COPD & Emphysema Support Group
COPD is a progressive disease characterized by airflow obstruction or limitation. Emphysema is characterized by loss of elasticity of the lung tissue, destruction of structures supporting the alveoli and of capillaries feeding the alveoli. Both have symptoms that include shortness of breath, among other respiratory troubles. If you are a COPD or Emphysema sufferer, join...
How Congestive Heart Failure Works
Treatment of CHF
The goal of treatment in CHF is to control the symptoms and treat the underlying cause as well as the precipitating cause. Before prescribing medications, your physician may want you to lose weight and stop smoking. These measures may reduce the workload on the heart as well as control some of the causes of CHF (high blood pressure, coronary artery disease). In addition, reducing the intake of salt and water can improve symptoms and may reduce the need of some medications. Exercise may be helpful to improve overall fitness. However, when CHF is severe, bed rest may be required.
Medications
Diuretics (water pills) are medications used to increase the amount of sodium (Na+) and water excreted by the kidneys. This reduces the blood volume and the amount of blood that the heart has to pump, thereby reducing its workload. The goal is to maintain ideal weight by eliminating edema. Diuretics include:
hydrochlorothiazide
chlorothalidone
metalazone (Zaroxolyn)
furosemide (Lasix)
bumetanide (Bumex)
trimeratene
spironolactone
A major side effect is a low potassium (K+) level, which can cause muscle cramping and abnormal heart rhythms. Potassium supplements or potassium-sparing diuretics can be used either alone or in combination with other diuretics.
Vasodilators are groups of medications that dilate or enlarge blood vessels. During CHF, the blood vessels are often constricted due to the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system. When vasodilators are used, they decrease the resistance and blood pressure against which the heart must beat, thus increasing the cardiac output. Angiotensin converting enzyme inhibitors (ACE inhibitors) are very effective vasodilators. This is one of the few medications that have actually been shown to prolong life in CHF patients. ACE inhibitors reduce blood pressure and fluid retention by preventing the renin-angiotensin-aldosterone system from working. ACE inhibitors include:
captopril (Capoten)
enalapril (Vasotec)
lisinopril (Zestril, Prinivil)
benazepril (Lotensin)
fosinopril (Monopril)
quinapril (Accupril)
Side effects include cough and occasionally a rash.
Angiotensin receptor blockers block the effects of angiotensin instead of blocking its production. Angiotensin receptor blockers include:
losartan (Cozaar)
irbesartan (Avapro)
valsartan (Diovan)
These medications do not cause the side effect of cough produced by ACE inhibitors.
Nitroglycerin dilates veins and can be taken under the tongue (Nitrostat), intravenously, by mouth (Isosordil, Sorbitrate, ISMO), or by skin patches (Nitro-Dur, Transderm-Nitro).
Calcium channel blockers dilate blood vessels and are sometimes used to treat CHF, especially when ischemia is present. These drugs also tend to decrease the force of the heart's contraction, however, and so can worsen CHF. Calcium channel blockers include:
nifedipine (Procardia XL, Adalat CC)
diltiazem (Cardizem)
verapamil (Calan, Isoptin)
amlodipine (Norvasc)
felodipine (Plendil)
nisoldipine (Sular)
Side effects include low blood pressure, headache, edema, and constipation.
Hydralazine is a vasodilator that acts on arteries. It is used less frequently since ACE inhibitors have been found to be more effective.
Alpha blockers block the alpha-adrenergic receptors of the sympathetic nervous system, thereby dilating blood vessels. Alpha blockers include prazocin (Minipress) and doxazosin (Cardura). Side effects include rapid heartbeat and low blood pressure.
Digitalis medications (digoxin, Lanoxin) increase the force of contraction of the heart muscle and also control abnormal heart rhythms, especially atrial fibrillation and atrial flutter. Therefore, digitalis is most useful when someone with atrial fibrillation or atrial flutter has CHF (a fairly common scenario). It improves heart function without increasing mortality. It has many side effects, including nausea, vomiting, many types of abnormal heart rhythms, confusion and negative interactions with other medications.
