Treatment options for end stage congestive heart failure

Dear Ask The Doctor: What does it mean when a doctor tells you home health nurse not to make any changes to your meds when in CHF and End Stage Cardiomyothopy, He has been on liquid lasix before several times and is on lasix regulary, two-three a day. He is also taking nitroglycerin almost on daily basis, his chest is heavy and he cannot walk more that 5-10 feet without losing his breathe, i just wonder if we are at the end and the doctor has done all he can do

Dear Gary: Exertion limited to 5-10 feet by shortness of breath and chest heaviness implies significant decompensation from heart failure (failure of the pump) and/or heart artery disease. I would recommend that he is clinically re-assessed by a heart failure specialist in order to ensure that he is receiving maximum therapy. Thetherapeutic options include medications such as diuretics, ACE inhibitors and Beta Blockers. It is also important to ensure that all potential causes for heart failure are investigated ensuring that his blood count and kidney function are normal,assess the strength of the heart muscle on echocardiogram and consider a coronary angiogram to ensure that there are no narrowings in the heart arteries. The final option is a special type of pacemaker which paces both sides of the heart. Not everyone with heart failure will benefit from this but it is worth discussing this with your physician, if this has not already beenperformed.