Congestive heart failure is not a disease but a condition that occurs when the heart is unable to pump enough blood to meet the needs of the body's tissues. About 285,000 people died of heart failure last year. Many therapies can help to ease the workload of your heart. Treatment may include lifestyle changes, medicines, device implantation, and surgery. Studies show that medicines also help improve your heart function and make it easier for you to exercise or do physical activity.

You are the most influential force in the treatment of your heart failure. You must, must, must participate in your care. We at the Texas Heart Institute at St. Luke's Episcopal Hospital Heart and Lung Transplant and Treatment Center are committed to help you improve your life. You may reduce the symptoms of heart failure and improve how you feel with medications and lifestyle changes. You are part of your health care team along with your doctors, nurses and your family. Your health care team will design a plan of management tailored to you. It will include:

• Medicines
• Diet
• Daily activity
• Exercise
• Lifestyle and health habits
• Family support

Why So Many Medications?

Taking your medicines every day is extremely important to treating your heart failure. Your doctor may add medications one at a time, or he may start two or more. You may need more frequent clinic visits at times your medication is being adjusted for the optimal dose for you.

Important Reminders About Medications

• Take medications exactly as your doctor ordered them. Do not skip doses, take more than ordered to make up forgotten doses, or forget to refill prescriptions.
• Bring all the medications you are taking each time you see the doctor along with your medication record.
• Understand what each medicine is for, what it looks like, and common side effects.
• Be patient as your doctors find the right medications for you along with the best time, amount and combination to take them.
• Do not take over-the-counter medications without asking your doctor or nurse.
• Check your medications for an expiration date. Ask your pharmacist if you have any questions.
• Check with St. Luke's Heart Failure Center before taking any new medication prescribed by a new doctor or over-the-counter drugs.
• Let us know if you are having difficulty taking your medications due to times of doses or cost of medications. Share any problems with us.

Keeping Track of Your Medications

Heart Failure patients are oftentimes overwhelmed by the amount of medications they must take. Get a system that works. You need to know:

Other important things to remember:

• Bring your medications with you each time you come to the clinic, hospital or plan to see the doctor.
• Always carry a list with you of medications you are currently taking. Consider purchasing a Medic Alert bracelet.
• Use the medication chart or diary provided for you.
• • Bring it with you to any doctors appointments.
  • Make sure your nurse updates this with any changes.
• Heart failure patients generally share in being overwhelmed by the cost of medications.
• • Shop around local pharmacies to find the best prices for each prescription.
  • Generic forms of most medications are usually cheaper. Your doctor will generally prescribe this if possible. Remind him.
  • Mail order pharmacies are also usually great sources of savings.
  • Internet/on-line pharmacies are usually very inexpensive but you need to plan ahead.
  • You may qualify for some governmental or pharmaceutical company assistance programs. Our social service department is available to assist you.
  • Please let us know if the cost is a problem with you taking your medications as prescribed.
• All medications have side effects and can interact with other drugs. It is very important that we know all drugs that you are taking.
• If you miss a dose, take the missed medicine at the next scheduled time. Do not go back and make up the dose.

Please call if:

• If you think a medicine is causing a problem. Do not just stop taking it. Some drugs have to be stopped gradually.
• If any physician starts you on a new medication or you begin an over-the-counter drug or herbal remedy.

Understanding Your Medications

Taking your medications every day is essential in treating your heart failure. Common kinds of medicines prescribed for treating heart failure include:

ACE inhibitors (Angiotensin-converting enzyme inhibitors)

• Accupril (quinapril)
• Altace (ramipril)
• Capoten (captopril)
• Lotensin (benazepril)
• Monopril (fosinopril)
• Prinivil/Zestril (lisinopril)
• Vasotec (enalapril)

ACE inhibitors make it easier for the heart to pump. They have been shown to help patients live longer and feel better. They prevent the further deterioration of heart function. This will usually be the first medication your doctor will prescribe for heart failure. It may take several days to weeks before you feel these effects.

Side Effects: Report any side effects right away. The most common side effects of ACE inhibitors are:

• Cough
• Dizziness
• Skin rash

We may monitor your potassium level and kidney function more often while you are taking ACE inhibitors.

