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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for congestive heart failure

Hello, I was diagnosed with Congestive Heart Failure, I've noticed during the day I'm fine I walk and breath really good, but throughout the day my breathing and walking is a little bad. I'm on Tracleer, water pills and Digoxin and I try to watch my diet, but I'm not sure what else too do.
Wed, 13 Apr 2016
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Critical Care Specialist 's  Response
Hi, there are several treatments to control congestive heart failure (CHF), but it is necessary to know the cause of cardiac dysfunction so that we can direct treatment. The answer for your question is not easy, but I'll try to help you.

First, we need unterstand what means a congestive heart failure: It is the loss of contractile function of the heart and it causes loss of the heart ability to pump the blood forward, so liquids become accumulated in various parts of the body, especially the lungs, liver and legs.

Second, we need to know the causes for CHF and direction therapy:
1- Ischemic Cardiomyopathy: Occurs by loss of contractile function after one or more myocardial infarctions. The greater the area affected by the heart attack, the greater the loss of contractile function and the greater the complications. When the coronary anatomy is favorable for angioplasty or coronary artery bypass surgery and there is viability of the heart muscle must be corrected ischemia, controlling and sometimes partially reversing the CHF.
2 - Valvular Cardiomyopathy: This occurs when one or more of the four heart valves is destroyed or loses the opening and closing function. These defects ends up hindering the pumping function of the heart. In this case, if there is clinical conditions, we can replace one or more of damaged valves. This process is done by a heart surgery for replacement or repair of these valves.
3- Cardiomyopathy secondary to infectious diseases occurs by destruction of the heart muscle infections caused by certain types of viruses or even by protozoa such as those that cause Chagas disease (very common in some areas of South America and Africa). For each of these conditions, there is a specific treatment and it is not be discussed here in this forum.
4- Cardiomyopathy secondary to antineoplastic drugs: It occurs after the use of some types of medications for treating cancer. For this condition, there is a specific treatment and it is not be discussed here in this forum.
5- Idiopathic cardiomyopathy: We found no factors that have lead to the loss of contractile function of the heart. In this case, there is no specific treatment, only general treatment.

The general actions that all patients with CHF should do are the following:
- Make exercise supervised by a specialized team in cardioplumonar rehabilitation.
- Making rigorous use of various medications to improve contractile performance of the heart muscle, such as beta-blockers, angiotensin converting enzyme inhibitors Angiotensin ...
- Avoid the intake of excessive amounts of liquid and salt. In general, everyone should not take more than 1500ml of fluid per day and no more than 2g of salt per day.

There are a few exception of treatments such as the use of some types of pacemaker ressincronizam that the walls of the cardiac muscle, contractile improving performace. The cardiac transplantation or using a artifical heart is only indicated in extreme cases, when none of the above treatments are possible or effective, associated with significant worsening of cardiac function. These are the least common treatment used.

For all these reasons, there is no simple answer to your case. So I suggest you have a thorough discussion with your cardiologist so that they can together optimize their treatment.

Hope I have answered your question. If you have any further questions I will be happy to help you. Wish you good health.
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