- Heart Disease (Coronary Artery Disease) Slideshow Pictures
- Atrial Fibrillation Slideshow: Causes, Tests and Treatment
- Take the Heart Disease Quiz!
Congestive heart failure medications overview
Congestive heart failure is a chronic (ongoing) condition. Discuss all medications, herbs, supplements you are taking with your doctor. Listed are some of the medications used to treat congestive heart failure.
ACE inhibitors (angiotensin converting enzyme)
ACE inhibitors have been used for the treatment of hypertension for more than 20 years. This class of drugs has also been extensively studied in the treatment of congestive heart failure. These medications block the formation of angiotensin II, a hormone with many potentially adverse effects on the heart and circulation in patients with heart failure. In multiple studies of thousands of patients, these drugs have demonstrated a remarkable improvement of symptoms in patients, prevention of clinical deterioration, and prolongation of survival. In addition, they have been recently been shown to prevent the development of heart failure and heart attacks. The wealth of the evidence supporting the use of these agents in heart failure is so strong that ACE inhibitors should be considered in all patients with heart failure, especially those with heart muscle weakness.
Possible side effects of these drugs include:
- a nagging, dry cough,
- low blood pressure,
- worsening kidney function and electrolyte imbalances, and
- rarely, true allergic reactions.
When used carefully with proper monitoring, however, the majority of individuals with congestive heart failure tolerate these medications without significant problems. Examples of ACE inhibitors include:
- captopril (Capoten),
- enalapril (Vasotec),
- lisinopril (Zestril, Prinivil),
- benazepril (Lotensin), and
- ramipril (Altace).
For those individuals who are unable to tolerate the ACE inhibitors, an alternative group of drugs, called the angiotensin receptor blockers (ARBs), may be used. These drugs act on the same hormonal pathway as the ACE inhibitors, but instead block the action of angiotensin II at its receptor site directly. A small, early study of one of these agents suggested a greater survival benefit in elderly congestive heart failure patients as compared to an ACE inhibitor. However, a larger, follow-up study failed to demonstrate the superiority of the ARBs over the ACE inhibitors. Further studies are underway to explore the use of these agents in congestive heart failure both alone and in combination with the ACE inhibitors.
Possible side effects of these drugs are similar to those associated with the ACE inhibitors, although the dry cough is much less common. Examples of this class of medications include:
Certain hormones, such as epinephrine (adrenaline), norepinephrine, and other similar hormones, act on the beta receptor's of various body tissues and produce a stimulative effect. The effect of these hormones on the beta receptors of the heart is a more forceful contraction of the heart muscle. Beta-blockers are agents that block the action of these stimulating hormones on the beta receptors of the body's tissues. Since it was assumed that blocking the beta receptors further depressed the function of the heart, beta-blockers have traditionally not been used in persons with congestive heart failure. In congestive heart failure, however, the stimulating effect of these hormones, while initially useful in maintaining heart function, appears to have detrimental effects on the heart muscle over time.
However, studies have demonstrated an impressive clinical benefit of beta-blockers in improving heart function and survival in individuals with congestive heart failure who are already taking ACE inhibitors. It appears that the key to success in using beta-blockers in congestive heart failure is to start with a low dose and increase the dose very slowly. At first, patients may even feel a little worse and other medications may need to be adjusted.
Possible side effects include:
Beta-blockers should generally not be used in people with certain significant diseases of the airways (for example, asthma, emphysema) or very low resting heart rates. While carvedilol (Coreg) has been the most thoroughly studied drug in the setting of congestive heart failure, studies of other beta-blockers have also been promising. Research comparing carvedilol directly with other beta-blockers in the treatment of congestive heart failure is ongoing. Long acting metoprolol (Toprol XL) is also very effective in individuals with congestive heart failure.
Digoxin (Lanoxin) has been used in the treatment of congestive heart failure for hundreds of years. It is naturally produced by the foxglove flowering plant. Digoxin stimulates the heart muscle to contract more forcefully. It also has other actions, which are not completely understood, that improve congestive heart failure symptoms and can prevent further heart failure. However, a large-scale randomized study failed to demonstrate any effect of digoxin on mortality.
