Heart Failure

	Topic Overview
	Health Tools
	FAQs
	Cause
	Symptoms
	What Increases Your Risk
	When to Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Living With Heart Failure
	Coping With Your Feelings
	Medications
	Surgery
	Other Treatment
	End-of-Life Decisions
	Related Information
	References
	Credits
	Audio articles:
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What is heart failure?

Heart failure means that your heart muscle does not pump as much blood as your body needs. Failure does not mean that your heart has stopped. It means that your heart is not pumping as well as it should.

Because your heart cannot pump well, your body tries to make up for it. To do this:

• Your body holds on to salt and water. This increases the amount of blood in your bloodstream.
• Your heart beats faster.
• Your heart gets bigger. See a picture of an enlarged heart.

Your body has an amazing ability to make up for heart failure. It may do such a good job that you don't know you have a disease. But at some point, your heart and body will no longer be able to keep up. Then fluid starts to build up in your body, and you have symptoms like feeling weak and out of breath.

This fluid buildup is called congestion. It's why some doctors call the disease congestive heart failure.

Heart failure usually gets worse over time. But treatment can slow the disease and help you feel better and live longer.

What causes heart failure?

Anything that damages your heart or affects how well it pumps can lead to heart failure. The most common causes of heart failure are:

• Coronary artery disease (CAD).
• Heart attack.
• High blood pressure.

CAD and heart attack are the most common causes of heart failure in men. In women, high blood pressure is the most common cause.¹

Other conditions that can lead to heart failure include:

• Diabetes.
• Diseases of the heart muscle (cardiomyopathies).
• Heart valve disease.
• Disease of the sac around the heart (pericardial disease), such as pericarditis.
• A slow, fast, or uneven heart rhythm (arrhythmia).
• A heart problem that you were born with (congenital heart defect).
• Long-term alcohol abuse, which can damage your heart.

What are the symptoms?

Symptoms of heart failure start to happen when your heart cannot pump enough blood to the rest of your body. In the early stages, you may:

• Feel tired easily.
• Be short of breath when you exert yourself.
• Feel like your heart is pounding or racing (palpitations).
• Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:

• Feel short of breath even at rest.
• Have swelling (edema), especially in your legs, ankles, and feet.
• Gain weight. This may happen over just a day or two, or more slowly.
• Cough or wheeze, especially when you lie down.
• Need to urinate more at night.
• Feel bloated or sick to your stomach.

If your symptoms suddenly get worse, you will need emergency care.

How is heart failure diagnosed?

Your doctor may diagnose heart failure based on your symptoms and a physical exam. But you will need tests to find the cause and type of heart failure so that you can get the right treatment. These tests may include:

• Blood tests.
• A chest X-ray.
• An electrocardiogram (EKG or ECG) to check your heart’s electrical system.
• An echocardiogram to see the size and shape of your heart and how well it is pumping.
• Cardiac catheterization to check your heart and its blood vessels (coronary arteries).

A stress test to look for coronary artery disease.

An echocardiogram is the best and simplest way to find out if you have heart failure, what type it is, and what is causing it. Your doctor can also use it to see if your heart failure is getting worse. It can measure how much blood your heart pumps to your body. This measurement is called the ejection fraction. If your ejection fraction gets lower and you are having more symptoms, it means that your heart failure is getting worse.

How is it treated?

Most people with heart failure need to take several medicines. Your doctor may prescribe medicines to:

• Help keep heart failure from getting worse. These drugs include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, and vasodilators like hydralazine and nitroglycerin.
• Reduce symptoms so you feel better. These drugs include diuretics (water pills), digoxin, and potassium.
• Treat the cause of your heart failure.

It is very important to take your medicines exactly as your doctor tells you to. If you don't, your heart failure could get worse.

Depending on the cause of your heart failure, you might need surgery to help your heart work better. For example:

• You might havebypass surgery orangioplasty to open clogged arteries, or you may need surgery to repair or replace a heart valve.
• You might need to have apacemaker or adefibrillator if you have a problem with your heart rhythm. These help your heart keep a steady rhythm.

Lifestyle changes are an important part of treatment. They can help slow down heart failure. They may also help control other diseases that make heart failure worse, such as high blood pressure, diabetes, and coronary artery disease. The best steps you can take are to:

• Eat less salt (sodium). Sodium causes your body to retain water and makes it harder for your heart to pump. Your doctor may also ask you to limit how much fluid you drink.
• Get regular exercise. Your doctor can tell you what level of exercise is safe for you, how to check your pulse, and how to know if you are doing too much.
• Take rest breaks during the day.
• Lose weight if you are overweight. Even a few pounds can make a difference.
• Stop smoking. Smoking damages your heart and makes exercise harder to do.
• Limit alcohol. Ask your doctor how much, if any, is safe.

