Preventive non-drug based treatments

  1. Bed rest. The patient must rest in bed but this should not occur for prolonged periods of time, because it favors pulmonary thromboembolisms, bronchopulmonary infections, decubitus, in elderly patients it may favor the development of osteoporosis, and in patients suffering from prostate conditions it may favor the development of urinary retention.
    The patient should lay in a half-upright position, leaning against pillows. This is done in order to avoid the development of decubitus. It is recommended to keep a rubber ring-pillow under the sacral gluteal region. The patient should defecate regularly, since defecating forcefully may become a cause for embolisms.
  2. Diet. It is very important to cease the consumption of salt. At the very beginning the diet should categorically not include salt, and it must be of a hypocaloric variety. It is recommended to consume vegetables and very little protein. However, extreme, rigorous diets are not recommended for long term consumption, seeing that they may be poor in calories or protein. With the passage of time, more food types may be added to enrich the diet, but it must always cater to the special prerequisites for these patients.
    It is also recommended to limit the consumption of sodium, ceasing tobacco consumption (if they are a smoker), ceasing alcohol consumption, take medication to treat anemia or thyroid dysfunction, if present, and losing weight for patients who are overweight or obese. Patients are recommended to become immunized against the flu and pneumonia, and to exercise regularly. In this way, patients can improve their lifestyle, and lower their risk for developing complications.

Drug based treatment

Drug based treatments vary across different stages, symptoms and various patients belonging to various age groups and specifications. Treatment is usually complex and involves utilizing drug combinations.

Treatment should be individualized

  • For cardiac insufficiency of the first stage, it is enough to expand the amounts of time spent resting or relaxing for a few days, consuming a saltless diet and taking sedatives like bromure, valium, etc.
  • For cardiac insufficiency Stage 2A and 2B, cardiotonic drugs should be used, as well as thiazide diuretics in conjunction with kalii chloratin or combined with spironolactone or lasix (furosemide).
  • For cardiac insufficiency of Stage 3, in addition to digitalis treatment and diuretics, liquid removal from the serous cavities should occur periodically. Lipotropic substances and vitamins are also used, etc.
  • For cardiac asthma and especially for acute pulmonary edema emergency measures must be taken from the very beginning, even if the patient is at home.

Several relevant drug classes include

Vasodilators, diuretics, digoxin, anticoagulants, antiarrhythmic drugs, beta blockers and calcium pump inhibitors in cases when they are necessary. Treatment aims at curing the symptoms.

  1. Cardiotonics such as lanatoside C
  2. Digoxin
  3. Thiazide diuretics such as hydrochlorothiazide
  4. Loop diuretics such as furosemide
  5. Metoprolol, carvidolol
  6. Sorbides, nitrosorbide, isosorbide
  7. Warfarin, sintrom, rivaroxaban
  8. Injection fraction enhancer when the injection is under 45% concentrated, sacubitril (entresto)

Surgery is sometimes used in order to treat certain symptoms. Common procedures utilized include myotomy, myectomy, myocardial bridging, substituting or repairing the mitral valve, implantation of a defibrillator in the heart, heart transplant, implantation of a pacemaker, etc.

Prognosis and prophylaxis

Given that rheumatism, hypertonic disease and atherosclerosis are the most common causes which lead to cardiac insufficiency, treating these conditions individually means simultaneously preventing cardiac insufficiency. In addition to the primary conditions, treatment must be taken to treat any bronchopulmonary infections, influenza infections, streptococcal infections, etc, since they can cause cardiac disease patients to not be able to compensate.

It is of high importance to maintain proper hygiene and diet. Patients must forego physical exertion and psychological stresses. Their diet should be adapted to be easily digestible, rich in vitamins (especially of the B complex), and it should not contain more than 0.5 - 2.0 g of sodium taken per day. These individuals can be treated as outpatients but still remain under continuous medical supervision.  

Prognosis is a matter upon which limited remarks can be made. It is intrinsically connected to the nature of the cardiopathy which caused the insufficiency. The prognosis is less favorable for patients suffering from infarction of the myocardium, hypertonic disease or aortic defects than it is for patients suffering from stenosis or mitral ailments.
This occurs because in the aforementioned severe conditions, the main pressure falls on the left ventricle, which is constructed of thicker muscular walls, and can resist damage for longer periods of time. When the left ventricle can no longer compensate, the disease worsens and it is difficult to recover.

In the case of less severe conditions, the right ventricle sustains most of the damage, which means it becomes impossible to compensate faster, but the patients can recover faster as well. Prognosis may worsen in the advent of complications such as embolisms and pulmonary infarctions, etc. The prognosis is more favorable for constrictive pericarditis which disappears after a pericardiectomy.


Medically Reviewed by a doctor on 19 Jun 2018
Medical Author: Dr. med. Diana Hysi