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Heart failure is usually a chronic condition that has taken years to develop and worsen. Treatment for heart failure is generally designed for three purposes: to improve any symptoms, to slow progression of the heart failure, and to prolong survival. In addition, physicians may choose to treat the underlying conditions that contributed to the heart failure.
Finally, most patients are advised to make lifestyle changes, regardless of the severity of their condition. These may include modifying their diet, limiting salt intake, achieving and maintaining a healthy weight, learning and practicing stress management skills, quitting smoking, and getting regular exercise, depending on the severity of the illness.
Lifestyle choices that are more specific to heart failure may include:
- Limiting physical activity until approved by one’s physician, and then staying as active as possible. Heart failure patients who exercise regularly typically show significant improvement, whereas heart failure patients who are inactive show a clear decline. In studies, tai chi (an ancient Chinese workout involving slow, relaxing movements) has been shown to benefit patients living with heart failure. However, exercise in any form is beneficial. Patients should consult their physician before beginning an exercise program.
- Scheduling relaxation and rest periods throughout the day.
- Avoiding excessive fluid intake.
- Keeping a diary of one’s daily weight, and notifying one’s physician if there is a weight gain of three or more pounds in a single week (which may indicate fluid retention and the need for an immediate change in treatment). Patients experiencing weight loss in spite of what appears to be adequate calorie intake should also discuss their situation with their physician. A study has found that some patients with heart failure may need to adjust their diet to meet increased energy needs.
- Avoiding excessive salt intake, which may contribute to fluid retention.
- Limit alcohol intake.
Patients with heart failure should always consult their physician before taking any over-the-counter medicines, vitamins or herbal supplements.
Depending upon the nature of the underlying damage or malfunction that led to heart failure, medications may be prescribed to reduce the heart’s workload, affect remodeling, counter abnormal hormonal levels, increase blood flow, widen vessels or eliminate excess water from the body. Because the medications have different effects, they may be used in combination. Medications used to treat heart failure and related conditions include:
- ACE inhibitors. A type of vasodilator that expands blood vessels to allow blood to flow easier and more freely, allowing the heart to pump more efficiently. ACE inhibitors act by preventing the production of a chemical that causes blood vessels to expand so the heart does not have to work as hard to pump blood. Reports from the National Institutes of Health indicate that the use of ACE inhibitors has been the most significant factor in heart failure survival rate improvement over recent years. They also have a favorable impact on the heart itself (e.g., affecting remodeling).
- Angiotensin-II receptor blockers. These may also be used in conjunction with ACE inhibitors. They can also be used in patients who cannot take ACE inhibitors or beta blockers.
- Beta blockers. May prevent progression of the disease and improve symptoms by slowing the heart’s contraction rate and reducing its pumping action, thus lessening the heart’s workload. For many years beta blockers were considered inappropriate for people with heart failure because they can potentially weaken the heart muscle and cannot be used when the patient’s health is unstable. Recent studies have shown that selected beta blockers may be very helpful in treating heart failure. They have been shown to decrease mortality and improve left ventricular function in these patients. Beta blockers also reduce the likelihood that these patients will suffer from significant heart rhythm problems.
- Diuretics. Often referred to as water pills, these reduce the symptoms of congestion by helping to flush excess salt and fluids from the body. They are very useful in treating people with heart failure and fluid retention. Spironolactone, a “potassium-sparing” diuretic, has been found to be effective therapy in patients with severe heart failure.
- Inotropes. Intravenous (IV) drugs that increase the force of the heart’s contractions, allowing the heart to beat less frequently and more effectively. Individuals with severe heart failure often benefit from being hospitalized and being given these powerful medicines intravenously for 24 to 48 hours.
- Digoxin. A weak inotrope, digoxin appears to have an effect on hormones that make heart failure worse. It helps the heart contract more vigorously and effectively, and helps to reduce the symptoms of heart failure. It is most often used to control the fast heart rate of atrial fibrillation.
- Nitrates. These medications dilate the blood vessels, reduce the amount of blood returning to the heart, reduce the pressure in the arteries and make it easier for the heart to pump blood
In some cases, the physician will also seek to treat the underlying condition that caused the heart failure in the first place. Although not common, heart failure can be reversed once the underlying condition has been treated. For most people, however, heart failure is a chronic and progressive condition that can be managed but rarely cured.
If the heart failure was caused by coronary artery disease, the patient may be recommended for:
- Balloon angioplasty. A catheter-based procedure in which plaque is pressed back against artery walls to make more room for blood to flow through the artery.
- Coronary stenting. The insertion of a wire mesh metal tube called a stent into a clogged vessel in order to help keep it open. This usually occurs in conjunction with balloon angioplasty.
- Coronary artery bypass surgery, for patients with severe or total artery blockage
Other surgical and invasive therapies used to treat underlying conditions that contribute to heart failure include:
- Heart valve surgery, in patients with severe valvular regurgitation or valvular stenosis
- Pacemaker insertion to correct the slow heart rhythm (bradycardia) that can worsen heart failure.
- Cardiac resynchronization (e.g., biventricular pacemaker) to coordinate the contraction of the right and left ventricles in patients with heart failure.
- Implantable cardioverter defibrillator (ICDs) to monitor for and, if necessary, correct episodes of life threatening arrhythmias. ICDs are sometimes used in combination with a biventricular pacemaker.
 Aneurysm surgery in selected patients.
- Heart transplant surgery, in the most severe cases.
- Insertion of a left ventricular assist device prior to transplant surgery.
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