Recommended Treatment By Stage of Heart Failure
The treatment for heart failure will depend on how much your symptoms affect your level of physical activity. Heart failure is identified by stages ranging from Stage A–no symptoms and no limitations on physical activity, to Stage D–symptoms are present even at rest and physical activity causes discomfort.
(no limitation of physical activity, no symptoms)
ACE-inhibitors, beta-blockers, blood pressure medication, healthier lifestyle habits: reduce smoking and alcohol, eat right, and exercise.
(slight limitation of physical activity, no symptoms)
All of the above plus diuretics, restricting fluids and salt, a biventricular CRT device.
(noticeable limitation of physical activity, displays symptoms)
All of the above plus discussion of heart transplant, surgery, clinical trials, or hospice/palliative care.
(physical activity with discomfort, displays symptoms even at rest)
- ACE-inhibitors – An Angiotensin Converting Enzyme (ACE) inhibitor helps to dilate blood vessels to increase the amount of blood your heart can pump. It also works to stop the production of angiotensin II, which can build up in your vessels, block blood flow, and increase blood pressure.
- Beta-blockers – Beta-blockers decrease the heart’s need for blood and oxygen by slowing the heart down. They also help the heart beat in a regular rhythm.
- Diuretics – Diuretics can be prescribed to reduce swelling and fluid build up.
CARDIAC RESYNCHRONIZATION THERAPY
CRT defibrillator (CRT-D) – Most congestive heart failure patients have fast heart rhythms that put them at risk of dying from sudden cardiac death. CRT systems with an integrated defibrillator (CRT-D) synchronize the heartbeat and can also deliver electrical shocks to prevent life-threatening ventricular fibrillation.
Patients with devices have historically been considered ineligible for Magnetic Resonance Imaging (MRI). Beginning in 2011, the US Food and Drug Administration (FDA) has approved pacemaker and ICD technology that can be used safely during MRI. Today there are CRT devices available that are MR conditional.
WHAT HAPPENS IN CRT DEVICE SURGERY?
The implantation of a CRT-P or CRT-D system is the same as for a pacemaker or defibrillator (ICD).
- The CRT device is inserted through a small incision on the left side of the body. The physician pushes three thin, insulated cables (leads) from the collarbone (clavicle) to the heart through a punctured vein. The leads are positioned in the heart using an X-ray screen. The physician pushes the leads through a vein and into the right atrium and the right chamber (ventricle). Another lead is inserted into the coronary vein to stimulate the left chamber.
- When the leads are correctly placed, the physician connects them to the CRT device, tests them and adjusts the settings.
- Then the physician puts the implanted device in a pocket in the pectoral muscle below the collarbone and closes it with a few stitches.