How Heart Failure Is Treated

Heart failure is a serious disease that cannot be cured. Survival and quality of life with heart failure can be improved with medical treatment, lifestyle modification, and, sometimes, with specialized surgical procedures. Prescription medications, such as beta blockers, ACE inhibitors, and diuretics, are the most commonly used approaches to heart failure treatment. The drugs used work by stimulating the heart to pump more efficiently, preventing excess fluid from building up in the body, or by lowering blood pressure. Valve replacement, a pacemaker, or other interventions may be considered in some patients.

Prescriptions

Prescription medications are the most effective treatments for management of heart failure. These medications often have to be adjusted periodically as your disease progresses. Sometimes, your doctor may prescribe a combination of medications for management of your heart failure because they combat the symptoms of heart failure in different ways. Options include:

Beta blockersBeta blockers—Zebeta (bisoprolol), Coreg (carvedilol), and Toprol (metoprolol)—are used for heart failure because they slow down the heart rate. This allows the heart to fill more completely before pumping, which provides the body with more blood with each heartbeat. This helps alleviate some of the fatigue that you can experience as a result of heart failure. 

DiureticsDiuretics are medications that promote elimination of water from the body by acting on the kidneys. This relieves the edema and shortness of breath of heart failure, as both of these symptoms are the result of fluid pressure in the body. Commonly used diuretics include Lasix (furosemide), Bumex (bumetanide), and Esidrix (hydrochlorothiazide). Potassium levels can become low with diuretic use, so mineral supplementation may be required.

Angiotensin-converting enzyme (ACE) inhibitorsThese medications work directly on the blood vessels of the body to lower the pressure that your heart has to pump against. The most common ACE inhibitors used in heart failure include Prinivil and Zestril (lisinopril), Lotensin (benazepril), Capoten (captopril), Vasotec (enalapril), and Monopril (fosinopril).

Angiotensin II receptor blockers (ARBs)ARBs work by lowering blood pressure, which reduces the strain on the heart. Examples of ARBs include Losartan (Cozaar) and Benicar (olmesartan).

Aldosterone antagonists: Aldosterone antagonists, such as Aldactone (spironolactone), work against a hormone called aldosterone and remove fluid from the body. They are known as "potassium-sparing," because they prevent the potassium level in the body from becoming too low. 

Hydralazine with nitrates: This combination works to dilate (expand) arteries, lowering blood pressure. This prevents worsening of heart failure, which occurs when the heart pumps against high pressure for years. 

Neprilysin inhibitorsEntresto is a combination of valsartan, an ARB inhibitor and a new agent, sacubitril. Sacubitril inhibits the enzyme neprilysin, causing an increase in levels of natriuretic peptides, which help regulate blood pressure, as well as salt and fluid levels. It is still a relatively new treatment for heart failure, and its effect in comparison to the more established medications, as well as its long-term side effects, are not fully understood yet. 

Dopamine: By making the heart beat more forcefully, dopamine helps it circulate oxygen-rich blood more efficiently. Dopamine increases the amount of urine the body produces, which helps the body get rid of the extra fluid building up in the lungs, arms, and legs. Interestingly, unlike many of the other medications used for heart failure that lower blood pressure, dopamine raises blood pressure. In some circumstances, this effect is helpful because low blood pressure may occur in heart failure.

Dopamine isn't usually the first treatment choice for heart failure, but it is especially useful in premature babies and infants with other heart problems. It can boost babies' heart rates and blood pressure, significantly improving their chances of survival. Dopamine shouldn't be taken with beta blockers, which lengthen and strengthen the normal effect of dopamine.

Home Remedies and Lifestyle

If you have heart failure, home remedies and lifestyle adjustments are absolutely necessary aspects of managing your condition. While these steps cannot cure heart failure, not following these lifestyle recommendations is associated with worsening of the symptoms of heart failure and progression of the disease itself. 

Salt restriction: Salt consumption is associated with an increase of fluid in the body. This is not a problem for healthy people, as the body can rebalance and eliminate excess fluid and salt fairly efficiently. However, if you have heart failure or kidney disease, this doesn't happen as efficiently as it should, increasing your chances of fluid accumulation. Many people with heart failure notice that symptoms of swelling and shortness of breath worsen with an increased salt intake. You can get advice from your dietitian or doctor regarding the exact amount of salt you can consume on a daily basis. 

Diet: Regularly eating a healthy diet, without excess cholesterol and fat (especially trans fat), can help prevent coronary artery disease (CAD) and heart failure from worsening.

Watching your weight: Maintaining a healthy weight helps protect your heart from the burden of being forced to pump blood to support a heavier body—a concern, as a strain on the heart is already a problem in heart failure. To lose weight successfully, you may need advice from a dietitian, who can evaluate your diet to see if you should cut back on carbohydrates, fat, or calories in general. 

