How the doctor treats your CHF exacerbation depends on how severe it is. You may have to visit your doctor’s office or go to an outpatient clinic, or it may even re-quire you to be admitted to the hospital for treatment.
Initially, the head of the patient’s bed should be elevated. This reduces the amount of blood returning to the heart and makes it easier for the heart to pump. Patients may be most comfortable in a sitting position with their legs dangling over the side of the bed. The patient should eliminate any factors that may have contributed to the exacerbation when possible, such as resting if they’ve been too active or taking medication they may have forgotten to take. They should restrict fluid and salt.
The doctor should treat low blood cell counts (also known as anemia) as well as low thyroid hormone levels (called hypothyroidism) if they are present.
Doctors usually use a combination of medications when treating CHF exacerbations. Therapy generally starts with nitrates and diuretics if the patient’s blood pressure and pulse are stable. The following are some of the medications that may be used during an acute ex-acerbation of CHF.
- Diuretics or “water pills” such as furosemide and hydrochlorothiazide help your kidneys to get rid of excess salt and water. They can be given by mouth or intravenously and work quickly.
- Vasodilators are a class of medications that include nitroglycerin. As their name implies, they dilate the blood vessels and decrease the pressure on your heart, making it easier to pump blood.
- Inotropes are medications that increase the contractility of the heart and make it pump more effectively. This class of drugs includes the drug dobutamine.
- Natriuretic peptides.Nesiritide (brand name Natrecor) is a new drug for the treatment of CHF. In fact, it has emerged as one of the first new treatments for acute CHF in more than a decade. The body produces these proteins that appear to have an effect on easing the heart’s workload when it’s un-able to pump blood efficiently. The new natriuretic peptide–based treatments are alternatives to inotropes and vasodilators.
- Oxygen In order to increase the amount of oxygen in your blood, the doctor may provide a higher concentration of oxygen in the air you breathe. Oxygen can be delivered by nasal prongs or by a face mask. The added oxygen may help reduce shortness of breath and make your heart beat more effectively.
If you are having severe difficulty breathing on your own and are not responding to medication, your lungs may need help in getting oxygen in the blood. Some ways of increasing the level of oxygen in your blood include using continuous positive airway pressure, endotracheal intubation, and a mechanical ventilator.