Digoxin is useful for many patients with significant congestive heart failure symptoms, even though long-term survival may not be affected. Potential side effects include:
These side effects, however, are generally a result of toxic levels in the blood and can be monitored by blood tests. The dose of digoxin may also need to be adjusted in patients with significant kidney impairment.
Diuretics are often an important component of the treatment of congestive heart failure to prevent or alleviate the symptoms of fluid retention. These drugs help keep fluid from building up in the lungs and other tissues by promoting the flow of fluid through the kidneys. Although they are effective in relieving symptoms such as shortness of breath and leg swelling, they have not been demonstrated to positively impact long-term survival.
Nevertheless, diuretics remain key in preventing deterioration of the patient's condition thereby requiring hospitalization. When hospitalization is required, diuretics are often administered intravenously because the ability to absorb oral diuretics may be impaired, when congestive heart failure is severe. Potential side effects of diuretics include:
- electrolyte abnormalities,
- particularly low potassium levels,
- hearing disturbances, and
- low blood pressure.
It is important to prevent low potassium levels by taking supplements, when appropriate. Such electrolyte disturbances may make patients susceptible to serious heart rhythm disturbances. Examples of various classes of diuretics include:
- furosemide (Lasix),
- hydrochlorothiazide (Hydrodiuril),
- bumetanide (Bumex),
- torsemide (Demadex),
- spironolactone (Aldactone), and
- metolazone (Zaroxolyn).
One particular diuretic has been demonstrated to have surprisingly favorable effects on survival in congestive heart failure patients with relatively advanced symptoms. Spironolactone (Aldactone) has been used for many years as a relatively weak diuretic in the treatment of various diseases. Among other things, this drug blocks the action of the hormone aldosterone.
Aldosterone has many theoretical detrimental effects on the heart and circulation in congestive heart failure. Its release is stimulated in part by angiotensin II (see ACE inhibitors, previously). In patients taking ACE inhibitors, however, there is an "escape" phenomenon in which aldosterone levels can increase despite low levels of angiotensin II. Medical researchers have found that spironolactone (Aldactone) can improve the survival rate of patients with congestive heart failure. In that the doses used in the study were relatively small, it has been theorized that the benefit of the drug was in its ability to block the effects of aldosterone rather than its relatively weak action as a diuretic (water pill). Possible side effects of this drug include elevated potassium levels and, in males, breast tissue growth (gynecomastia).
Latest Heart News
Daily Health News
There are a variety of medications to treat congestive heart failure. Most medicaiton regimines for patients with congestive heart failure are tailored to each patient. Examples of medicaitons prescribed for congestive heart failure include ACE inhibitors (for example, Altace, Capoten, Vasotec); beta blockers; digoxin (Lanoxin); and diuretics. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed before taking any medication.
Multimedia: Slideshows, Images & Quizzes
Heart Disease: Causes of a Heart Attack
Heart disease prevention includes controlling risk factors like diet, exercise, and stress. Heart disease symptoms in women may...
Heart Disease: Symptoms, Signs, and Causes
What is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest...
Am I Having a Heart Attack? Symptoms of Heart Disease
Heart attacks symptoms vary greatly for men and women, from anxiety and fatigue to nausea and sweating. Learn the warning signs...
Heart Healthy Diet: 25 Foods You Should Eat
What foods are heart healthy? Learn what foods help protect your cardiovascular system from heart attack, coronary heart disease,...
Lower Your Cholesterol, Save Your Heart
Need to lower your cholesterol levels? Use these smart diet tips to quickly and easily lower your blood cholesterol levels....
Heart Failure Quiz
What is heart failure? Learn about this dangerous condition, as well as who is at risk, and what to do about it.
Heart Disease Quiz: Test Your Medical IQ
Take our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes,...
High-Fiber Super Foods: Whole Grains, Fruits, & More
Learn about high-fiber foods. From fresh fruits to whole grains, these fiber-rich foods can lower cholesterol, prevent...
Picture of Heart Detail
The heart is composed of specialized cardiac muscle, and it is four-chambered, with a right atrium and ventricle, and an...
Picture of Heart Catheter
Catheter procedures are much easier than surgery on patients because they involve only a needle puncture in the skin where the...
Food Swaps for Meals and Snacks for Heart Health in Pictures
Explore 10 food swaps for heart-wise dining. Learn what food to buy and how to cook in order to make a big difference for your...
