Besides the treatments mentioned, there may be other heart failure treatments depending on your clinical situation. Your doctor will discuss these options with you if he/she thinks they may benefit you.

1. Percutaneous coronary intervention
2. Open-heart surgery
• Coronary Artery Bypass Graft
• Heart valve surgery
3. Device therapy for Heart Failure
• Pacemakers
• Implantable cardioverter defibrillator
4. Artificial Heart and Heart Transplantation

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention (PCI), also called coronary angioplasty and stenting, is a procedure using wires and X-rays to guide a small balloon into the narrowed part of a blood vessel in the heart. The balloon is then blown up to open up the narrowing. This is often followed by placing a wire mesh called a stent inside the blood vessel – to reduce the chance of the narrowing occurring again. This procedure improves blood flow to the heart muscle and relieves heart pain (chest pain/angina). It may also improve the overall heart strength and, thus, heart function.

Open Heart Surgery

Heart Valve Repair or Replacement

For the heart to pump efficiently, the four valves of the heart must be able to open completely and close appropriately to let blood flow forward. In valve stenosis (obstruction), when the valve is not able to open fully, the heart needs to work harder to pump blood forward across the obstructed valve.

Sometimes, the valve leaflets do not close tightly. This is called valve regurgitation or incompetence. Then, a proportion of blood will flow backwards, resulting in inefficient heart function.

Severely diseased heart valves may need to be repaired or replaced with artificial valves to restore heart efficiency.

Types of Replacement Valves:

• Tissue valves made using animal or human tissue.
• Mechanical valves made from synthetic materials such as metal and plastic.

Coronary Artery Bypass Graft (CABG)

Coronary Artery Bypass Graft (CABG) is open-heart surgery which brings blood flow back to the heart muscles.

The purpose of this surgery is to bypass blocked heart arteries using an artery in the chest wall or veins taken from the legs.

This surgery is done for patients with multiple blocked heart arteries where PCI could not be performed safely. By bringing the blood flow back to the heart muscles, heart function can be improved. In addition, it also relieves heart pain.

Related: Heart Rhythm Disorder (Arrhythmia)

Device Therapy for Heart Failure

Pacemaker

The pacemaker is a small device that stimulates your heart with a tiny electrical current to make your heart muscle contract when your heart’s natural electrical conduction system does not work as it should. It is implanted in your chest and connected to your heart through wires (also called leads) to monitor your heartbeat and to pace your heart as needed. When the pacemaker senses that the heart is not beating fast enough, it will send a tiny electrical impulse to stimulate the heart to beat. The electrical impulses are too small to be felt by you.

Types of Pacemakers

The type of pacemaker used depends on your heart rhythm and heart function. Your doctor will recommend the type of pacemaker that is best suited for your heart condition.

The different types of pacemakers include the following:

• Single-chamber pacemakers have one lead, which is placed in the right atrium (upper chamber) or right ventricle (lower chamber) of the heart.
• Dual-Chamber Pacemakers have two leads, one in the right atrium and another in the right ventricle, to simulate the natural conduction system of the heart.
• Biventricular pacemakers have leads in the right atrium, the right ventricle and another lead that is inserted into a vein behind the heart to pace the left ventricle. This is an important advancement in heart failure treatment and is used for a patient with a weak heart who continues to suffer from symptoms of heart failure despite medical treatment. It has been shown that the biventricular pacemaker can result in fewer symptoms, improvement in heart function and may even prolong life expectancy.

Implantable Cardioverter Defibrillators (ICD)

When heart failure occurs, life-threatening heart rhythm disorders can trigger suddenly. If urgent treatment is not given, it can lead to death.

These Rhythm Disorders Are:

• ventricular tachycardia (beating too fast) and
• ventricular fibrillation (unstable rhythm)

These can cause fainting spells, collapse and sudden death. The emergency treatment for a patient suffering from these rhythm abnormalities includes cardiopulmonary resuscitation and a strong electric shock to the heart using a defibrillator.

The Implantable Cardioverter Defibrillator (ICD) device can save lives by correcting these abnormal heart rhythms.

Like a pacemaker, the ICD is a small electronic device implanted in the chest to monitor the heart rhythm at all times. When it detects ventricular tachycardia or fibrillation, it sends an electric shock to the heart to put a stop to the abnormal rhythm. It also functions as a pacemaker if the heart rate is too slow.

Not every patient with heart failure needs a device such as a pacemaker or an ICD. Your doctor will be able to advise you on this.

Artificial Heart and Heart Transplantation

These are advanced forms of treatment for very sick patients with heart failure. Artificial hearts are mechanical pumps that take over the function of the heart. They are usually used for temporary relief of heart failure until the injured heart recovers or until the patient receives a heart transplant.

Heart transplantation is usually the last option for a patient with advanced heart failure. There are strict criteria for who can have heart transplantation, and this procedure is not commonly performed in Singapore.

Download the HealthHub app on Google Play or Apple Store to access more health and wellness advice at your fingertips.

Read this next:

• Heart Failure - Advance Care Planning (ACP)
• Pacemakers, Defibrillators and Cardiac Implants
• Medical Devices and You