Treatment of Heart Failure and Cardiomyopathy
Diet & Exercise
Once you have a cardiomyopathy or heart failure diagnosis, it is essential to learn about the salt content of foods by reading labels and identifying salt rich recipes. High salt diets can make heart failure worse. This is especially common when a patient with a cardiomyopathy or heart failure travels – you may have less control over what you eat on the road when eating at restaurants, with friends, or with relatives.
Once your doctor treats your heart failure, and ensures you have no problems with your arteries or your heart rhythm, you should be able to exercise. With good medical treatment, and once all of your heart testing is completed, your doctor will reassure you that it is safe to exercise. In addition to medication and a salt free diet, exercise in patients with heart failure and cardiomyopathy may help your heart improve, help you feel better, and even live longer.
You must take care with over the counter medications and prescription medications once you have heart failure. Non-steroidal anti-inflammatory (Advil, Motrin, Ibuprofen, Aleve) should be avoided as they can make heart failure worse.
If you have heart failure and your doctor determines that you have too much fluid in your system, a diuretic is often prescribed (e.g. furosemide / Lasix). Diuretics help your body remove excess fluid through your kidneys and bladder.
Once your condition improves, you may not need regular diuretics, especially with other medications and by adhering to a salt free diet. Some patients use a flexible diuretic regimen, which means they identify fluid overload (e.g. by noting edema) and only take a diuretic when they are retaining excess fluid.
Monitoring kidney function with a blood test is necessary when starting a diuretic or if the dosage changes. Some diuretics (spironolactone, eplerenone) have extra effects on the heart which can even help heart muscle get stronger over time.
Angiotensin Converting Enzyme (ACE) Inhibitors
This class of medication relaxes blood vessels and makes it easier for your heart to pump. They won’t make your heart stronger, but they help stop the heart from getting weaker, and get you feeling better quickly. The dose starts low and your doctor will change the dose depending on your blood pressure. It is necessary to monitor your kidney function with a blood test when you start these medications. ACE inhibitors can be started even when you have extra fluid in your system.
This class of medication blocks the effects of adrenaline on the heart. In the long run, this is the only type of medication that can make a weak heart muscle stronger. In general, we wait until ACE inhibitors and diuretics have reduced any extra fluid out of your system before we start beta blockers. The starting dose is low, and gradually increased over several weeks to months, depending on your heart rate, blood pressure, and if you are retaining any extra fluid.