Heart Failure Patient Self-Management Workbook
CHAPTER 4:
Treatment: Medication & surgery
Taking medications isn’t easy. As a matter of fact, almost half of all people take their medications wrong!
They either fail to take them completely, miss a dose, take a medication at the wrong time, take an incorrect dose, or fail to have a prescription filled.
One of the reasons people with heart failure have such difficulty is because they typically take four or more medications. Keeping track of several prescriptions can be hard for almost anyone.
It’s important to note why you must take your medications as directed. Here are a few of the main reasons:
- Taking the right medication at the right dose may prolong your life by preventing complications and slowing the progression of heart failure.
- Taken in proper doses, medications allow you to be more active by increasing your exercise ability. They also decrease symptoms. Forgetting medications is likely to cause weight gain and increased shortness of breath as well as other symptoms.
- Many studies have shown that by taking your medications as prescribed can prevent Emergency Room visits or hospitalizations.
DO YOU HAVE A PROBLEM TAKING YOUR MEDICATIONS PROPERLY?
Ask yourself the following questions:
- Do you ever forget to take your medications? Yes or No
- Are you ever careless about taking your medications? Yes or No
- When you feel better, do you sometimes stop taking your medicine? Yes or No
- Sometimes if you feel worse when taking your medicine, do you stop taking it? Yes or No
If you answered YES to any of these questions, then you and your family should consult your health care team to work out a medication plan. The first step should be to understand about the medications that have been prescribed for you and how they should be taken. Your physician and the pharmacist who fills the prescriptions are a good information resources.
Here some questions to ask about your medications:
- What is the name of the medicine? Is this the brand or generic name? Does it matter which one is used?
- What is the medicine supposed to do?
- How much (how many mgs?) do I take, and when should it be taken – and for how long?
- What should I do if I forget to take my medicine?
- What foods, drinks and other medicines should be avoided while taking this medicine?
- What are the possible side effects? What should be done if they occur?
- Is any written information available about the medicine?
- What is the expiration date?
The number of pills you take may seem overwhelming, especially at first. But doctors need to prescribe multiple medications for heart failure because each one treats a different symptom. Each medication also comes with its own instructions and rules. This can make it difficult to remember what to take, when and how often to take it.
For your convenience, we have provided a sample Medication Log for recording information about your medications. Click here to see the Medication Log and print copies.
QUICK REFERENCE MEDICATION TABLE
Click here for a list that includes some of the more common medications used to treat heart failure. For more complete information, consult your doctor or pharmacist.
DRUG INTERACTIONS AND SIDE EFFECTS
Like all medicines, heart failure medications can cause side effects and may not combine well with other drugs. Remember that people react to medications in different ways. Just because a drug can cause a particular side effect doesn’t mean that everyone will experience it.
AN OVERVIEW OF SIDE EFFECTS
When taking any kind of medication, you should report any unpleasant side effects to the doctor right away. You should also make the doctor aware of any other medications you are taking, whether prescription or
over-the-counter.Different heart failure medications can sometimes cause side effects. For example, vasodilators, which are drugs that lower blood pressure and reduce the heart’s work by expanding the blood vessels, can cause nausea, dizziness, headaches, and low blood pressure. Among these drugs are ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and nitrates.
Other drugs affect the hear t itself. Some of these medicines, such as digoxin, can cause irregular heartbeats and rapid breathing. Others, such as diuretics, which remove excess salt and water from the body, can also cause low blood pressure, kidney complications, and excessive loss of potassium and fluid.
The potential for side effects shouldn’t keep you from taking the medications you need. Talk to your doctor or pharmacist about potential side effects of each drug you are taking, and report any side effects you encounter to your doctor. You and your family can work with the doctor to see what can be done about side effects.
Sometimes the dosage can be adjusted, a medication can be taken at a different time, or a new medication can be substituted.
SOME DRUGS DON’T MIX
Potentially dangerous drug interactions can occur when different drugs mix together and work against each other. To avoid this problem, the doctor should be told about any other drugs that you are taking. These include prescription medicines as well as over-the-counter drugs like pain relievers or herbal medicines. Also, it’s a good idea to ask the doctor whether any of the prescribed heart failure drugs could cause problems when combined.
It’s important to realize that some non-prescription/over-the-counter medications could make heart failure worse. For instance, cough and cold remedies may elevate blood pressure and increase the heart’s workload. Anti-inflammatory agents, such as aspirin, ibuprofen, and naproxen can make the body retain sodium and water, and can decrease kidney function. Other non-prescription/over-the-counter medications might contain anti-inflammatory substances as well.
That’s why it’s so important for you to keep your doctor fully informed about anything you’re taking.
Ask your pharmacist about any new non-prescription medicine. Remember to list herbal and dietary supplements, including vitamins, on your Medication Log.
HELPFUL INFORMATION ON TAKING YOUR MEDICATION
- Use a weekly pillbox – a box with seven separate compartments for the days of the week. Sometimes the boxes also have slots for four different times of day: morning, noon, late afternoon, and bedtime.
- Take medications at the same time of day so it
becomes a routine.- Link taking medicines with a particular activity, such as tooth brushing. This will help you remember that it’s time to take your pills.
- If a medication is causing unpleasant side effects, work with your health care team to figure out how you might eliminate or minimize them. Sometimes the dosage can be adjusted, a medication can be taken at a different time, or a new medication can be substituted.
- To avoid potentially dangerous drug interactions, tell your doctor about any other medications you are taking, even over-the-counter drugs like pain relievers, herbal medicines, or vitamins.
- If your doctor prescribes more than one heart failure drug, ask whether combining them could cause any problems.
