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Best Drugs To Treat Heart Failure
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Generated by cloudfront (CloudFront) Request ID: pBjetLXSrv47o1MEQottrzk-OiNZuULx0yshmYirv-xKtHZYimotcQ==Medications That Can Cause Heart Failure
Heart failure is often caused by other health problems, like heart disease or diabetes. But common medications can also bring it on.
This condition isn't what it sounds like: Your heart doesn't stop. It just doesn't pump blood as well as it should. That means you may be short of breath, feel weak, and have swollen legs and feet, among other symptoms.
Some drugs and natural supplements cause or worsen heart failure because they:
People with heart failure take an average of 6.8 prescription medicines a day. The more drugs you take, the more likely you are to have a drug-drug interaction. This can put your heart at risk.
These drugs can raise your risk of heart failure or related problems:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription NSAIDs include diclofenac, ibuprofen, indomethacin, and ketorolac. More than 70 million prescriptions are written every year for this type of pain reliever. NSAIDs can boost heart failure odds because they make you retain water and salt, make it harder for your blood to flow, and make it tougher for diuretic drugs (often used to treat high blood pressure) to work.
Diabetes medications. Your body gets rid of metformin through your kidneys, so it isn't a good choice if your kidneys don't work like they should. Thiazolidinediones (pioglitazone, rosiglitazone) cause fluid retention and weight gain in people with heart failure and make people who don't have it more likely to get it. Doctors aren't sure why, but dipeptidyl peptidase-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) seem to send people with heart failure to the hospital. Never stop taking a medication without your doctor's OK, though.
Blood pressure medicine. Calcium channel blockers can worsen edema or fluid that stays in your body's tissues. Central agonists (clonidine, moxonidine) cause changes in the way your body releases hormones that affect your heart.
Other types of drugs that can bring on heart failure include:
You may not think twice about taking over-the-counter (OTC) drugs for minor things like a headache or stuffy nose. But if you're at risk of heart failure, or if you already have it, you might want to limit or avoid some medications.
OTC NSAIDs, just like the prescription ones, can make heart failure worse. They can even make it more likely that you'll go to the hospital for heart failure.
Watch out for cold medicines. Some have NSAIDs like ibuprofen. Others have sodium or ingredients that can worsen your heart failure or conditions that come along with it.
Nasal decongestants often contain drugs that narrow your blood vessels. Look for the word vasoconstrictor on the label. These can cause heart problems when you take more than you should for a long time.
Ask your doctor for a list of safe OTC drugs and tips on what to look for on product labels.
There's no government regulation of natural supplements, so you can't always be sure the package contains what the label says it does. Some can cause serious risks, especially if you have a health condition.
That goes for vitamins, too. They seem harmless because they occur naturally in food. But in pill form, it's a different story. More than 400 IU of vitamin E daily can increase your chances of developing heart failure.
Supplements can also interact with other drugs. One natural product may be fine for your neighbor but put your health at risk.
Tell your doctor about every natural supplement you take so you can find out the pros and cons. In the meantime:
Avoid products that can interact with heart medications, like digoxin and blood thinners.
Keep everyone on your health care team in the loop about the drugs and supplements you take. This keeps your risk low. It's also a good idea to limit any drugs or supplements you don't need. Some tips:
What Is Peripartum Cardiomyopathy?
Medically reviewed by Rafle Fernandez, MD
Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is a rare heart condition that can occur during the later stages of pregnancy or in the weeks to months following pregnancy. "Cardiomyopathy" is a term for a heart muscle weakness. A weak heart muscle impairs the heart's function and often leads to heart failure.
Peripartum cardiomyopathy occurs in about 1 of every 1,000 to 4,000 deliveries. Some symptoms are similar to symptoms you may notice in pregnancy, like shortness of breath, fatigue, and leg swelling.
Read on to learn more about peripartum cardiomyopathy, its symptoms, management, and outlook.
What Is Peripartum Cardiomyopathy?Peripartum cardiomyopathy is an otherwise unexplained heart failure that occurs near the end of pregnancy or in the year following pregnancy. In peripartum cardiomyopathy, the heart is often enlarged, and the pumping function of the heart's main chamber (the left ventricle) is impaired. This leads to heart failure symptoms like shortness of breath and swelling.
Usually, the left ventricle pumps out over half of the blood inside it with each heartbeat. This is a measure known as the ejection fraction (EF), and normal EF is around 55% or higher. However, in PPCM, there is a reduced EF (less than 45%) as the left ventricle is weakened. This is also known as systolic heart failure or heart failure with reduced ejection fraction (HFrEF).
Peripartum cardiomyopathy usually occurs near the end of pregnancy or shortly after but can be diagnosed anytime during the year after pregnancy. In some cases of peripartum cardiomyopathy, there can be improvement and a full recovery in heart muscle function with time and medications.
What Causes Peripartum Cardiomyopathy?The exact cause of peripartum cardiomyopathy is still under investigation. Studies have suggested a role of genetics, inflammation, and abnormal immune response during pregnancy. One theory involves the breakdown of the prolactin hormone (that stimulates breast milk production during and after pregnancy) into a toxic fragment to the heart.
This may explain how treatments that use bromocriptine, a medication that reduces prolactin levels, is beneficial in peripartum cardiomyopathy.
