New York Heart Association Classification Scale on Heart Failure

Drugs for heart failure

Drugs to relive symptoms:

Diuretics, Nitrates, Digoxin

Drugs the helps to improve survival:

Angiotensin converting enzyme inhibitors, Beta blockers, Aldosteron antagonist, Angiotensin II receptor blockers, Angiotensin receptor inhibitors, Sodium glucose co-transporter 2 inhibitors, sinus node inhibitors.

The type of drug used depends on the type of heart failure. In systolic heart failure all the drug classes are helpful. In diastolic heart failure only ACE inhibitors, ARBs, Aldosterone antagonists and beta-blockers are typically used.

The following surgeries and devises may be required for some patients with heart failure

Heart bypass surgery

Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart. The patient will be given general anesthesia. Once the patient is unconscious the heart surgeon will make an 8 to 10-inch (20.5 to 25.5 cm) surgical cut in the middle of your chest. Your breastbone will be separated to create an opening. This allows your surgeon to see your heart and aorta, the main blood vessel leading from the heart to the rest of your body.

Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart and lungs while your heart is stopped for the surgery. The machine adds oxygen to your blood, moves blood through your body, and removes carbon dioxide.

Heart Valve Surgery

Heart valve surgery is used to repair or replace diseased heart valves. Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must also flow through a heart valve.

There are 4 valves in your heart:

• Aortic valve
• Mitral valve
• Tricuspid valve
• Pulmonic valve

Aortic valve and mitral valve are the most common valves to be repaired. Rarely, tricuspid and pulmonic valves are replaced or repaired.

Before surgery, you will receive general anesthesia.

In open-heart surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. You are connected to a heart-lung bypass machine if your heart is stopped while connected to this machine. This machine does the work of your heart, providing oxygen and removing carbon dioxide.

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin.

Several Different Techniques Are Used

• Percutaneous surgery
• Robot surgery

Heart Pacemaker

A pacemaker is a small, battery-operated device. This device senses when your heart is beating irregularly or too slowly.

Pacemakers weigh as little as 1 ounce (28 grams). Most pacemakers have 2 parts:

• The generator:Contains the battery and the information to control the heartbeat.
• The leads:Wires that connect the heart to the generator and carry the electrical messages to the heart.

A pacemaker is implanted under the skin. This procedure takes about 1 hour in most cases.

You will be awake during the procedure.

A small incision is made on the left side of the chest below your collarbone. A pacemaker generator is then placed under the skin at this location.

Using live X-ray guidance, the doctor places the leads through the cuts into the veins and then into the heart. These leads are connected to the generator.

Types of Pacemakers

• Transcutaneous pacemaker
• Transvenous pacemaker

When your heart beats too slowly, your body and brain may not get enough oxygen.

Symptoms May Include

• Light headedness
• Tiredness
• Fainting spells
• Shortness of breath

Implantable Cardioverter-Defibrillator

An ICD is a device that detects any life-threatening rapid heartbeat. If an arrhythmia occurs, the ICD quickly sends an electrical shock to the heart. The shock changes the rhythm back to normal. This is called defibrillation.

The ICD is made of 3 parts:

• The pulse generator contains the battery and electrical circuit that reads the electrical activity of your heart.
• Your ICD has 1, 2, or 3 electrodes. Most ICDs have a built-in pacemaker.
• There is a special kind of ICD called a subcutaneous ICD. This device has a lead that is placed in the tissue to the left of the breastbone rather than in the heart. This type of ICD cannot also be a pacemaker.

The surgeon places the electrode into a vein and then into your heart. This is done using a special X-ray to see inside your chest.

The surgeon then connects the electrodes to the pulse generator and pacemaker. This procedure usually takes 2 to 3 hours.

Why the Procedure Is Performed

• Episodes of abnormal heart rhythms
• Congenital heart problems or genetic health conditions

Ventricular Assist Device

Ventricular assist devices (VADs) help your heart pump blood from one of the main pumping chambers to the rest of your body or to the other side of the heart. These pumps are implanted in your body. In most cases, they are connected to machinery outside your body.

A ventricular assist device has 3 parts:

• Pump:The pump weighs 1 to 2 pounds (0.5 to 1 kilogram). It is placed inside or outside of your belly.
• An electronic controller:The controller is like a small computer that controls how the pump works.
• Batteries or another power source:The batteries are carried outside your body. They are connected to the pump with a cable that goes into your belly.

During Surgery

The heart surgeon opens the middle of your chest with a surgical cut and then separates your breastbone. This allows access to your heart.

Depending on the pump used, the surgeon will make space for the pump under your skin and tissue in the upper part of your belly wall.

The surgeon will then place the pump in this space.

A tube will connect the pump to your heart. Another tube will connect the pump to your aorta or one of your other major arteries. Another tube will be passed through your skin to connect the pump to the controller and batteries.

Surgery most often lasts 4 to 6 hours.

There are other types of VADs (called percutaneous ventricular assist devices) which can be placed with less invasive techniques to help the left or right ventricle. However, these typically cannot provide as much flow (support) as the surgically implanted ones.

Why the Procedure Is Performed

You may need a VAD if you have severe heart failure that cannot be controlled with medicine, pacing devices, or other treatments.

You may get this device while you are on a waiting list for a heart transplant. Some people who get a VAD are very ill and may already be on a heart-lung support machine.