- Take doses exactly as prescribed and be sure to refill prescriptions on time.
- If you are taking a diuretic (water pill), ask your doctor if you can time it so you’re less likely to urinate at night. You’ll get a better night’s sleep.
- When taking diuretics, ask your doctor if you need to take a potassium supplement or if just eating high-potassium foods is adequate.
- Medications are typically available in brand name and generic forms, and some insurance plans will only pay for the generic unless the doctor indicates otherwise. Ask your doctor whether you need a specific brand of drug or can take the generic form.
- Keep a written record of when you take your medication and bring it with you to doctor appointments. Use the Medication Log.
- If you find it too hard to keep track of your medications and when they need to be taken, ask if there is a way to simplify your medication schedule.
SURGERY AND OTHER MEDICAL PROCEDURES
Surgery isn’t often used to treat heart failure. However, it is recommended when the doctor can identify a correctable problem that is causing heart failure – such as a defect or a blocked coronary artery. Surgery also may be in order when the heart failure is so severe that it can’t be helped with medications or dietary and lifestyle changes.
HOW TO FIND A SURGEON
There are several ways to find a skilled surgeon. In most cases, you can ask your doctor for the names of
surgeons they recommend.You can also visit our Web site and use the “Find a Physician” tool to locate surgeons in your community.
Once you have selected a qualified surgeon, you will want to talk with the doctor to find out how much experience they have with the procedure you require and whether you are comfortable with their style. You might also call the surgeons’ hospitals to ask how often they’ve performed the particular operation. Additionally, you can call the state medical board to find out if they have ever faced malpractice charges.
Schedule an in-person meeting so you can get a better sense of each surgeon’s attitude. Is he or she frank and honest with you?
Whether it is you or your loved one who is having the surgery, you need all the facts explained clearly.
Look for a surgeon who will educate you about your condition and treatment options, as well as the proposed surgical procedure and necessary follow-up.WHAT SURGICAL AND OTHER MEDICAL PROCEDURES MIGHT BE USED?
Valve Replacement
Heart failure is sometimes the fault of a defective or
diseased heart valve. Heart valves regulate the flow of blood inside the heart. When they don’t work properly, this puts extra strain on the heart and can lead to hear t failure.Correcting the problem surgically can often improve or resolve the condition.
A variety of different replacement valves can be used: a mechanical valve made from metal and plastic, one made from human tissue, or one taken from a donor. During the surgery, the patient is connected to a heart-lung machine that supplies blood to the brain and body. The bad valve is removed and replaced.
After the operation, patients usually take medicines to
prevent blood clots from forming around the new heart valve.This treatment is often long-term to ensure the new valve works properly. Most heart valve surgeries are a success, but the operation is only considered as an option when a defective or diseased valve threatens someone’s life.
Angioplasty
Heart failure is sometimes caused by an undersupply of blood to the heart muscle, due to blockages in the coronary ar teries. Removing these blockages can improve overall heart function, which may improve or resolve heart failure symptoms. Angioplasty is used to reopen blocked vessels.
Surgeons insert a hollow catheter into the diseased artery and push a small deflated balloon into the blocked section. Then they inflate the balloon to widen the artery.
The balloon is removed once the artery has been fully opened. Although there is a slight risk of damage to the artery during angioplasty, it usually improves the person’s condition.
Coronary Artery Bypass
While angioplasty reopens blocked vessels, a coronary artery bypass reroutes the blood supply around a blocked section of the artery. During this procedure, surgeons remove healthy blood vessels from another part of the body, such as the leg or chest wall. They then surgically attach them to the diseased arter y in such a way that the blood can flow around the blocked section.
After a bypass operation, it’s especially important for people to watch their diets and reduce the amount of fat and cholesterol they eat, since these cause the arteries to clog. Doctors also recommend following a routine of increased physical activity to build up strength in the heart muscles.
Defibrillator Implantation
Some people who have severe heart failure or serious arrhythmia (irregular heartbeat) are candidates for implantable defibrillators. These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when an abnormal rhythm is detected.
Heart Transplant
Some people have severe, progressive heart failure that can’t be helped by medications and dietary and lifestyle changes. In such cases a heart transplant may be the only effective treatment option.
Surgeons replace the damaged heart with a healthy one taken from a donor who has been declared brain dead. It can take months or even years to find a donor heart that closely matches the tissues of the person receiving the transplant. But this matching process increases the likelihood that the recipient’s body will accept the heart. In some cases, surgeons will implant a left-ventricular assist device to help the heart function during this waiting period. This mechanical pump aids the pumping action of the left ventricle (lower left chamber).
During a transplant procedure, the surgeon connects the patient to a heart-lung machine, which takes over the functions of the hear t and lungs. The surgeon then removes the diseased heart and replaces it with the donor heart. Finally, the major blood vessels are reconnected and the new heart is ready to work.
The outlook for people with heart transplants is good during the first few years after the transplant. In fact, more than 80 percent of patients survive for more than a year after their operations. However, the number of patients who receive heart transplants is still relatively low, around 2,500 each year.
Left Ventricular Assist Device (LVAD)
The left ventricular assist device (LVAD) is a mechanical pump-type device that is surgically implanted. It helps
maintain the pumping ability of a heart that is unable to effectively function on its own. This device is sometimes referred to as a “bridge to transplant.”People awaiting a heart transplant often have to wait for a long time before a suitable heart becomes available. During this wait, the patient’s already weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can assist the weakened heart and “buy time” for the patient.
One typical type of LVAD will have a tube going into the left ventricle that pulls blood from the ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle).
This effectively “bypasses” the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the wall of the abdomen to the outside of the body and attached to the control system for the pump. LVADs are typically used for weeks to months.