Is there hope for Dad with CHF, severe cardiomyopathy and other diagnoses?

  My 58 y.o. father has a hx of kidney transplant ('91) due to inherited polycystic kidney disease, heart attack ('94), hiatal hernia, diabetes (non-insulin dependent), obese (6'0" @ 262 lbs.) and the latest 2 diagnoses of "severe" cardiomyopathy and congestive heart failure w/EF of 20.  He is on the following meds - Prednisone (5 mg am), Diltia XT (180 mg am), Neoral (150 mg am&pm), Nitrostat (0.4 mg prn), Demadex (20 mg am&pm), Lanoxin (.125 mg @ 5 pm), Zestril (2.5 mg am&pm), Zebeta (1.25 mg am), Cardura (1 mg am&pm), Potassium (CL 10 MEQ ER 3x/day), Glyburid MCR (3 mg am&pm), Prilosec (20 mg am), Claritin (10 mg am), Ecotrin OTC (325 mg am), Bayer aspirin (prn for angina pain).  He has not had a good nights sleep in months - up every hour going to the bathroom. He has very little energy and is tired all of the time.  He's experiencing reflux almost daily now.  He has a lot of fluid retention.  He still has angina pain.  I live 3K miles away from him and am trying to come up with a more substantial treatment.  He has an HMO combined with Medicare, eff.3/1.  I would like to get a second opinion on his condition.  His specialists are not co-managing his care.  I can't get his physicians to call me.  He has lost appx. 12 lbs. since 1/99 by taking SlimFast and I don't think this is good for him.  I wondered what treatment options would be available for him?  Are there any clinical trials he might qualify for?  Are there any new miracle drugs on the market that may help him?  Would a change in his medications or the times he takes it possibly help him with the feeling of being so tired all of the time?  With his painful hernia and lack of energy, what exercise options are available for him?  How can he safely, quickly and effectively lose weight?  I love my Dad so much.  Can you help him?  Is there hope medically speaking? Would he ever qualify for a heart transplant?  Thank you for reviewing this and we look forward to receiving your response.

[Cleveland Clinic, MD]

Dear Donna,
Topic Area: Heart Failure
Thank you for your question.  Heart failure, or congestive heart failure (CHF) is a syndrome of low heart output, shortness of breath and swelling in the extremities.  The most common cause of heart failure is ischemic (secondary to blockages in the arteries).  Other common causes are hypertensive (high blood pressure), viral, valvular and idiopathic.  The diagnosis of CHF is made by symptoms and testing of the heart.  An echocardiogram or heart catheterization is usually done to measure the function of the pumping chamber.  Other investigations may be performed depending upon the cause of the CHF.
Treatment of heart failure can be medical or surgical.  If failure is due to blockages or valve problems then surgery is often recommended.  Medical management includes digoxin, ACE (angiotensin-converting enzyme) inhibitors and diuretics.  Newer evidence has shown that low dose beta-blockers improve symptoms and survival in patients with CHF.  End stage CHF is treated with heart transplantation if the patient is a candidate.  
CHF is a common problem and there are new treatments being developed.  It is a chronic problem and must be followed closely by a doctor with adjustment of her medication as needed.  If your father's doctor is not a specialist in the area of heart failure he may consider seeking the opinion of such a specialist.  We have an excellent heart failure clinic here and if he lives close to Cleveland he can make an appointment by calling the number below.  Don't give up hope.  Heart failure is a difficult disease to treat but new advances are being made every day.
Further information can be found at:
http://www.healthanswers.com/health_answers/search_get_answer/forums/circulatory/frame1.htm
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.