Beta blockers have been found to be useful for CHF. By blocking the beta-adrenergic receptors of the sympathetic nervous system, the heart rate and force of contraction are decreased. Of course, this must be done carefully because decreasing these two things can actually worsen CHF. Beta blockers include:
metoprolol (Lopressor, Toprol-XL)
atenolol (Tenormin)
carvedilol (Coreg)
Sympathomimetic medications act similarly to the sympathetic nervous system and are used when CHF is severe, such as in cardiogenic shock. They treat CHF by increasing the force of the heart's contraction. Sympathomimetic drugs include dopamine (Inotropin) and dobutamine (Dobutrex). Because they must be taken intravenously and are extremely strong, these medications are used mainly when CHF has become life threatening. They can cause abnormal heart rhythms and ischemia.
Occasionally, there are circumstances when surgery can treat CHF. The most common surgical procedures are:
Heart valve replacement When a heart valve malfunctions, valve replacement can reverse the symptoms. In some cases, this can be a life-saving procedure.
Congenital heart defect correction Surgical repair of congenital heart defects is frequently used to restore normal functioning as much as possible.
Coronary artery bypass If Coronary artery disease (CAD) is the cause of CHF, then correcting the CAD with coronary artery bypass grafts can be useful.
Heart transplant When CHF persists and worsens despite maximum therapy, then a heart transplant can be an option. Patients considered for transplants usually suffer from severe symptoms (Class 4 on the New York Heart Association's scale), have ejection fractions of 15 to 20 percent and have one year survival rates of 50 percent. The improvement in anti-rejection drugs (especially cyclosporine) have increased survival from this procedure. There are also some devices that assist the severely failed heart, such as an intra-aortic balloon pump and a left ventricular assist device. These are used as bridges to keep a person alive until a donor heart can be found.
I dont have high blood pressure, I never have but I take Lisinopril daily because it helps my heart and blood vessels work better, which makes me better.
You can read a lot more about CHF and how your heart works by going here.
http://health.howstuffworks.com/diseases-conditions/cardiovascular/heart/congestive-heart.htm
I hope this helps someone,
Love to all here,
Holly
Treatment of CHF
The goal of treatment in CHF is to control the symptoms and treat the underlying cause as well as the precipitating cause. Before prescribing medications, your physician may want you to lose weight and stop smoking. These measures may reduce the workload on the heart as well as control some of the causes of CHF (high blood pressure, coronary artery disease). In addition, reducing the intake of salt and water can improve symptoms and may reduce the need of some medications. Exercise may be helpful to improve overall fitness. However, when CHF is severe, bed rest may be required.
Medications
Diuretics (water pills) are medications used to increase the amount of sodium (Na+) and water excreted by the kidneys. This reduces the blood volume and the amount of blood that the heart has to pump, thereby reducing its workload. The goal is to maintain ideal weight by eliminating edema. Diuretics include:
hydrochlorothiazide
chlorothalidone
metalazone (Zaroxolyn)
furosemide (Lasix)
bumetanide (Bumex)
trimeratene
spironolactone
A major side effect is a low potassium (K+) level, which can cause muscle cramping and abnormal heart rhythms. Potassium supplements or potassium-sparing diuretics can be used either alone or in combination with other diuretics.
Vasodilators are groups of medications that dilate or enlarge blood vessels. During CHF, the blood vessels are often constricted due to the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system. When vasodilators are used, they decrease the resistance and blood pressure against which the heart must beat, thus increasing the cardiac output. Angiotensin converting enzyme inhibitors (ACE inhibitors) are very effective vasodilators. This is one of the few medications that have actually been shown to prolong life in CHF patients. ACE inhibitors reduce blood pressure and fluid retention by preventing the renin-angiotensin-aldosterone system from working. ACE inhibitors include:
captopril (Capoten)
enalapril (Vasotec)
lisinopril (Zestril, Prinivil)
benazepril (Lotensin)
fosinopril (Monopril)
quinapril (Accupril)
Side effects include cough and occasionally a rash.
Angiotensin receptor blockers block the effects of angiotensin instead of blocking its production. Angiotensin receptor blockers include:
losartan (Cozaar)
irbesartan (Avapro)
valsartan (Diovan)
These medications do not cause the side effect of cough produced by ACE inhibitors.
Nitroglycerin dilates veins and can be taken under the tongue (Nitrostat), intravenously, by mouth (Isosordil, Sorbitrate, ISMO), or by skin patches (Nitro-Dur, Transderm-Nitro).