Physical activity: Staying active keeps your heart muscles strong. If you have heart failure, it is important for you to exercise and to do so wisely, as overexertion can be dangerous for your heart. Talk with your doctor about your target heart rate during exercise to ensure that you do not take part in an activity that is too straining.

Specialist-Driven Procedures

Surgery or other procedures do not cure heart failure itself. They can, however, improve heart function, regulate an irregular heart rhythm, or repair heart valve abnormality, which may be appropriate and beneficial in some—though not all—people with this condition.

Defibrillator implantation: An implantable defibrillator is a pacemaker-like device that is used to prevent sudden death in people who are at high risk for this event. If a lethal arrhythmia occurs, the implantable defibrillator can automatically deliver a shock to the heart to restore the rhythm back to normal.

Cardiac resynchronization therapy (CRT): A CRT device is a specialized pacemaker that can coordinate the pumping action of the hearts' right and left ventricle, to improve the efficiency of the heartbeat. CRT can be useful in selected people with heart failure who also have certain kinds of bundle branch block.

Both of the above procedures may take place in the operating room or in a specialized cardiac suite in the hospital. They are usually done under local anesthesia and are typically tolerated well. Most people stay in the hospital for observation for about 24 hours. 

Left ventricular assistive device (LVAD) implantation: LVADs are battery-operated pumps implanted in the body to assist the heart with pumping. They were initially considered a way to support the heart function for people who were waiting for heart transplants, but they are effective and can be used as a more long-term plan.

Placement of these devices requires general anesthesia and a recovery period of several days. You should also expect your medical team to test the effectiveness of the device shortly after the procedure and periodically for the long term.

Heart transplant: A heart transplant is a procedure in which your heart is surgically removed and completely replaced with a donor's heart. This is a major surgical procedure, requiring general anesthesia and intense monitoring during surgery. You should expect close monitoring after surgery, several weeks of recovery, as well as a plan for cardiac rehabilitation after your transplant. 

Catheter ablation: A catheter ablation is a procedure that inhibits erratic electrical activity that causes heart rhythm abnormalities by creating a lesion in the area responsible for the problems. You might benefit from this procedure if you have an irregular heart rhythm. 

You may have the procedure in the operating room or in a specialized cardiac procedural suite in the hospital. You can expect a relatively quick recovery if your procedure is uncomplicated. 

Valve replacement: A replacement heart valve can address blood flow restriction due to abnormal valve structure. This may be a routine procedure, or it may be quite extensive, depending on the severity of the valve problem and how many valves are affected.

A heart valve replacement uses either an artificial valve or one composed of human or pig tissue. Which type of heart valve replacement is best for you depends on your anatomical heart valve problem and your personal preferences.

Complementary Medicine (CAM)

There are some alternative therapeutic interventions that have been proven to show benefit in the management of heart failure. These approaches do not cure or improve the condition, and they have not been proven to prolong life. However, they may improve symptoms and help in preventing the worsening of heart failure. 

  • Mind-body intervention: Techniques such as yoga, tai-chi. acupuncture, biofeedback, and reflexology are generally done with the guidance and supervision of a trained expert. Studies have shown that these interventions can provide small to moderate benefits for people who have heart failure. 
  • Stress reduction: Stress management through techniques such as meditation, counseling, mindfulness, and lifestyle adjustment have all been shown to produce moderate benefit in heart failure. In general, there are a wide variety of stress management techniques, and it is important to select the approach that best fits your personality best.
  • Curcumin: A natural spice derived from turmeric, curcumin has shown some preliminary promise in heart failure in animals. Its effectiveness in preventing or treating heart failure in humans is unknown.

Over-the-Counter Therapies

Over-the-counter medications are not normally beneficial in heart failure. In fact, a number of them can cause heart failure to worsen. Some can also interfere with prescription heart failure medications, preventing them from working as they should. If you have heart failure, it is best not to use over-the-counter drugs, even for routine health problems, without checking with your doctor or pharmacist first. 

Some of the most common over-the-counter medications you should avoid if you have heart failure include:

  • Non-steroidal anti-inflammatories (NSAIDs): Drugs such as aspirin, Advil or Motrin (ibuprofen), and Aleve or Naprosyn (naproxen) can cause an increase in your blood pressure. 
  • Cough medications containing pseudoephedrine (Sudafed, Actifed, Contrex, and Nyquil) may also increase your blood pressure. 

Over-the-counter medications that are considered safe to take if you have heart failure include:

  • Chlortrimeton or Aller-Chlor (chlorpheniramine)
  • Robitussin DM (guaifenesin with dextromethorphan)
  • Claritin (loratadine)

But again, it's always best to check with your doctor before starting a new medication if you have heart failure.

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