazing amount of accurate, plain English info here. Use the Site Index or the site search engine to find what you need
Talk to Us Post to The Beat Goes On to benefit from other CHFers' real-life experience
Get The Right Doc -
a CHF Specialist!
You need a CHF specialist, not a primary care physician, not an osteopath, not an internist, not a general cardiologist. Find a heart failure clinic in your city and go to appointments with different CHF docs until you find one who fits the bill. That means he admits when he doesn't know something, stays up to date on treatments, and does not mind answering all your questions in plain English. If your doc intimidates you, you won't feel free to ask him all the questions you should, and that's bad. If he's in a hurry, he'll miss something sooner or later, and that's bad. If he's cold and impersonal, he might view you as a chart or a case instead of a a person, and that's bad. Choose your CHF doc with care. It's worth the effort. The right CHF specialist can make the difference between good quality of life and unending misery - also between life and death. That's no joke. Just ask at The Beat Goes On
Low Sodium Diet Eat no more than 2 grams (2000 mg) sodium a day - at most. This means a lot more than just laying off the salt shaker. Check out Kitchen Corner for a good start. Salt causes your cells to retain fluid, which causes that nasty swelling (edema) mentioned earlier
Don't get fat! It creeps up on you: Before you know what happened, you're at least 25 pounds overweight. Look, you are too tired to be very active, you feel lousy and you're near the fridge all day so you're eating more than you think you are. Face it, you have eat less or you're gonna get fat. That will stress your heart and also stress you out emotionally. I use the Atkins eating plan but it won't work for everyone. Find something that works for you to prevent fat gain, and do it now!
Restrict Fluids No more than 2 liters daily for most CHFers who have symptoms. Place an empty 2 liter pop bottle on the kitchen counter. Every time you get a drink, pour the same amount as you drink into the bottle. When it's full, you've had your whole day's supply. Ice, broth, pudding, soup and jello count as fluids. Don't cheat - cheating will just make you miserable. The less fluid you drink (without dehydrating), the less blood your heart has to pump. Some doctors don't agree with this idea though so talk to your doctor
Take Your Meds Not taking your meds is a real bad move. If you think one of them is bad for you, tell the doctor and get it changed or adjusted. Don't play doctor. Get a pill organizer - one that holds at least 7 days worth of meds and has 3 good sized compartments for each day. This prevents mistakes - pick one up at your local drugstore. If you get side effects after taking meds, try taking pills 2 hours apart, or taking any one-a-day meds at bedtime
Be Careful With Your Diabetes Beta-blockers can raise blood sugar so monitor your level carefully. Some diabetes meds can be dangerous for heart failure patients, such as glucophage (metformin). Others should be used with caution like Avandia and Actos. Cross-check all your diabetes and heart meds with both your doctor and your pharmacist - ask questions!
Exercise An official Cardiac Rehab program is best but you can do it without one. Walking is the best exercise but you will need to do resistance training if possible to feel and function better. Get an okay from your doctor first but by all means, do it! Get a treadmill (motorized is best) and use it. You will feel better and live longer.
Weigh Yourself Daily At the same time (morning is best) and in just your birthday suit. If you gain more than 2 or 3 pounds overnight, you are getting edema even if it doesn't show yet. An extra diuretic pill or phone call to the doc is in order. If you don't do this, your stomach lining may accumulate fluid. Then diuretic pills like Lasix don't absorb right, so they don't work right. That starts a vicious cycle ending in the Emergency Room for IV diuretics. Weigh yourself each day!
Regular Blood Testing Be sure your doc is testing your blood regularly. This is to check for potassium and magnesium levels, among other things. Skewed electrolyte levels are no joke. Levels too high or too low can be deadly and many CHF meds affect electrolyte levels. Blood tests also check for liver damage from meds. A urine sample may be taken at the same time for certain kidney tests. If your doctor isn't regularly checking your blood, I strongly suggest changing doctors to one who will. It is important
Stagger Your Meds
If you get dizzy, lightheaded, too tired or whatever, try taking your meds at different times of day - you don't have to take them all together! Taking a beta-blocker 2 hours after an ACE inhibitor (or vice-versa) may stop your blood pressure from dropping a lot all at once, and so on. Experiment - just be sure you do take them all!
Take Care Of Your
Teeth
Heart meds can give you a dry mouth. That lack of saliva allows germs to stay in your mouth instead of being constantly rinsed away naturally. This can lead to infection, which is the last thing you want. Brush after every meal, floss if you can, and see your dentist twice a year for teeth cleaning. If you have any valve leakage at all, your CHF doc may prescribe you antibiotics to take immediately before any dental work and again immediately afterward
Miscellaneous Goodies
Attitude Get a positive one and keep it. You'll live longer and happier - and so will everyone around you <g>
Learn All about your illness and its treatments. It gives you a sense of control. Knowledge also allows you to monitor your treatment and ask the doc intelligent and useful questions
Don't smoke You already knew that. Right?
No Booze Alcohol is a cardio-toxin - that's right, it's literally poison. Stay away from it. Period. Despite what the alcohol industry and the unfocused Framingham study suggest, booze is bad for your heart. It doesn't take a genius to figure this out
Accept Your
Limitations
You are not lazy or useless - just slower than you'd like. Accept your physical condition while always attempting to better it
Wear a
Medic Alert
bracelet
A hospital Emergency Room visit while you are unconscious can kill you if the doctors don't know you have CHF and what meds you take. Get an appropriate bracelet or necklace, have them engraved with the appropriate warning/condition information and wear them all the time. It's also a good idea to carry a wallet card listing all your problems, your meds, and your doctor's and family's phone numbers
Wash your hands You have a weak heart and you take a lot of prescription drugs. That means you have a weaker immune system than you think. Do yourself a favor and wash your hands when you should - often - after using the bathroom, after petting your dogs, before handling your pills or food, after a visit to the doctor's office, and so on. This will reduce your chances of getting colds or the flu. That can make a very big difference in quality of life since a simple cold can take you down hard when you have CHF. I carry a little squeeze bottle of waterless antibacterial hand soap, purchased in the grocery store, and use it instead of public sinks when I'm out and about.
Get a Dog A good dog is a big comfort. Cats - who needs 'em?! ;-)

