Heart Failure
Treatment Overview
Treatment depends on the cause of heart failure, which type you have, the severity of your symptoms (classification), and how well your body is able to compensate.
Treatment of heart failure that is caused by a filling problem (diastolic heart failure) may differ from treatment of heart failure that is caused by a pumping problem (systolic heart failure). Identifying the type of heart failure you have will help guide proper treatment.
Sometimes heart failure can be fixed if another problem can be corrected, such as through heart valve replacement surgery or treatment to correct hyperthyroidism.
If heart failure develops shortly after a heart attack, it can sometimes be reversed with coronary artery bypass surgery or angioplasty, medicine, and cardiac rehabilitation.
Initial treatment
The goal of treatment for early stage heart failure is to relieve symptoms and prevent additional heart damage. You will probably take a diuretic first to reduce blood pressure and fluid buildup. Next, your doctor will probably prescribe one or more other medicines, including an ACE inhibitor. If you cannot tolerate the ACE inhibitor, you will probably use an angiotensin II receptor blocker (ARB). ACE inhibitors and ARBs reduce the heart's workload, lower blood pressure, and reduce fluid retention and swelling.
You may also take a beta-blocker medicine. These drugs can keep heart failure from getting worse and, in some cases, will improve your heart function and prolong life. Some people can't take beta-blockers because of their side effects.
Lifestyle recommendations include the following:
- Eat less salt. For more information, see:
- Exercise under the direction of your doctor. For more information, see:
- Lose weight if you are overweight.
- Stop smoking, because smoking increases your risk of heart disease and makes it more difficult to exercise. For more information, see the topic Quitting Smoking.
- Avoid overuse of alcohol. Moderate drinking means no more than 2 drinks a day for men and 1 drink a day for women.
- Control your high blood pressure. Exercising, limiting alcohol intake, and controlling stress will help keep your blood pressure in a healthy range too. For more information, see the topic High Blood Pressure (Hypertension).
- Control your diabetes.
Your doctor will also need to treat the cause of your heart failure. You may need to take additional medicine for coronary artery disease, high blood pressure, diabetes, or an abnormal heart rhythm (arrhythmia).
Ongoing treatment
Although some causes of heart failure are reversible, in most cases heart failure cannot be cured. Most likely you will have to take medicine for the rest of your life. Ongoing treatment is aimed at decreasing the progression of the disease and preventing complications and hospital stays. Treatment should also improve symptoms and help you live longer.
ACE inhibitor medicines are the cornerstone of treatment for most people with heart failure. If you cannot tolerate the ACE inhibitor, you will probably use an angiotensin II receptor blocker (ARB). ACE inhibitors and ARBs can prolong life and reduce symptoms.
If you have continued swelling, you may need to take a diuretic medicine, such as furosemide (Lasix) or bumetanide (Bumex). If you have moderate to severe heart failure, you may need to take the diuretic spironolactone (Aldactone), which has properties that can prevent heart failure from getting worse in addition to improving your symptoms.
Beta-blocker medicines are often prescribed because they can keep heart failure from getting worse and, in some cases, will improve your heart function and prolong life. But some people are not able to take them because of their side effects.
If your heart failure is getting worse or you have been hospitalized for sudden heart failure, your doctor might add digoxin (such as Lanoxin) to your treatment. Digoxin can lower the number of times that people have to go to the hospital for heart failure.
If symptoms are not controlled with the other medicines, ARBs (angiotensin II receptor blockers), nitrates, and hydralazine may be added.
If you have not made diet and lifestyle changes already, these changes are important in managing your symptoms.
Activity and exercise for people with heart failure are very important. If you are not already active, your doctor will want you to begin an exercise program. Prescribed exercise is often part of a cardiac rehabilitation program. For more information on starting and maintaining an exercise program, see:
Getting too much sodium, not taking medicines as directed, and having an illness such as pneumonia or influenza are some of the most common reasons that people with heart failure have to be hospitalized. Getting immunizations for pneumonia and flu infections, watching your sodium intake, and taking medicines as prescribed all are important to reduce the chance that your condition will get worse.
Your doctor will likely work with you to develop some guidelines for managing weight gain caused by fluid buildup. For example, if you suddenly gain weight—such as 3 lb (1.4 kg) or more in 2 to 3 days—your doctor may recommend that you take an additional diuretic (water pill) that day. Your doctor may give you a slightly different weight gain to watch for.
Biventricular pacemakers, which make the heart’s lower chambers (ventricles) contract together, may be an option for people who have heart failure and problems with the heart's electrical system. Doctors call this treatment cardiac resynchronization therapy, or CRT. This type of pacemaker can help you feel better so you can be more active. It also can help keep you out of the hospital and help you live longer.4 In some cases, you may get a pacemaker that is combined with a device that can shock your heart back to a normal rhythm if it is beating dangerously fast. The device is called an implantable cardioverter-defibrillator, or ICD. It can prevent sudden death. For more information on pacemakers, see:
Implantable cardioverter-defibrillators (ICDs) are another possible treatment for people with heart failure. An ICD gives the heart a shock to stop a deadly rhythm and return the heart to a normal rhythm. ICDs cannot improve symptoms of heart failure. But an ICD can prevent sudden death from an abnormal heart rhythm and may help you live longer. For more information, see:
If you get a pacemaker or ICD, you will want to know how to be safe and keep it working right. For more information, see:
Your doctor may also recommend oxygen therapy to reduce shortness of breath and increase your ability to exercise. For more information, see:
You will probably need to continue treatment to correct or control any other problems (such as high blood pressure, diabetes, or coronary artery disease) or sudden heart failure triggers (such as fever, arrhythmia, anemia, or infection).
You will have regular appointments with your doctor so that he or she can monitor how you are responding to treatment and manage any changes in how your body responds. Gradual adjustments and frequent monitoring are a normal part of the treatment of heart failure and will help you avoid sudden heart failure or other complications.
Treatment if the condition gets worse
In some cases when standard medical treatment does not help, other measures are considered. These include heart transplant and ventricular assist devices (VADs), which are mechanical pumping devices that help the heart pump blood. But these are options only for a very small number of people.
Other lifestyle changes may include limiting fluids. For more information, see:
Palliative care
As your condition gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.
Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.
If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
End of life
Thousands of people in the United States die from heart failure each year despite the best efforts of doctors and modern medicine. Since the disease can quickly progress to a more severe form, many people (and their families) are not prepared for decisions that they must make regarding the type of care they wish to receive at the end of their lives. You will need to decide whether you want life-support measures if your condition becomes more severe. An advance directive is a legal document that instructs doctors on how to care for you at the end of your life. Advance directives can include the ability to refuse treatment in specific situations. For more information, see the topic Care at the End of Life.
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| Author: | Robin Parks, MS | Last Updated: August 25, 2008 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology | |
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