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Treating Heart Failure for Lasting Health

Treating Heart Failure for Lasting Health

Following the get-better strategy you create with your doctor will help improve your quality of life.

If you’re among the 5.7 million people in the United States living with heart failure, you may wonder why you should even bother following a treatment plan. Your heart has failed—what’s the point?

Despite its name, heart failure actually means your heart isn’t working as well as it should. While there’s no cure for the condition, there’s plenty you can do to treat the symptoms, improve your quality of life and keep your condition from getting worse. Treatment for heart failure may include lifestyle changes, medications and surgery.

Tweak your lifestyle habits
Your doctor will likely advise you start addressing heart failure with some strategic lifestyle changes.

Follow a heart-healthy diet: The American Heart Association (AHA) recommends eating a variety of nutrient-rich foods. You may have heard the lineup before: lean protein such as fish and skinless chicken; fresh or frozen fruits and vegetables; whole grains like those found in whole grain bread and plain oatmeal; low-fat dairy; and nuts and legumes such as black beans and chickpeas.

Eating salt can cause the body to retain excess fluid, and since it’s common for people with heart failure to have fluid retention, you should also limit your sodium intake. The AHA has set an ideal limit of 1,500 milligrams of sodium per day due to its blood pressure-reducing affects. Talk to your doctor about how limiting salt might help you improve heart failure symptoms and what amount of daily sodium you should shoot for. You may be advised to follow certain heart-healthy eating patterns, such as the Dash diet.

You should also consult with your doctor on how much liquid you should consume. Too much fluid in your body can make it harder for your weakened heart to do its job. Too little fluid can pose problems as well.

Maintain a healthy weight: Excess weight raises blood pressure and blood cholesterol, lowers HDL (“good”) cholesterol and puts strain on the heart. If you’re overweight, talk with your doctor about how to incorporate heart-healthy foods into a weight loss plan you can stick with. And, with your doctor’s okay, aim to make exercise a regular part of your routine. The AHA recommends 30 minutes of moderate physical activity—a brisk walk, water aerobics or ballroom dancing, for example—at least five days a week.

If you smoke, quit: Cigarettes are bad for everyone, but if you have heart failure they’re especially toxic. That’s because of what nicotine does to your heart. Specifically, it temporarily increases your blood pressure and it can block the blood vessels that feed the heart. If you don’t smoke, but live with a smoker, you’re not off the hook, either.

The good news for anyone looking to kick the habit: The benefits to your health begin almost right away. Within half an hour of smoking your last cigarette, your blood pressure and heart rate recover from the nicotine-related spikes, according to the AHA and the U.S. Surgeon General. After a year, your risk of coronary heart disease is cut in half.

Lower your levels of stress: Experts aren’t sure how stress affects your heart, but this much is certain: It can trigger behaviors (like smoking, drinking alcohol and overeating) that are bad for your heart.

Take your medications as prescribed
Depending on the severity of your condition, your treatment plan may also include taking medication. Since each of the most commonly prescribed drugs for heart failure treats a different aspect of the condition, you may be prescribed more than one of the following drugs. Ask your doctor to explain the purpose of any prescription you’re asked to take and how long you can expect to be on it.

  • Angiotensin-converting enzyme (ACE) inhibitors
    Among the benefits these drugs hold is that they lower blood pressure and reduce strain on the heart. They do that by inhibiting the production of angiotensin—a chemical that causes blood vessels to become narrow. They may also reduce the risk of a future heart attack. Some studies have shown that they lead to improved symptoms, reduced hospitalization and better survival in some heart failure patients. (Commonly prescribed: captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril and trandolapril.)
  • Angiotensin II receptor blocks (ARBs)
    Similar to ACE inhibitors, these drugs also work by blocking the activity of the chemical angiotensin, which causes arteries to become narrow. As a result, your blood vessels relax and blood is able to flow more easily. The way they work in heart failure patients specifically is not fully understood, but they serve as an alternative treatment for patients who can’t tolerate ACE inhibitors. (Commonly prescribed: candesartan, losartan and valsartan.)
  • Angiotensin-receptor neprilysin inhibitors (ARNIs)
    A new class of drugs, ARNIs don’t have a long history as a treatment for heart failure patients. They’re usually prescribed only after more common medications, such as ACE inhibitors and ARBs, have been tried. (Commonly prescribed: sacubitril/valsartan.)
  • Beta-blockers (beta-adrenergic blocking agents)
    These drugs are believed to benefit heart failure patients in part by slowing heart rate and lowering blood pressure to decrease the heart’s workload. They also reduce the risk of abnormal heart rhythms and lower one’s chances of dying unexpectedly. (Commonly prescribed: bisoprolol, metoprolol succinate and carvedilol.)
  • Isosorbide dinitrate and hydralazine
    This combination drug helps relax blood vessels, making it easier for the heart to pump blood. It offers potential benefits for most heart failure patients and research suggests it’s especially beneficial to African-Americans with heart failure. A study published in 2004 in The New England Journal of Medicine found that it lowered the risk of death in African-Americans with advanced heart failure. (Commonly prescribed: isosorbide dinitrate/hydralazine.)
  • Diuretics (a.k.a. water pills)
    People with heart failure often retain fluid which makes it harder for the heart to do its job. Cutting back on sodium and limiting your liquids may be enough to help your body eliminate excess fluids. If not, your doctor may prescribe a diuretic. There are three different classes of diuretics: thiazide diuretics (including chlorothiazide, hydrochlorothiazide and chlorthalidone), loop diuretics (such as bumetanide and ethacrynic acid) and potassium-sparing diuretics (see below). Each one works a little differently, so talk to your doctor about which one makes sense for you.
  • Aldosterone antagonists
    A type of diuretic, these drugs work by specifically blocking a hormone called aldosterone, which causes people with heart failure to retain sodium and fluids. These drugs have been shown to help people with severe heart failure live longer. Like some other diuretics, though, they may raise levels of potassium in your body, so your doctor will want to monitor you closely if you are prescribed a diuretic. (Commonly prescribed: spironolactone and eplerenone.)

Consider surgical options if recommended
If you have severe heart failure, your doctor may advise that you require one of the following medical procedures or surgery.

  • Implantable cardioverter defibrillator (ICD)
    If you have severe heart failure and have suffered from or are at high risk for sudden cardiac arrest (when the heart suddenly and unexpectedly stops beating), your doctor may recommend an ICD. If so, you’ll undergo surgery, during which an ICD will be placed under the skin of your chest. Its job is to then check your heart rate and use electrical pulses to correct any irregular heartbeats.
  • Cardiac resynchronization therapy (CRT)
    When both sides of your heart no longer contract at the same time—which is the case for some heart failure patients—the beating of your heart is disrupted. If you have this problem, you may need to have a type of pacemaker called a CRT implanted near your heart.
  • Left ventricular assist device (LVAD)
    Your doctor may recommend a procedure in which a mechanical heart pump (the LVAD) is surgically implanted to help your weakened heart pump blood out to the rest of your body.

Certain cases of heart failure may warrant surgery, such as valve replacement surgery, angioplasty, coronary artery bypass or—in very severe and worsening cases—heart transplant.

Medically reviewed in November 2018.

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