Calcium channel blockers dilate blood vessels and are sometimes used to treat CHF, especially when ischemia is present. These drugs also tend to decrease the force of the heart's contraction, however, and so can worsen CHF. Calcium channel blockers include:
nifedipine (Procardia XL, Adalat CC)
diltiazem (Cardizem)
verapamil (Calan, Isoptin)
amlodipine (Norvasc)
felodipine (Plendil)
nisoldipine (Sular)
Side effects include low blood pressure, headache, edema, and constipation.
Hydralazine is a vasodilator that acts on arteries. It is used less frequently since ACE inhibitors have been found to be more effective.
Alpha blockers block the alpha-adrenergic receptors of the sympathetic nervous system, thereby dilating blood vessels. Alpha blockers include prazocin (Minipress) and doxazosin (Cardura). Side effects include rapid heartbeat and low blood pressure.
Digitalis medications (digoxin, Lanoxin) increase the force of contraction of the heart muscle and also control abnormal heart rhythms, especially atrial fibrillation and atrial flutter. Therefore, digitalis is most useful when someone with atrial fibrillation or atrial flutter has CHF (a fairly common scenario). It improves heart function without increasing mortality. It has many side effects, including nausea, vomiting, many types of abnormal heart rhythms, confusion and negative interactions with other medications.
Beta blockers have been found to be useful for CHF. By blocking the beta-adrenergic receptors of the sympathetic nervous system, the heart rate and force of contraction are decreased. Of course, this must be done carefully because decreasing these two things can actually worsen CHF. Beta blockers include:
metoprolol (Lopressor, Toprol-XL)
atenolol (Tenormin)
carvedilol (Coreg)
Sympathomimetic medications act similarly to the sympathetic nervous system and are used when CHF is severe, such as in cardiogenic shock. They treat CHF by increasing the force of the heart's contraction. Sympathomimetic drugs include dopamine (Inotropin) and dobutamine (Dobutrex). Because they must be taken intravenously and are extremely strong, these medications are used mainly when CHF has become life threatening. They can cause abnormal heart rhythms and ischemia.
Occasionally, there are circumstances when surgery can treat CHF. The most common surgical procedures are:
Heart valve replacement When a heart valve malfunctions, valve replacement can reverse the symptoms. In some cases, this can be a life-saving procedure.
Congenital heart defect correction Surgical repair of congenital heart defects is frequently used to restore normal functioning as much as possible.
Coronary artery bypass If Coronary artery disease (CAD) is the cause of CHF, then correcting the CAD with coronary artery bypass grafts can be useful.
Heart transplant When CHF persists and worsens despite maximum therapy, then a heart transplant can be an option. Patients considered for transplants usually suffer from severe symptoms (Class 4 on the New York Heart Association's scale), have ejection fractions of 15 to 20 percent and have one year survival rates of 50 percent. The improvement in anti-rejection drugs (especially cyclosporine) have increased survival from this procedure. There are also some devices that assist the severely failed heart, such as an intra-aortic balloon pump and a left ventricular assist device. These are used as bridges to keep a person alive until a donor heart can be found.
I dont have high blood pressure, I never have but I take Lisinopril daily because it helps my heart and blood vessels work better, which makes me better.
You can read a lot more about CHF and how your heart works by going here.
http://health.howstuffworks.com/diseases-conditions/cardiovascular/heart/congestive-heart.htm
I hope this helps someone,
Love to all here,
Holly
Heart problems go hand in hand with lung issues so this is a good read for all.
Best,
Joni
The article helped me understand more about how my condition has
changed; as I am now told I have restricted blood vessels.
ouch I know now never get one of those shots in the arm. O M G
What do you take..heck if I know what or which or anything about those blockers.
All I know is the doctor heart one I see friday. and see what she thinks about not taking statins.
Holly, since Lisinopril is by RX only, your doctor must have prescribed it and my question is why? Are Ace Inhibitors often used as a preventive type medication for COPD? Is it a common procedure?
Sorry to be so inquisitive but it is just an interesting thought. I am familiar with the drug because it is one of the ones my husband takes post heart attack and stent placement a few years ago.
Also, my granddaughter that has been diagnosed with POTS takes an ace inhibitor. This has just opened up a lot of questions for me.