 Supplements

CoQ10
CoQ10 comes in
sublingual
liposomal spray
gelcaps
tablets
It is one link in the chain of nutrients that produce energy in human cells. Coenzyme Q 10 is a required supplement if you take a statin cholesterol-lowering drug! I also recommend you take CoQ10 if you were diagnosed with heart failure less than one year ago.
     If you take tablets, chew them with food - the fat makes them absorb properly. Expensive gel-caps just add oily fat to the pill to make them absorb well. Start with a low dose of around 30mg and work your way up to roughly 100mg twice a day. If you are quite small or quite large, adjust that dose. If on a statin, keep taking CoQ10. If newly diagnosed and not on a statin, I recommend taking CoQ10 for one year, then stopping and seeing what happens. This stuff is expensive.
Vitamins
Multi-vitamins Take them. You need them. I have seen no real agreement on which vitamins to take. I take a multi-vitamin/mineral tablet twice a day with food. Suit yourself, but do not take huge doses of any vitamins.
Amino Acids
L-carnitine
Carnitor
An amino acid shown in trials to improve heart failure. I take 333mg Carnitor 3 times a day after meals. This is a prescription form. If you have drug benefits with your health insurance, ask your heart failure specialist to prescribe this. If not, buy over-the-counter. If using over-the-counter, I recommend 500mg to 1000mg 3 times a day.
Taurine An amino acid shown in trials to improve heart failure. I take 2000mg once a day after my exercise. I recommend 2000 to 4000mg daily. If you take more than 2000mg, take it in 2 smaller doses twice a day (such as one 2000mg dose after breakfast and one 2000mg dose after dinner).
Creatine This is another amino acid shown lacking in CHFers. I take 6000mg creatine monohydrate once a day after my weight workout. You should take about 4000mg a day if taking it just for heart failure. If you are quite small or quite large, adjust the dose. If you currently have kidney dysfunction, ask your doctor before taking creatine
L-arginine An amino acid shown to increase exercise tolerance in people with heart failure. L-arginine helps your body produce nitric oxide, which dilates your arteries - a good thing.
Magnesium
Magnesium Magnesium helps prevent arrhythmias. Your magnesium level is reduced by loop diuretics like Lasix and Demadex. Magnesium and vitamin D are required for calcium to be absorbed and used by your body. I take about 100mg three times a day (two of those doses are in my multi-vitamin/multi-mineral pills). Taking too much will just give you diarrhea.
Selenium
Selenium Selenium may be necessary for best uptake of CoQ10. It is often low in chronically ill people. Taking selenium supplements helps your metabolism handle free radicals
Chromium
Chromium Chromium may also be useful for proper absorption of CoQ10. It is considered helpful by some CHFers. Take up to 200 micrograms daily. Watch for weight gain
Calcium
Tumms or Rolaids Diuretics reduce your body's calcium. Steroids such as prednisone drastically reduce bone density in the very first week of treatment. You can take Tumms or Rolaids as a calcium supplement. I take a calcium supplement that also contains magnesium and zince, which your body needs to use the calcium. Decide for yourself the proper dose. Do not take antacids, calcium supplements, or high-calcium foods within 2 hours of taking your digoxin (Lanoxin). Also do not take a bunch of calcium all at once because your system cannot absorb it that way. Take calcium supplement doses at least 3 hours apart.

