Heart failure develops when the heart muscle cannot pump blood effectively, diminishing its pumping power. Because the body’s need for oxygen-rich blood is not being met, a range of symptoms can occur. It is a long-term condition that can progress over time. Fortunately, a variety of treatments are available to manage symptoms, improve heart function, and slow the disease’s progression.
Lifestyle and Home Management
Managing heart failure begins with daily habits and self-care to control symptoms and prevent the condition from worsening. A primary focus is on dietary changes, particularly reducing sodium. Excess salt leads to fluid retention, which increases the volume of blood the weakened heart must pump. Healthcare providers recommend limiting sodium intake to 2,000–3,000 milligrams or less per day and reading food labels to avoid hidden sodium.
In addition to dietary salt, managing fluid intake is another component of home care. Because the heart’s inefficient pumping can cause fluid retention, a doctor may suggest limiting liquids to reduce the heart’s workload. Daily monitoring is also recommended. Weighing yourself each morning can detect sudden weight gain, an early sign of fluid buildup, while tracking symptoms provides valuable information for the healthcare team.
Regular physical activity, approved by a doctor, can strengthen the heart and improve circulation. An exercise plan, often part of a cardiac rehabilitation program, is tailored to an individual’s capacity. It is also beneficial to abstain from smoking and limit alcohol, as these habits place additional stress on the heart. Managing stress through relaxation techniques like deep breathing or meditation can also be helpful.
Medications
Medication is a central part of nearly every heart failure treatment plan, with multiple drugs often used in combination. One major group includes angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and angiotensin receptor-neprilysin inhibitors (ARNIs). ACE inhibitors and ARBs work by relaxing blood vessels, which lowers blood pressure and eases the heart’s pumping action. ARNIs combine an ARB with a neprilysin inhibitor, which also helps the body get rid of sodium and water.
Beta-blockers are another class of medication for heart failure. These drugs slow the heart rate and reduce the force of its contractions, decreasing the heart’s demand for oxygen and lessening its workload. This can help the heart muscle recover and function more effectively over time. Common beta-blockers for heart failure include bisoprolol, carvedilol, and nebivolol.
To address fluid retention, doctors prescribe diuretics, also known as water pills. These medications help the kidneys remove excess sodium and water, which reduces swelling and can ease shortness of breath caused by fluid in the lungs. Aldosterone antagonists are another type of diuretic that blocks the hormone aldosterone, helping to reduce fluid retention and prevent scarring of the heart muscle.
A newer class of medications is the sodium-glucose cotransporter-2 (SGLT2) inhibitors. Originally for diabetes, these drugs reduce the risk of hospitalization and death for people with heart failure, even those without diabetes. They work in the kidneys to help remove sugar from the body, which has a mild diuretic effect and other positive impacts on the heart and blood vessels.
Medical Devices and Surgical Procedures
When lifestyle changes and medications are not sufficient, medical devices and surgical interventions may be considered. For individuals at risk of life-threatening arrhythmias, or irregular heartbeats, an implantable cardioverter-defibrillator (ICD) may be recommended. This small device is placed in the chest to monitor the heart’s rhythm. It delivers an electrical shock to restore a normal beat if a dangerous rhythm is detected.
Some people with heart failure experience discoordination in the pumping action of the ventricles. Cardiac resynchronization therapy (CRT), or biventricular pacing, can address this. A special pacemaker is implanted to send electrical signals that coordinate the contractions of the ventricles, helping them pump more efficiently. This improves the heart’s overall function and alleviates symptoms.
If heart failure is caused by a correctable issue, surgery may be an option. Coronary artery bypass surgery can be performed for heart failure due to coronary artery disease, rerouting blood flow around blocked arteries. Another surgical option is heart valve repair or replacement. If a faulty valve forces the heart to work harder, repairing or replacing it can improve heart function.
Advanced and End-Stage Options
For severe heart failure that no longer responds to other treatments, more advanced therapies are available. One option is a ventricular assist device (VAD), a mechanical pump implanted in the chest to help a weakened heart circulate blood. A VAD supports the heart’s function rather than replacing it. It can be a temporary “bridge to transplant” for patients awaiting a heart transplant or a long-term “destination therapy” for those ineligible for one.
A heart transplant is the definitive surgical treatment for eligible patients with end-stage heart failure. The procedure involves replacing the diseased heart with a healthy donor heart. The availability of donor hearts is limited, and not all patients are suitable candidates. Transplant recipients must take lifelong medications to prevent their body from rejecting the new organ.
Palliative care is an important consideration for anyone with advanced heart failure. This specialized medical care focuses on providing relief from the symptoms and stress of the condition to improve quality of life for the patient and family. It can be provided at any stage of illness and alongside other treatments. Palliative care offers an extra layer of support for the challenges of living with heart failure.