Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.
Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly.
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
. Angiotensin-converting enzyme (ACE) inhibitors. These drugs relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis, Prinivil) and captopril.
. Angiotensin II receptor blockers. These drugs, which include losartan (Cozaar), valsartan (Diovan) and candesartan (Atacand), have many of the same benefits as ACE inhibitors. They may be an option for people who can’t tolerate ACE inhibitors.
. Beta blockers. These drugs slow your heart rate and reduce blood pressure. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle) and bisoprolol.
. Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you’re taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
. Aldosterone antagonists. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). These are potassium-sparing diuretics that have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that’s high in potassium.
. Positive inotropes. These medications may be given by IV to people with certain types of severe heart failure who are in the hospital. Positive inotropes can help the heart pump blood more effectively and maintain blood pressure. Long-term use of these drugs has been linked to an increased risk of death in some people. Talk to your health care provider about the benefits and risks of these drugs.
. Digoxin (Lanoxin). This drug, also called digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
. Hydralazine and isosorbide dinitrate (BiDil). This drug combination helps relax blood vessels. It may be added to your treatment plan if you have severe heart failure symptoms and ACE inhibitors or beta blockers haven’t helped.
. Vericiguat (Verquvo). This newer medicine for chronic heart failure is taken once a day by mouth. It’s a type of drug called an oral soluble guanylate cyclase (sGC) stimulator. In studies, people with high-risk heart failure who took vericiguat had fewer hospital stays for heart failure and heart disease-related deaths compared with those who received an inactive pill (placebo).
. Other medications. Your doctor may prescribe other medications to treat specific symptoms. For example, some people may receive nitrates for chest pain, statins to lower cholesterol or blood-thinning medications to help prevent blood clots.
Your doctor may need to adjust your doses frequently, especially when you’ve just started a new medication or when your condition is worsening.
You may be admitted to the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen for a long time.
Surgery or other procedures
Surgery or other procedures to implant cardiac devices may be recommended to treat the underlying problem that led to heart failure. Surgery or other procedures for heart failure may include:
. Coronary bypass surgery. If severely blocked arteries are causing your heart failure, your doctor may recommend coronary artery bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it below and above the blocked arteries in your heart. The new pathway improves blood flow to your heart muscle.
. Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. Surgeons can repair the valve by reconnecting valve flaps or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve.
Heart valve repair or replacement may be done as open-heart surgery, a minimally invasive surgery or a heart procedure using flexible tubes called catheters (cardiac catheterization).
. Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It isn’t a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It’s implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also work as a pacemaker and speed your heart up if it is going too slow.
. Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren’t pumping in sync with each other. A device called a biventricular pacemaker sends electrical signals to the ventricles. The signals trigger your ventricles to contract in a more coordinated way, which improves the pumping of blood out of your heart. CRT may be used with an ICD.
. Ventricular assist devices (VADs). A VAD — also known as a mechanical circulatory support device — is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both ventricles of your heart, it is most frequently implanted in the left ventricle.
Your doctor may recommend a VAD if you’re waiting for a heart transplant. Sometimes, a VAD is used as a permanent treatment for people who have heart failure but who aren’t good candidates for a heart transplant.
. Heart transplant. Some people have such severe heart failure that surgery or medications don’t help. These people may need to have their hearts replaced with a healthy donor heart.
A heart transplant isn’t the right treatment for everyone. A team of doctors at a transplant center will evaluate you to determine whether the procedure may be safe and beneficial for you.
Palliative care and end-of-life care
Your doctor may recommend including palliative care in your treatment plan. Palliative care is specialized medical care that focuses on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.
It’s possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device isn’t an option. If this occurs, you may need hospice care. Hospice care provides a special course of treatment to terminally ill people.
Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, psychological, social and spiritual support for people who are ill and those closest to them.
Hospice care is available in your own home or in nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity.
Although it can be difficult, discussing end-of-life issues with your family and medical team is important. Part of this discussion will likely involve advance care directives — a general term for oral and written instructions you give concerning your medical care should you become unable to speak for yourself.
If you have an ICD, one important consideration to discuss with your family and doctors is whether it should be turned off so that it can’t deliver shocks to make your heart continue beating.
Lifestyle and home remedies
Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make:
. Stop smoking. Smoking damages your blood vessels, raises blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster.
If you smoke, ask your doctor to recommend a program to help you quit. You can’t be considered for a heart transplant if you continue to smoke. Avoid secondhand smoke, too.
. Check your legs, ankles and feet for swelling daily. Contact your doctor if the swelling worsens.
. Discuss weight monitoring with your doctor. Weight gain may mean that you’re retaining fluids and need a change in your treatment plan. Ask your doctor how often you should weigh yourself and when to contact your doctor because of weight gain.
. Maintain a healthy weight. If you’re overweight, a dietitian can help you work toward your ideal weight. Even losing a small amount of weight can help improve your heart health.
. Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins.
. Limit salt. Too much salt (sodium) can cause water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet.
Ask your doctor if you should follow a no-salt or low-salt diet. Keep in mind that salt is already added to prepared foods, and be careful when using salt substitutes.
. Limit saturated or trans fats in your diet. In addition to avoiding salty foods, limit the amount of saturated and trans fats in your diet. These potentially harmful dietary fats increase your risk of heart disease.
. Get vaccinations. Ask your doctor about getting influenza, pneumonia and COVID-19 vaccinations.
. Limit alcohol and fluids. Your doctor may recommend that you don’t drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms.
If you have severe heart failure, your doctor may also suggest that you limit the amount of fluids you drink.
. Be active. Moderate aerobic activity helps keep the rest of your body healthy and conditioned, reducing the demands on your heart muscle. But be sure to talk to your doctor about an exercise program that’s right for you. Your doctor may suggest a walking program or a cardiac rehabilitation program at your local hospital.
. Reduce stress. When you’re anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, since your heart is already having trouble meeting the body’s demands.
Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
. Sleep easy. If you’re having shortness of breath, especially at night, sleep with your head propped up using a pillow or a wedge. If you snore or have had other sleep problems, make sure you get tested for sleep apnea.
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