To stay as healthy as possible, work closely with your doctor. Have all your tests, and go to all your appointments. It is also important to:

• Talk to your doctor before you take any new medicine, including nonprescription and prescription drugs, vitamins, and herbs. Some of them may make your heart failure worse.
• Keep track of your symptoms. Weigh yourself at the same time every day, and write down your weight. Call your doctor if you have a sudden weight gain, a change in your ability to exercise, or any sudden change in your symptoms.

What can you expect if you have heart failure?

Medicines and lifestyle changes can slow or even reverse heart failure for some people. But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure gets worse, you may need to limit your activities. Treatment can often help reduce symptoms, but it usually does not get rid of them.

Heart failure can also lead to other health problems. These may include:

• Trouble with your heart rhythm (arrhythmia).
• Stroke.
• Heart attack.
• Mitral valve regurgitation.
• Blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism).

Your doctor may be able to give you medicine or other treatment to prevent or treat these problems.

Heart failure can get worse suddenly. If this happens, you will need emergency care. To prevent sudden heart failure, you need to avoid things that can trigger it. These include eating too much salt, missing a dose of your medicine, and exercising too hard.

You may want to think about planning for the future. A living will lets doctors know what type of life-support measures you want if your health gets much worse. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

Knowing that your health may get worse can be hard. It is normal to sometimes feel sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicines, counseling, or both may help you cope.

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Heart failure: Should I get a pacemaker?
	Heart failure: Should I get an implantable cardioverter-defibrillator (ICD)?
	Sleep apnea: Should I have a sleep study?
	Actionsets are designed to help people take an active role in managing a health condition.
	Anxiety: Using positive thinking
	Depression: Using positive thinking
	Heart failure: Activity and exercise
	Heart failure: Avoiding medicines that make symptoms worse
	Heart failure: Avoiding triggers for sudden heart failure
	Heart failure: Checking your weight
	Heart failure: Eating less salt
	Heart failure: Taking medicines properly
	Heart failure: Watching your fluids
	Heart problems: Living with a pacemaker or ICD
	Insomnia: Improving your sleep
	Low-salt diets: Eating out
	Oxygen therapy: Using oxygen at home
	Positive thinking: Stopping unwanted thoughts
	Stress management: Breathing exercises for relaxation
	Stress management: Doing guided imagery to relax
	Stress management: Doing meditation
	Stress management: Doing progressive muscle relaxation
	Stress management: Managing your time
	Stress management: Practicing yoga to relax
	Stress management: Reducing stress by being assertive

Many problems can cause heart failure, including damage to the heart's muscle, valves, or electrical system. These can all affect how well the heart pumps.

Problems that damage the heart muscle

• Coronary artery disease (CAD) and heart attack (most common causes)
• High blood pressure and diabetes that are not controlled
• Alcohol, illegal drugs (such as cocaine), and some prescription medicines (such as those for chemotherapy)
• Heart problems you've had from birth (congenital heart disease)
• Infection or inflammation of the heart muscle (such as myocarditis)

Other things that damage the heart's valves

• Valve problems you've had since birth
• Infection of a heart valve (endocarditis)
• Aging
• Rheumatic fever

Problems with the heart's electrical system

• Fast, slow, or irregular heart rhythms, including atrial fibrillation
• Electrical signals that don't flow as they should from the upper to the lower part of the heart (heart block)

Other problems

• Disease of the sac around the heart (pericarditis)
• Postpartum heart failure. This rare problem can happen late in a woman's pregnancy or within the first 5 months after delivery.
• Severe anemia
• Hyperthyroidism

Certain triggers , such as too much sodium or not taking medicines the right way, may suddenly make heart failure worse. This can sometimes cause deadly problems such as pulmonary edema or cardiogenic shock.

At first you may not have any symptoms from heart failure. But as your heart has more trouble pumping enough blood to your body, you may get short of breath when you walk or do other activities. You also may feel very tired.

Your heart will try to make up for heart failure by pumping faster and by pumping more blood with each beat. But over time, these efforts can make your heart weaker and can make symptoms worse.

How doctors talk about heart failure

• Heart failure is grouped—or classified—according to symptoms. Your treatment is based partly on what class of symptoms you have.
• There's also another way to define heart failure. It's based on the stages you might go through as your heart failure gets worse. Your doctor also may make treatment choices based on your stage of heart failure.

Symptoms of sudden heart failure

Sometimes your symptoms may get worse very quickly. This is called sudden heart failure. It causes fluid to build up in your lungs, causing congestion. (This is why the problem is often called congestive heart failure.) Symptoms may include:

• Severe shortness of breath.
• An irregular or fast heartbeat.
• Coughing up foamy, pink mucus.

Sudden heart failure is an emergency. You need care right away.

Heart failure is usually caused by another health problem, often coronary artery disease or high blood pressure. So anything that increases your risk for one of those problems also increases your risk for heart failure.

• Risk factors for coronary artery disease and heart attack include smoking, having high cholesterol or diabetes, and having a family history of heart disease.
• Risk factors for high blood pressure include being overweight, being inactive, and having a family history of high blood pressure.
• Risk factors for heart valve disease include older age and an infection of the valves.

