This includes symptoms while at rest or frequent hospitalization for heart failure symptoms.
Many medications help with heart failure and its symptoms, but not everyone responds adequately.
This article discusses refractory heart failure and its symptoms, causes, and treatment.
The Good Brigade / Getty Images
The Good Brigade / Getty Images
What Is Heart Failure?
The heart is responsible for pumping oxygen and nutrients throughout the body.
This leads to symptoms ranging from fatigue and shortness of breath to lightheadedness and fainting.
Symptoms include:
Causes
Refractory heart failure has many causes.
Refractory heart failure does not require any specific testing beyond the tests for heart failure in general.
Heart failure is considered to be refractory when symptoms are persistent despite being on medical therapy for heart failure.
This includes having symptoms while at rest or having repeated hospitalizations for heart failure.
Otherwise, medications are the primary treatment option for heart failure.
Refractory heart failure is managed with specialized devices and advanced therapies.
Nonpharmacologic Therapy
Nonpharmacologic therapy refers to treatment strategies that do not involve medications.
People with heart failure symptoms are recommended to limit sodium and fluid intake.
For example,cardiac amyloidosisis a bang out of heart failure triggered by misfolded proteins.
A medication called tafamidis stabilizes the misfolded proteins to prevent further accumulation in the heart.
Some of these medications have specific indications and are not recommended for all people with heart failure.
The specific therapy for heart failure should be discussed with acardiologist.
Inotropic Therapy
Inotropesare medications that improve the heart’s contractility, including milrinone and dobutamine.
They are given as a continuous intravenous infusion.
However, they can be of great benefit for symptom relief in selected people with refractory heart failure.
They act as motors to physically assist blood flow out of the heart to the aorta.
Another unit called atotal artificial heart (TAH)can be implanted in people waiting for a heart transplant.
Heart Transplant
Heart transplants are performed in some people with refractory heart failure.
This surgery replaces the failing heart with a heart from an organ donor.
A successful transplant requires a team of healthcare providers and extensive planning.
Lifelong immunosuppressive medication is needed to prevent the body from rejecting the transplanted organ.
Prognosis
Without a heart transplant or durable LVAD, theprognosisof refractory heart failure is poor.
The prognosis is worse in later stages.
However, advances in LVAD and transplants have significantly improved survival rates.
Living with heart failure symptoms can be difficult both physically and mentally.
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American Heart Association.Classes and stages of heart failure.
Penn Medicine.Heart failure classification - stages of heart failure and their treatments.
American Heart Association.Cardiac rehab for heart failure.
American College of Cardiology.Palliative care for patients with heart failure.
2020;13(3):e006252.