 Prescription Meds
Meds are expensive. For financial help with them, click here

Routine Testing
Blood testing If you take heart failure meds, you need certain blood tests done now and then, to keep you safe. Please see this page for more about this routine but critical testing.
What Dose?
Target dose What doses should you take of heart failure meds? See this FAQ page
ACE Inhibitors
Vasotec enalapril
Altace ramipril
Monopril fosinopril
Capoten captopril
Prinivil/Zestril lisinopril
Accupril quinopril
Lotensin benazepril
Aceon perindopril erbumine
Mavik trandolapril
Angiotensin-converting enzyme (ACE) inhibitors are the first-line therapy for CHF. ACE inhibitors prevent worsening of heart function and lighten the heart's work load. There can be large price differences from drug to drug. Watch for lightheadedness and persistent, dry cough.
ARBs
Cozaar (losartan)
Avapro irbesartan
Atacand candesartan cilexetil
Diovan valsartan
ARBs are ACE Receptor Blockers. They are also called ACE 2 antagonists. ARBs such as losartan may give many of the same benefits as ACE inhibitors without side effects such as cough. However, ACE inhibitors are still more important in CHF treatment than ARBs because they have been thoroughly proven to make us feel better and live longer.
Diuretics
Demadex torsemide
Edecrin ethacrynic acid
Lasix furosemide
Bumex bumetanide
Triameterene dyrenium
Indapamine indapamide
hydrachlorothiazide
Diuretics wring fluid out of your system the old fashioned way: they make you pee. The less fluid in your system, the less blood your heart has to pump, the less congestion in your lungs, and the easier you breathe. There are 2 types of diuretics: loop and thiazide. Loop diuretics are more powerful. One mg of Bumex = 10mg of Demadex = 40mg of Lasix.
     Loop diuretics cause potassium, magnesium, thiamine, and calcium loss but since ACE inhibitors slow potassium loss, they may offset each other. A very small dose (2.5 mg) of Zaroxolyn taken 30 minutes before your Lasix can really turbocharge the draining effect. Be sure to take Lasix 1 or 2 hours before or after eating (not with food) - with Demadex it doesn't matter.
     Please note that Demadex may be better for CHFers than Lasix. See this page. If Lasix isn't getting the job done, ask your doctor about this. Magnesium, potassium, calcium, and vitamin B1 supplements are recommended. Watch for gout and avoid licorice!
Digoxin
Lanoxin
digoxin
Digoxin/Lanoxin is a "cardiac glycoside." Such therapies have been used for weak hearts for centuries. Digoxin is still useful, especially in severe CHF. It helps your heart beat stronger and reduces CHF symptoms. Watch for confusion, nausea or visual disturbances. Also watch for swollen breasts (man or woman) and breast tenderness with long-term use
Beta-blockers
Beta-blockers
carvedilol
Zebeta
bisoprolol
Toprol XL
metoprolol
Beta-blockers prevent the body from telling your damaged heart to speed way up. An accelerated heart rate would wear your heart out way too fast. Coreg is the most widely used but others may work as well - or not. Beta-blockers make us live longer and many CHFers - but not all - feel better taking them. Coreg is an alpha and beta-blocker with several other actions as well. Watch for low blood pressure, slow heart rate, lightheadednesss, weight gain, or depression. Always take it with food! If you are diabetic and take a beta-blocker, watch your blood sugars very closely!
Coumadin
Coumadin
warfarin
Although commonly used in CHFers to prevent blood clots (and thus strokes), there is little evidence that this is necessary unless you have a-fib (atrial fibrillation). If you have a-fib, you need a blood thinner. Coumadin is questionable for CHFers in normal (sinus) rhythm, unless they have a history of clots or stroke. Watch for a tendency to bleed easily. Report excessive bruising to your doc. You will need to have your blood tested regularly if on Coumadin. Please read this information too
Aspirin
aspirin
Once commonly used in CHFers who were not taking Coumadin, there is no evidence that all CHFers should take aspirin every day. My own CHF specialist took me off daily aspirin as soon as I came under his care. For the run of the mill CHFer, it may actually be slightly detrimental to take a full-sized aspirin every day. If you take it, 81mg daily of enteric (coated) aspirin is best - baby aspirin size. Watch for stomach upset and a tendency to bleed easily. See this article for more
Aldosterone-blockers
Aldactone
spironolactone
Inspra
eplerenone
Long approved as a diuretic, the RALES trial showed a new use for this old drug. Taken at low doses - 25mg daily - it does not act as a diuretic but it does make us less likely to die. I'm all for that! It affects potassium, like most diuretics, so a blood test should be done when the drug is started, at the very least. Watch for growing breasts - 1 in 10 men will suffer this or impotence. The swollen breasts in men will not disappear if you stop taking the drug.
     A new drug called eplerenone may give the same benefits without all the side effects
Vasodilators
Apresoline
hydralazine
Isordil/Sorbitrate
isosorbide dinitrate
Many brand names of
nitroglycerin
Imdur
isosorbide mononitrate
Vasodilators expand the blood vessels, lowering the resistance against which the heart must pump. This is called reducing afterload. These can be powerful drugs, so use with care. Watch for headaches and dizziness. Alpha blockers are vasodilators and expand blood vessels, and Coreg has this effect to some extent. Morphine dilates veins - called reducing preload - and decreases anxiety, so it may (and probably should) be used in end-stage CHF
IV Drugs
Primacor IV
milrinone
Inocor IV
amrinone lactate
dobutamine
dopamine
Natrecor
nesiritide
Usually given intravenously, inotropes and certain other IV drugs make the heart pump more strongly. They are usually used only in severe CHF and are fairly short acting. Since they speed up the wearing out of your heart, they are not used unless really necessary. They do really help quality of life in severe or end-stage heart failure, though. They may be used in CHF clinics, hospitals or at home, with therapy started by a visiting nurse and ended by the patient or a caregiver. Natrecor is a new drug that has many of an inotrope's benefits without many of the side effects - a big step forward
Statins
Zocor simvastatin
Mevacor lovastatin
Pravachol pravastatin
Lescol fluvastatin
Lipitor Atorvastatin
For those CHFers who have CAD, cholesterol control is crucial. Because less physical activity raises LDL, most CHFers are put on drugs to maintain healthier cholesterol levels. Watch for constipation, stomach upset, or muscle cramps. Many cholesterol lowering drugs lower your CoQ10 level. The price of different cholesterol lowering drugs may differ drastically. If you suffer muscle weakness or soreness a lot after starting a statin drug, see your doctor immediately since a rare side effect causing this can be dangerous
Study Drugs
All non-FDA approved drugs CHFers often are asked to participate in drug trials. The drugs are free and so are medical services for complications, required tests, and physical exams. There is always risk in trials. However, since most CHFers are already on risky drugs, many are willing to enter trials. Read about the different levels or "phases" of drug trials below
 
