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How is heart failure treated?

Most often, your heart failure symptoms can be controlled with medicines, diet and finding the right balance between rest and low-level exercise. With early detection and treatment, there is a good chance you will lead a more normal life. Your heart failure symptoms may come and go or, in a few cases, go away completely.

Dr. Francis X. Downey, MD
Cardiothoracic Surgeon

The treatment for heart failure starts with medications to treat episodes of acute decompensation—sudden shortness of breath, lack of oxygen, drop in blood pressure, etc. Some patients will go long periods without an episode. Treatment can include intravenous (IV) medications to both help the heart pump and get extra fluid out of the body. However, IV medications, over time, lead to a higher death rate because of the risk of ventricular arrhythmias, ventricular fibrillations and sudden cardiac death.

Patients who have failed medical therapy, meaning medications have failed to keep the heart failure in check, may be eligible for transplant.

If a patient is ineligible for a heart transplant or has to wait, a ventricular assist device (VAD) is an option.

A VAD is mechanical pump that is surgically implanted into the heart or attached to the heart to support the patient.

Total artificial heart, which is a mechanical pump that supports both sides of the heart, is another option.

Kismet Rasmusson, FNP
Cardiologist (Heart Specialist)

Heart failure treatments will depend on the cause and extent of structural damage to the heart. When the heart is weakened (referred to as systolic dysfunction) classes of medicines are prescribed to limit symptoms (diuretics and digoxin) and to improve survival and reduce hospitalizations (ACE inhibitors or ARBs, beta blockers and aldosterone blockers). Beyond medications, in select patients biventricular pacemakers may be used to help resynchronize a dyssynchronous heart and internal cardiovertor defibrillators are implanted to abort potentially lethal arrhythmias. For patients with severe systolic dysfunction, heart transplant and/or artificial heart pumps (left ventricular assist device- LVAD) may be considered. When the heart muscle has a normal squeeze but has trouble relaxing (heart failure with preserved function or diastolic dysfunction) the treatments will include diuretics and medications to control other common conditions that commonly coexist such hypertension, atrial fibrillation and coronary artery disease. An important part of treatment includes teaching patients to live with this chronic condition- this includes understanding medications, staying as active as they can, weighing daily to monitor for fluid retention, following a low sodium diet and fluid restriction, and recognizing problematic symptoms. See more about heart failure treatments at http://intermountainhealthcare.org/heartfailure.

Do not be discouraged by the word "failure." For most patients, heart failure cannot be cured, but you can prevent it from getting worse and often help it get better. Here are some things that you can do to feel better:

  • Lifestyle changes (eat low salt food, watch your fluid intake, exercise, weigh yourself daily, quit smoking, avoid alcohol, go to your doctor's appointments)
  • Medications (diuretics, Angiotensin-Converting Enzyme (ACE) Inhibitors, Angiotensin Receptor Blockers, Beta Blockers)
  • Regular aerobic exercise, which provides remarkable benefits in restoring circulatory regulation as well as general well-being in heart failure and has been shown to decrease the need for hospitalization
  • Budgeting your energy for those activities that are most important to you, allowing time for rest and recharging

For some patients, further therapies may be considered, such as:

  • Devices to improve the timing of heart function, such as biventricular pacemakers
  • Reconstructive surgical therapy, including bypass, valve repair, and ventricular reconstruction
  • Cardiac assist devices to provide mechanical support for pumping the left side or both sides of the heart
  • Heart transplant
Linda Martinez
Cardiac Rehabilitation Specialist

The treatment of heart failure requires prescription medicine as well as life style changes. The treatment can be summed up as follows:

  • Medications
  • Low salt diet (usually no more than 2 gms or 2000 mg of salt or “sodium” a day)
  • Daily weights
  • Exercise or activity guidelines
  • Becoming familiar with the signs and symptoms of worsening heart failure and when to call your healthcare provider
  • Implantable devices in selected individuals based on degree of dysfunction of the heart.  (these devices are similar to pacemakers and are implanted most often under the collar bone in some individuals based on the degree of heart dysfunction)  This type of therapy is only used under the care of a cardiologist (a doctor who specializes in heart disease).
Joane Goodroe
Nursing Specialist

Patients with congestive failure need to be aware of the amount of liquids they take in and what comes out on a daily basis. Many patients in congestive failure are very thirsty and actually drink too many liquids. Their heart is unable to handle the fluids and it backs up in the lungs. Patients should weigh themselves each morning. If the patient sees a weight gain of more than four pounds in one day, call the doctor to see if he wants to alter the medications. Also, it is helpful for the patient to track the amount of fluids the patient drinks in one day. Decreasing the fluids can reduce the symptoms of congestive heart failure.

Linda Rohyans
Cardiac Rehabilitation Specialist

There are many lifestyle modifcations you can make that will help you manage your heart failure. All of the following recommendations are "Positive Self-Care Behaviors" that have helped many people:

  • Taking Prescribed Medications: Be sure to take all medications that your healthcare provider has ordered for you. Ask why you are taking the medications so you will better understand the importance of missing any doses. Always let your provider know if you are having difficulty obtaining your medications.
  • Follow-Up Care: As with any relationship in your life, communicating your specific needs as a unique individual requires a commitment of time, effort, and trust. The relationship you have with your healthcare team should be a 2-way street; keeping all appointments with your healthcare team provides the opportunity for assessment, discussion, and planning; all of which may potentially keep you out of the hospital.
  • Daily Weights: By weighing yourself every day, you will be better informed of how you are doing with your fluid status (how full your tank is). You will be better able to see quickly if you are gaining fluid and you will be in better control of preventing the worsening of symptoms (shortness of breath and swelling).
  • Low-Salt Diet: Are you aware that the cells in our taste buds renew themselves every few weeks (similar to when the top layer of skin cells on our body slough off and new cells come through)? Even though it may be challenging to adjust to healthier food choices, it will become easier as you "train" your new taste cells to appreciate a lower level of salt intake.
  • Recognizing and Reporting Symptoms: You are the only one who knows your body the best! By becoming more in-tune with how you feel every day, you will become more confident with your self-assessment. If you are more tired or short of breath today by doing the very same activity you performed yesterday, that could possibly raise a little red flag in your mind, and certainly, information your healthcare team would need to know.

Remember, the best way to help your heart failure is with self-care management and working with your healthcare team. Liviing with heart failure can be overwhelming and sometimes you may feel like it is "too big." Like the saying: "How do you eat an elephant? One bite at a time." You are just one decision away from making the positive lifestyle changes to help you live with heart failure.

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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.