The main symptom of heart failure is severe shortness of breath. Pain occurs only when heart failure is precipitated by a heart attack. If nitroglycerin is available, put one under the tongue and remain propped up in bed or sit until the ambulance arrives.
Oxygen is useful and is given immediately at onset of heart failure. Morphine allays anxiety and pools blood in the lower part of the body. Both of these actions bring relief. Nitroglycerin paste, ointment, or patch is applied to the skin, and a powerful diuretic, furosemide, is given intravenously. Furosemide acts within minutes, pooling blood in the lower half of the body, and causes the kidneys to remove sodium and water from the blood and excrete them in the urine. If relief is not obtained, further injec¬tions of furosemide are given.
The cause of heart failure and the precipitating factors are then treated, if possible. Atrial fibrillation is success¬fully treated with digoxin. Hypertension can cause heart failure, and the blood pressure must be lowered. An ACE inhibitor is used to dilate arteries and lower blood pressure, and thus rest the heart. Patients with heart failure have a hospital stay of five to 7 days. Prognosis depends on the cause and precipitating factors outlined. Heart failure does not mean the end. Some patients do much less than before, but they can live active lives for 5–15 years with good medical treatment. The reassuring news is that avoidance of precipitating factors can help enormously and the recent use of judicious doses of carvedilol or metoprolol along with spironolactone or eplerenone will have a major impact in improving morbidity and mortality from heart failure.