Drug Trials

Drug trials are called Phase 1, Phase 2 or Phase 3.
  Phase 1 trials only study safety. More trials cannot take place unless Phase I trials show a drug to be reasonably safe when given to humans. People in a Phase I trial are closely watched for any sign of harm caused by the drug. Because safety is the question, Phase 1 trials are small but they also allow researchers to start understanding how the drug will work in people. At this point in testing, no one even knows if the new drug will do what it is designed to do. Phase I trials are the most dangerous for patients.
  Phase 2 trials confirm that a new drug is safe enough for more people to try, and show whether a drug is effective over the short-term. Phase 2 trials also help decide what doses will be used in Phase 3 trials. Phase 2 trials are usually placebo-controlled and double-blinded. Neither the patient nor the doctors know if a patient is getting the drug or a placebo. These trials are larger than Phase I trials and take longer. There is still significant risk because only a small group of people has tested the drug for safety so far.
  Phase 3 trials prove or disprove the effectiveness and safety of a drug over the "longer" term. They are usually double-blinded and placebo-controlled. They can involve hundreds or thousands of patients over months or years. Although the number of patients can be large, risks for patients are smaller because of all the earlier testing. The large scope of these trials lets researchers observe benefits and overall safety of the drug as well as identify less common side effects. Phase 3 trials are incredibly expensive and only drugs which look very profitable make it to this type testing.

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Updated March 2, 2007 

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007 Jon C.

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