Harvard Heart Letter

Ask the doctor: What is a good plan for serious heart failure?

Q. My 69-year-old husband has had cardiomyopathy and diabetes for several years. Lately, his ankles are always swollen. At his last doctor's visit, my husband's cardiologist said his heart has leaky valves and his ejection fraction is 10%. What would be the best plan for him?

A. The combination of leaking valves and a low ejection fraction is serious indeed. Your husband needs to work very closely with his physicians to make sure he is getting optimal care. The ideal scenario would be if he can work with a team that specializes in caring for people with heart failure.

Starting with medications, your husband should probably be taking a diuretic to help him get rid of excess fluid and an ACE inhibitor to ease the workload of his heart. It might be a good idea to try a beta blocker to see if it will help his heart deal with the high levels of adrenaline that are undoubtedly circulating in his bloodstream. He might also be a candidate for a drug called spironolactone.

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