How is congestive heart failure treated?

JoAnne Chichetti
Cardiac Rehabilitation

When standard heart failure medications no long control the symptoms of heart failure, there are surgical treatment options that can help improve heart failure symptoms. These options include bi-ventricular pacemakers, mechanical circulatory assist devices, and heart transplantation. 

The Bi-ventricular pacemaker is a treatment option when the lower chambers of the heart, the left and right ventricles, no longer contract (squeeze) at the same time. The bi-ventricular pacemaker, also known as cardiac resynchronization therapy, is surgically placed under the skin of the chest wall. The pacemaker can be programmed to pace both ventricles, which allows them to contract at the same time.  By synchronizing the ventricles, heart failure symptoms, such as shortness of breath improves. 

Mechanical circulatory assist devices, also known as ventricular assist devices (VADs) are designed to take over the function of the weakened heart. These devices are surgically implanted in the chest, and can help the right ventricle, left ventricle or both ventricles pump blood. These devices can be used as a bridge to a heart transplant or as destination therapy for patients not eligible for a transplant, or for those that do not want a heart transplant. These devices help pump oxygenated blood throughout the body, improving symptoms of shortness of breath and fatigue associated with advanced heart failure.

Heart transplantation is a surgical treatment option for end stage heart failure, when medications and surgical treatment options no longer relieve heart failure symptoms. Heart transplantation consists of removing the person’s failing heart and replacing the heart with a healthy heart from a deceased donor. Donor hearts are very scarce, so patients needing a heart transplant must be carefully evaluated by a heart transplant center.

Congestive heart failure may be treated with drugs, ventricular assist devices (VADs), or heart transplantation. 

Drugs used to treat heart failure include:


- ACE (angiotensin-converting enzyme) inhibitors, which help blood vessels dilate and help the body eliminate excess water, lowering the amount of work the heart has to do

- Beta blockers, sometimes used with ACE inhibitors, may slow heart rate and relax thickened heart muscle

- Digitalis, which increases the force of each heart beat and slows a heart rate that is too fast

- Diuretics, which help the body eliminate excess water and reduce blood pressure

- Investigational therapies, such as stem cell and gene therapies


When heart failure continues to progress despite these treatments, tissues throughout the body fail to receive the nutrients and oxygen that they require. Over time, this can cause organ failure.


The left ventricle is the chamber responsible for pumping oxygen-rich blood from the heart to the aorta for transport to the rest of the body. VADs help heart failure patients by taking on the workload of the left ventricle, helping the heart to pump oxygenated blood to the rest of the body. As a result, all tissues and organs receive the blood supply they need to do their jobs, and the patient feels better.

Johns Hopkins Medicine

There are several different courses available to treat congestive heart failure.

Most often, some type of medication is prescribed for heart failure patients, such as:

•Vasodilators, often the foundation of treatment for CHF, may be prescribed to dilate blood vessels, reducing blood pressure and easing blood flow

•Diuretics elevate the rate of urination, thus reducing the amount of fluid in the body and are useful for patients with fluid retention and hypertension.

•Digitalis glycosides strengthen the heart's contractions, helping to improve circulation.

•Anticoagulants (such as warfarin) help prevent blood clots.

•Beta blockers, calcium channel blockers and tranquilizers help improve blood flow, ease breathing and relieve anxiety.

•Beta blockers added to ACE inhibitors have been shown to improve survival.

It may be necessary, in advanced cases, to administer oxygen through a nasal tube. Mechanical devices for administration of oxygen are available for home use after the condition has stabilized in the hospital.

More severe cases of heart failure may require surgery to bypass blocked blood vessels or replace heart valves.

If the blood vessels are clogged with plaque, the doctor may perform an outpatient procedure called percutaneous transluminal angioplasty. The doctor will use a catheter and a balloon to expand the diameter of the blood vessel so blood can flow more freely.

If other treatments fail and the heart muscle has been too badly damaged, you may require a heart transplant. The survival rate for this surgery is 80 percent after one year and over 60 percent after four years.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.