Information for the public
Treatment
Treatment to stabilise your condition
Drug treatment
The first thing your doctor will want to do is to make your condition stable. You should be offered treatment with a diuretic to remove excess water from your body. It is given intravenously (directly into a vein) by injection, or you may be put on a continuous infusion (drip). While you are having diuretic treatment your healthcare team should regularly check your weight and urine output, and how well your kidneys are working. You might pass a lot of urine while you are on the diuretic, and a member of your healthcare team should discuss with you ways to deal with this. If your diuretic treatment is not working well, there are other medicines and approaches that may be used, and certain people may be offered a procedure called ultrafiltration. This involves removing fluid from your blood using a small portable machine.
In specific circumstances you may be offered drugs called nitrates, inotropes and vasopressors to treat acute heart failure. This should be in a centre with critical care services. You should not normally be offered opiates.
You should not be offered sodium nitroprusside for acute heart failure.
Other treatments used less commonly
Mechanical ventilation is used to help people to breathe when they cannot do this well enough without support.
You should not normally be offered non-invasive mechanical ventilation if you have excess fluid in the lungs caused by heart failure (this is called cardiogenic pulmonary oedema). But if you also have severe problems breathing and high levels of acid in your blood (acidaemia), you may be offered non-invasive mechanical ventilation. This involves placing a mask over the person's face and attaching it via a tube to a machine called a ventilator.
If you are having drug treatment for acute heart failure and you are still having difficulties breathing, are losing consciousness or are physically exhausted, you may be offered invasive mechanical ventilation. This involves putting you to sleep (general anaesthesia) then inserting a tube through the mouth into the lungs. The tube is attached to a ventilator.
Treatment after stabilisation
Your doctor should discuss with you your condition and its treatment, and begin to explore the impact that treatment might have on your health in the future. They should also give you information on this.
Drug treatment
If your heart failure was caused by left ventricular systolic dysfunction (known as LVSD, where the pumping chamber of the heart is not pumping well), you should start or restart beta-blockers while you are in hospital. You should not be discharged until your condition has been stable for 48 hours after starting or restarting the beta-blockers. You should also be offered a drug called an angiotensin-converting enzyme inhibitor (usually called an ACE inhibitor), or an angiotensin receptor blocker, and an aldosterone antagonist. If you are unable to take the ACE inhibitor or angiotensin receptor blocker because they are causing you problems, you should still be able to have an aldosterone antagonist.
If you were already taking beta-blockers before you developed acute heart failure, you should be able to carry on taking them. Your doctor should talk to you if there's any reason why you can't take them.
During treatment your healthcare team should monitor your condition – for example, your kidney function, heart rate and blood pressure.