- Heart failure medications help reduce strain on the heart, improve blood flow, and relieve symptoms such as swelling and fatigue.
- Treatment may include ACE inhibitors, beta blockers, diuretics, ARNIs, SGLT2 inhibitors, and other medications.
- Heart failure medication should be taken as prescribed, and treatment should not be stopped or changed without medical guidance.
Heart failure medication, such as enalapril, losartan, and sacubitril/valsartan, help reduce the strain on the heart by relaxing blood vessels, improving blood flow, and, depending on the medication, helping the body get rid of excess fluid. These effects make it easier for the heart to pump blood throughout the body.
Heart failure medication can help relieve symptoms such as chest pain or discomfort, palpitations, excessive fatigue, and swelling in the legs or feet. Different types of medication work in different ways, and more than one medication may be needed to control symptoms.
Heart failure medications should be prescribed by a cardiologist based on the symptoms and severity of the condition. In many cases, these medications need to be taken long-term or for as long as recommended by the cardiologist.
Main types
The main types of heart failure medication that may be prescribed by a doctor include:
1. ACE inhibitors
ACE inhibitors, or angiotensin-converting enzyme inhibitors, help control heart failure symptoms by relaxing blood vessels and reducing the workload on the heart.
These medications help blood flow more easily through the arteries, making it easier for the heart to pump blood.
Examples of ACE inhibitors that may be prescribed by a cardiologist for heart failure include enalapril, ramipril, and lisinopril.
2. Angiotensin receptor blockers
Angiotensin receptor blockers, also known as ARBs, may be prescribed for heart failure when ACE inhibitors are not appropriate or cause side effects that prevent their use, such as coughing or angioedema.
Examples of ARBs include losartan, olmesartan, irbesartan, candesartan cilexetil, and valsartan.
3. Diuretics
Diuretics may be used to treat heart failure by helping the body get rid of excess fluid, which can reduce blood volume, blood pressure, and strain on the heart.
According to the American Heart Association, reducing fluid buildup in the lungs, ankles, and legs can make breathing easier and help relieve swelling.
Examples of diuretics that may be prescribed by a cardiologist for heart failure include furosemide, hydrochlorothiazide, amiloride, eplerenone, and spironolactone.
4. Cardiac glycosides
Digoxin is a cardiac glycoside that may be used to treat heart failure. It increases the strength of the heart's contractions and can help control certain irregular heart rhythms, allowing the heart to pump blood more effectively and helping reduce heart failure symptoms.
However, digoxin can become toxic if blood levels are too high. People taking this medication may need regular medical follow-up and blood tests.
5. Beta blockers
Beta blockers reduce the workload on the heart and help it pump blood more efficiently. Over time, this can improve heart function and help reduce heart failure symptoms.
Examples of beta blockers that may be prescribed by a cardiologist include carvedilol, bisoprolol, and metoprolol succinate.
6. Vasodilators
Vasodilators relax and widen blood vessels, making it easier for the heart to pump blood.
For heart failure, hydralazine may be used together with isosorbide dinitrate. This combination may be prescribed in certain situations when other heart failure medications are not appropriate or as an additional treatment.
7. Sinoatrial node inhibitors
Ivabradine is a sinoatrial node inhibitor used to treat certain cases of heart failure. It works by slowing the heart rate, which reduces the amount of work the heart has to do to pump blood and can help relieve heart failure symptoms.
8. Angiotensin receptor-neprilysin inhibitors
Angiotensin receptor-neprilysin inhibitors, also known as ARNIs, combine two types of medication used to treat heart failure. They help relax blood vessels, lower blood pressure, and increase the removal of sodium and water from the body.
These effects reduce the amount of work the heart has to do to pump blood throughout the body, helping relieve heart failure symptoms.
The ARNI that may be prescribed by a cardiologist is sacubitril/valsartan.
9. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as dapagliflozin and empagliflozin, may be prescribed by a cardiologist to treat heart failure in people with or without diabetes.
These medications reduce strain on the heart, support heart and kidney function, and have a mild diuretic effect that can help reduce fluid buildup and swelling.
According to the American Heart Association and American College of Cardiology, SGLT2 inhibitors can reduce the risk of hospitalization for heart failure and cardiovascular death, including in people without diabetes.
10. Aldosterone antagonists
Aldosterone antagonists, also known as mineralocorticoid receptor antagonists or potassium-sparing diuretics, may be prescribed for heart failure, particularly heart failure with reduced ejection fraction (HFrEF).
These medications have a diuretic effect that helps reduce swelling caused by heart failure. They can also reduce strain on the heart and help control blood pressure.
Aldosterone antagonists also help protect the heart muscle from progressive changes, such as cardiac remodeling and fibrosis.
Examples of aldosterone antagonists that may be prescribed by a cardiologist include spironolactone and eplerenone.
Possible side effects
Heart failure medications can cause side effects such as dizziness, coughing, nausea, fatigue, and low blood pressure, depending on the medication prescribed.
If these side effects cause significant discomfort, a doctor should be notified. However, heart failure medication should not be stopped or changed without medical guidance.