Who's at Risk for Peripartum Cardiomyopathy?The following factors increase the risk of developing peripartum cardiomyopathy:
Being over age 30
History of preeclampsia, a blood pressure disorder during pregnancy
History of high blood pressure before pregnancy
Smoking
Family history of peripartum cardiomyopathy
Diabetes
Having had peripartum cardiomyopathy with a previous pregnancy greatly increases the risk, especially if the left ventricular function has not completely recovered.
What Are the Symptoms of Peripartum Cardiomyopathy?Some of the symptoms of PPCM can mimic symptoms that are commonly seen toward the end of pregnancy. It's important to discuss any new or changing symptoms with your healthcare provider.
Symptoms of peripartum cardiomyopathy are similar to symptoms in other types of heart failure, and include:
Shortness of breath
Difficulty breathing when lying flat, needing to prop your head on pillows to breathe comfortably, and waking up at night short of breath
Swelling in the feet, legs, abdomen
Sudden weight gain
Fatigue
Palpitations
Diagnosis of peripartum cardiomyopathy is often delayed since some of the symptoms are similar to symptoms that are frequently seen in pregnancy, like shortness of breath and leg swelling. When peripartum cardiomyopathy is suspected, a heart ultrasound, known as an echocardiogram, provides information about the heart's structure and function.
An echocardiogram can reveal a dilated heart and calculate the ejection fraction. It can also provide clues as to the cause of the cardiomyopathy. When no other cause is identified, and the condition is diagnosed in the right time frame relating to pregnancy, peripartum cardiomyopathy is diagnosed.
Other tests may include:
Laboratory tests for kidney function, electrolytes, and heart proteins (cardiac biomarkers)
Electrocardiogram (ECG or EKG)
Chest X-ray in some cases to evaluate fluid in the lungs
Other heart imaging tests to look for other causes of heart failure
Treatment of peripartum cardiomyopathy includes medications, and in some cases special medical devices to support your heart. If you experience fluid retention, you may be advised to limit salt intake.
When peripartum cardiomyopathy occurs during pregnancy, early delivery may be necessary. A cardiologist (heart specialist) and obstetrician-gynecologist (ob-gyn; a specialist who manages many aspects of women's reproductive health, including pregnancy and childbirth) will work together to determine risks and benefits to you and your baby and make recommendations on an individual basis.
It's essential to follow closely with a cardiologist who can prescribe medications for your heart and monitor your heart's function over time.
MedicationsMedications used in peripartum cardiomyopathy and other types of heart failure may include:
In some studies, bromocriptine has been shown to improve outcomes in peripartum cardiomyopathy. However, the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, a report by the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, states that evidence is uncertain.
Implications on Reproductive Health and BreastfeedingCareful consideration of medications is paid during pregnancy and breastfeeding to minimize risk to a developing fetus or infant. There is some conflicting evidence as to whether breastfeeding is safe in those with peripartum cardiomyopathy.
Previous European guidelines recommended against breastfeeding, but subsequent studies have not supported this recommendation. In addition, the choice of contraception is impacted by peripartum cardiomyopathy as certain hormonal contraceptives are not recommended.
Cardiac DevicesIn severe cases of peripartum cardiomyopathy involving cardiogenic shock, temporary circulatory support devices may be needed. These devices assist a weakened heart in pumping blood to your body. When there is an increased risk of arrhythmia (abnormal heart rhythm or heartbeat), such as in those whose heart remains weak for some time despite using medications, an implantable cardioverter defibrillator (ICD) may be recommended.
Peripartum Cardiomyopathy ComplicationsPeripartum cardiomyopathy can range in severity, with little impact on heart function and mild symptoms, to severe, with cardiogenic shock (life-threatening condition in which the heart can't pump enough blood and oxygen to the brain and other organs) and death. Complications can include:
Long-Term OutlookThe prognosis of peripartum cardiomyopathy varies widely. Studies have shown recovery of heart function in up to 75% of cases. Those diagnosed late in the time frame and with more severe peripartum cardiomyopathy are less likely to experience full recovery of heart function.
Importantly, peripartum cardiomyopathy can recur or worsen with subsequent pregnancies. If you have had peripartum cardiomyopathies, ask your cardilogist about the risks and benefits of getting pregnant again. If you do become pregnant, it is recommended to have careful monitoring during and after pregnancy.
How to Prevent Peripartum CardiomyopathyIt may not be possible to prevent PPCM, however, there are ways to help keep a strong heart in general. These include:
Quit smoking and avoid secondhand smoke.
Avoid alcohol (especially during pregnancy) outside of pregnancy limit alcohol and drink only in moderation.
Get regular physical exercise.
Eat a heart-healthy diet.
For those who have had peripartum cardiomyopathy previously, especially if heart function has not recovered, making a plan to avoid unexpected pregnancy is recommended.
SummaryPeripartum cardiomyopathy is a rare but potentially severe form of heart failure that can affect women late in pregnancy or the year after delivery. Symptoms may mimic some of those experienced in pregnancy, such as shortness of breath and ankle swelling. In severe cases, cardiogenic shock may occur.
Treatment includes medications, and sometimes cardiac devices are needed. A team of cardiologists and obstetricians can make an individualized treatment plan and discuss risks for future pregnancies.
Read the original article on Verywell Health.
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