If you experience any of these symptoms your doctor may be able to change the dose or type of ACE inhibitor. A very low percentage of patients cannot tolerate ACE inhibitors at all. Please do not stop taking your ACE inhibitor without your doctor’s advice.

Angiotensin Receptor Blockers (ARBs)

• Atacand (candesartan)
• Avapro (irbesartin)
• Cozaar (losartan)
• Diovan (valsartan)

ARBs function in a similar manner to ACE inhibitors by affecting blood pressure in a way that makes it easier for the heart to pump blood. They are most often used in patients that cannot take ACE inhibitors. They are not a substitute for ACE inhibitors and do not prolong life the way ACE inhibitors do.

Beta-blockers

This class of drugs has shown dramatic improvements in patients with heart failure. The drugs decrease the toxic effects of heart failure. They seem to work best in women, but men also have substantial benefit.

The difficulty in using beta-blockers is the early start up. Because these drugs will worsen the contraction of a weak heart, some patients will feel more tired and short of breath. This does not mean you have to stop beta-blockers. It just means you need to let your doctor know.

These drugs take time to work. In fact, the maximal beneficial effects can take six to eight months to occur.

Types of beta-blockers: There are many types of beta-blockers, but for heart failure, we recommend only two. Coreg (carvedilol) and Toprol XL (metoprolol succinate long acting). The dose to start is very low and increased every two weeks to the maximum tolerated dose.

Side Effects: Beta-blockers can cause dizziness, nausea, vomiting, impaired peripheral circulation resulting in cold hands and feet, and sleep disturbances. It is very important to take your pills every day, unless your doctor tells you otherwise. Beta-blockers should be taken with food. When your heart adjusts, you should feel better. Keep track of how you feel — and tell your doctor if anything bothers you. You may feel the same, or worse for three to 10 weeks. After that most people feel better. Do not stop taking beta-blockers suddenly. If your doctor wants you to quit, he or she will gradually reduce your dose.

Amiodarone

Amiodarone is a heart rhythm stabilizing drug (antiarrhythmic). It is the safest drug of its type to use, if needed, in patients with heart failure. You will need regular lab work to monitor its effect.

Diuretics

Commonly known as a “fluid pill”. Diuretics make you urinate more often. This gets rid of the extra fluid your body holds on to because of your heart failure. Your heart does not have to work as hard if it has less volume in the circulation system. Diuretics will decrease the swelling in your ankles, feet, legs and abdomen. You will also notice you will become more short of breath if you skip a dose.

Common diuretics are:

• Lasix (furosemide)
• Demadex (torsemide)
• Bumex (bumetanide)
• HydroDiuril (hydrochlorothiazide)
• Edecrin (ethacrynic acid)
• Zaroxolyn (metolazone)

Side Effects: To avoid potassium loss, eat potassium rich foods (citrus, bananas, raisins) and take your potassium supplement as prescribed. We will monitor your potassium level with blood work.

Other side effects include:

• Leg cramps
• Incontinence
• Dizziness/lightheadedness
• Gout
• Skin rash

Please call us if you gain two pounds in one day or more than five pounds in one week. We may tell you to increase your diuretics.

Potassium-sparing diuretics

Aldactone is a diuretic that will hold on to potassium. This drug has also been shown to improve survival in heart failure patients. Care must be taken to insure you monitor your potassium level closely. The most common side effect is painful enlargement of the breasts in men.

Digoxin/digitalis (Lanoxin) makes the heart pump stronger and more efficiently. Digoxin is usually well tolerated. Signs that there is too much digoxin in your body are:

• Nausea
• Loss of appetite
• Mental confusion
• Blurred or yellow–colored vision
• Palpitations or slow heart rate

Call your doctors if you experience any of these symptoms.

Anti-Platelet Agents

• Aspirin (ASA)
• Plavix (clopidogrel)

Anti-Platelet Agents make your blood less likely to clot. They prevent new heart attacks, strokes and leg blockages.

Side Effects: The most common side effects of anti-platelet agents are stomach bleeding, belly pain, and diarrhea. Report any side effects right away.

Anticoagulants

Coumadin is an oral blood thinner. Sometimes patients are given this drug to help prevent a stroke. All patients with heart failure and atrial fibrillation should be on Coumadin unless there is a specific reason to not use this drug.