Related Disease Conditions
Congestive Heart Failure (CHF) Symptoms, Treatment, and Life Expectancy
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
How the Heart Works: Sides, Chambers, and Function
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include: Smoking High blood pressure High cholesterol Diabetes Family history Obesity Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
Stress and Heart Disease
The connection between stress and heart disease is not clear. Stress itself may be a risk factor, or high levels of stress may make risk factors for heart disease worse. The warning signs of stress can be physical, mental, emotional, or behavioral. Reducing stressors in an individuals life not only can lead to a more productive life, but may also decrease the risk for heart disease and causes of heart disease.
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
What Causes Congestive Heart Failure?
Congestive heart failure is a chronic disease that progresses with time if left untreated. Heart failure can occur due to diseases of the heart, the blood vessels supplying oxygen and nutrients to the heart, or sometimes from factors outside the heart (extracardiac causes). With proper management, people who have congestive heart failure can lead nearly normal lives, depending on the severity of the condition.
Smoking and Heart Disease
Smoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
Heart Disease Treatment in Women
Heart disease treatment in women should take into account female-specific guidelines that were developed by the American Heart Association. Risk factors and symptoms of heart disease in women differ from those in men. Treatment may include lifestyle modification (diet, exercise, weight management, smoking cessation, stress reduction), medications, percutaneous intervention procedure (PCI), and coronary artery bypass grafting (CABG). Heart disease is reversible with treatment.
Treatment & Diagnosis
Medications & Supplements
- ACE Inhibitors (Side Effects, List of Names, Uses, and Dosage)
- Beta Blockers (Drug Class, List of Brand and Generic Names)
- lisinopril (Zestril, Prinivil, Qbrelis) ACE Inhibitor
- furosemide (Lasix)
- Lipitor (atorvastatin) vs. Crestor (rosuvastatin)
- Aldactone (spironolactone)
- atenolol, Tenormin
- digoxin (Lanoxin, Lanoxin Pediatric)
- metoprolol (Lopressor, Toprol XL)
- carvedilol (Coreg)
- hydrochlorothiazide (Microzide, Hydrodiuril)
- captopril (Capoten)
- Digoxin vs. digitalis
- ramipril (Altace)
- enalapril (Vasotec, Epaned)
- benazepril (Lotensin HTC)
- bumetanide, Bumex (discontinued brand)
- perindopril - oral, Aceon
- nadolol (Corgard)
- metolazone (Zaroxolyn)
- trandolapril (Mavik)
- quinapril (Accupril)
- Sectral (acebutolol)
- Digoxin vs. amiodarone
- Lasix (furosemide) vs. Edecrin (ethacrynic acid)
- betaxolol, Kerlone (Discontinued Brand)
- ivabradine (Corlanor)
- moexipril - oral, Univasc
- Brilinta (ticagrelor)
- Entresto (sacubitril and valsartan)
Prevention & Wellness
- FDA OKs Farxiga for Heart Failure With Reduced Ejection Fraction
- Helping Seniors Manage Meds After Hospital Reduces Readmission: Study
- AHA News: Millions Are Learning to Live With Heart Failure
- Heart Medicines Priced Out of Reach for Many Americans
- Bedtime May Be Best Time for Blood Pressure Meds
- AHA News: Women With Heart Failure Less Likely to Get Heart Pump Device
- Implant Approved to Improve Symptoms in Advanced Heart Failure
- Many Heart Failure Patients Might Safely Reduce Use of Diuretics
- Heart Failure Patients Shouldn't Stop Meds Even if Condition Improves: Study
- NIH Halts Stem Cell Trial for Heart Failure Due to Concerns About Fake Data
- Label Mix-up Spurs Recall of Accord Blood Pressure Meds
- FDA Recalls Some Valsartan Drugs Due to Impurity
- Got Unused Meds? Here's What to Do
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Roger, Veronique L., et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. "Heart disease and stroke statistics -- 2011 update: a report from the American Heart Association." Circulation 123.4 (2011): e18-e209.
Ho, K. K., et al. "The epidemiology of heart failure: the Framingham Study." Journal of the American College of Cardiology 22.4 Suppl A (1993): 6A-13A.