Thanks again,
My Nephrologist put me on Lisinopril two years ago.
She told me that studies show that Lisinopril strengthens the heart muscle, even when you dont have high blood pressure.
So she gives it to me as a preventive measure, a precursor to CHF.
Protecting my heart also protects my kidneys she told me.
Both my family doctor and my Pulmonologist agree with Nephrologist.
My blood pressure runs low, it always has so as long as I dont get dizzy I will continue to take the Lisinopril.
I hope this helps answer your question.
That answers some of my question and I do appreciate the information very much.
Have a great day,
Anna
I might also add that I do not have diabetes.
However other benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys glomeruli.
ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.
So this medication does lots of good things beyond blood pressure control.
Hope this also helps,
Have a very nice Easy Breathing Evening,
Always, Holly
Then, Pulmonary Doctor says I have Emphy; CHF; and PAD.
I know all of these are (or can be related) diseases due to my lung
disease. Yes, it weakens the heart. Yes, it can contribute to CHF.
Yes, I did not know, but apparently contributes to PAD.
Thing is------my oximeter shows me repeatedly that I do have POTS. I do not have to exert to go into tachycardia; just standing
causes it. That is why the "original" cardiologist told me I have POTS. None of my current doctors say I have POTS. I am not a doctor; but just standing causes my tachycardia. So, what am I to think and who am I to trust. I am not sure if I am on the right medication. I have lost 40 pounds, and no improvement in my
heart condition--------as the second cardiologist said nothing wrong with me but that I am obese and out of shape. CONFUSED??????
This information has been a tremendous help to me today,
Sally, I am surprised that you picked up on the POTS. It is not a common diagnosis. There seems that there are very few specialists that know how to treat it. at least sucessfully. She just passes out for no reason and stays that way until there is intervention, such as a someone shaking or speaking to her. She has had all of the heart tests except the cath. Was your POTS diagnoses confirmed when they put you on the tilt table?
The experts that we have talked to(and there have been many) say that the tilt table is the final confirmation of POTS.
Hope all have a good evening.
Anna
Well the second time he went to a different heart doctor they didn't see the same thing in his Nurular stress tests.
So I wonder about that why it shows one time and told he has to wait until he pass out several times. But he hasn't just gets dizzy every once in awhile.
His doctors don't know why?
Since his last stress tests show nothing he is using that results.
But he is kept on Lisinopril for high blood pressure just the same.
Thank you for the arthical just the same about heart failer. Holly.
Learning as much as possible is important for our health.
I had an MI once without knowing I had one, I had another MI that time I had a stint put in the LAD...the widow maker area.
I had lots of angian still.
I don't know if I have heart failer but I do have the other thing blockages in viens.
I have to take first blood thinners now I don't have too I use low doz asprin. I take my other pill for high blood pressure....and Protonics for stomac
But I am not that bad at all...I think I am doing good.
I think Sally is so much more scary with her heart and lung history!!!
Thanks for all of your helpful posts. I would like to print it out, but when I try to print it out, I get all of the posts that are in the group. Does anyone know how I can print just the post?
Thanks for your help.
Jean
It is a really good article.
Anna
I did not know till now that the heart was so involved with lung problems. I am learning new things as I go along. I'm sure I will be referred to a cardiologist soon. Thank you Holly for posting this very informative post. ;)
Linda
After I posted my last post about CHF I took off my oxy and walked slowly outside to set two water sprinklers on the lawn. When I came back in I piddled around here in the kitchen. I did put my oxy. back on. I was pretty SOB at that time. In a few minutes I had some pains hit me in my chest. Sort of in the middle at first. Scared I sat down on the couch to try and monitor the pains. The pain then moved to my left chest area. I sat there and decided to do the pursed lip breathing. I was not in a panic. Just shocked! I sat there for about 30 minutes before they began to subside. I then went and lie down on the bed for a while. I dozed for a while but I stayed there for about an hour and a half. I had my oxy. on all this time. I seem to be fine now.
But my question is did just that few minutes w/o the oxygen out in my yard cause this to happen to me?? Did it make my heart have to work harder for just those few minutes? I'll admit it scared me half to death but I did not let myself panic. My husband asked me if it was indigestion and I told him no. I've had indigestion many times and this was completely different. It happened before I had had anything to eat.
Linda