Call 911 or other emergency services immediately if you have:

• Chest pain that has not gone away within 5 minutes after you have taken one nitroglycerin dose and/or rested, especially if the pain is pressing or crushing and occurs with shortness of breath, sweating, and nausea.
• Symptoms of a stroke. These include:
  • Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.

• Symptoms of sudden heart failure, such as:
  • Severe shortness of breath (trouble getting a breath even when resting).
  • Suddenly getting an irregular heartbeat that lasts for a while, or getting a very fast heartbeat along with dizziness, nausea, or fainting.
  • Foamy, pink mucus with a cough and shortness of breath.

Call your doctor soon if you have symptoms of heart failure, which include:

• Being very tired or having weakness that prevents you from doing your usual activities.
• Trouble breathing during routine activities or exercise that did not cause problems before.
• Shortness of breath when you lie down.
• Waking up at night with shortness of breath or feeling as though you are suffocating.
• A dry, hacking cough, especially when you lie down.
• Sudden weight gain, such as 3 lb (1.4 kg) or more in 2 to 3 days.
• Increased fluid buildup in your body (most often in the legs).

Also call your doctor soon if you have been diagnosed with heart failure and your symptoms get worse. In general, it is a good idea to call your doctor anytime you have a sudden change in symptoms.

Watchful waiting

You can try home treatment for symptoms such as mild fluid buildup (edema) and feeling very tired. But sudden shortness of breath, even if it is mild, should always be checked by your doctor.

• If symptoms go away and don't return, you may not need more treatment.
• See your doctor if you often need home treatment to keep even minor symptoms under control.

Who to See

The following health professionals can treat you for heart failure:

• Family medicine doctor
• Internist
• Nurse practitioner (NP)
• Physician assistant (PA)
• Cardiologist
• Cardiovascular surgeon
• Cardiac electrophysiologist

Heart failure is a complex problem. So you will likely have several different tests over time. These tests can:

• Find out if you have heart failure.
• Find the cause of your heart failure.
• Find the type of heart failure you have.
• Show how bad your heart failure is (class and stage).
• See how well your treatment is working.

If you have symptoms that suggest heart failure, you may have:

• A review of your medical history and a physical exam.
• Lab tests.
• Electrocardiogram (EKG, ECG) and stress tests.
• Chest X-ray.
• Echocardiogram (echo).
• Brain natriuretic peptide (BNP).
• Cardiac catheterization.

An echocardiogram is the best and simplest way to diagnose heart failure. It also can help guide treatment.

Sometimes, because of a person's weight, breast size, or severe lung disease, an echocardiogram might not be accurate. If that happens, a cardiac blood pool scan may be done instead. It checks how well the left ventricle is pumping. But it's not as good at finding heart valve disease and a thick heart muscle.

Tests also may be done to find areas of the heart that are not getting enough blood. These tests include:

• Cardiac perfusion scan. This test can show poor blood flow to the heart.
• Cardiac catheterization. This test can be used to check for blocked or narrowed heart arteries and to measure pressures inside the heart.

Your treatment for heart failure depends on:

• The cause of your heart failure.
• Which type of heart failure you have.
• How bad your symptoms are (classification).
• How well your body is able to make up for your heart failure.

Sometimes heart failure can be fixed if another problem can be corrected, such as by replacing a heart valve or treating hyperthyroidism.

Heart failure caused by a heart attack may be treated with coronary artery bypass surgery or angioplasty, medicine, and cardiac rehabilitation.

Initial treatment

In the early stages of heart failure, you'll take medicines and make lifestyles changes that can improve your symptoms. Treatment also may prevent more damage to your heart.

You will have regular doctor visits to see how treatment is working and to make changes to your care as needed.

Medicines

You will likely take:

• Adiuretic to reduce your blood pressure and fluid buildup.
• AnACE inhibitor to reduce how hard your heart has to work, lower your blood pressure, and reduce fluid buildup and swelling.
• Anangiotensin II receptor blocker (ARB) if you can't take an ACE inhibitor.
• Abeta-blocker to control your blood pressure and slow your heart rate.

You also will likely take medicines to treat the cause of your heart failure. For more information, see the Medications section.

It's very important to take your medicines exactly as your doctor prescribes.

Lifestyle changes

You will need to make some changes in your daily life to treat heart failure. Your doctor may ask you to:

• Eat less salt.
• Be more active.
• Stay at a healthy weight, or lose weight if you need to. Even a few pounds can make a difference.
• Stop smoking.
• Limit alcohol.
• Control your blood pressure.
• Control your diabetes.
• Limit how much fluid you drink.

Making lifestyle changes can be hard. For more information, see the Living With Heart Failure section.

Ongoing treatment

You will keep following your lifestyle changes, such as limiting sodium, not smoking, and being active.

Your doctor will add other medicines and other treatments as you need them. Your doctor also will try to prevent or treat problems—such as fever, arrhythmia, and anemia—that can lead to sudden heart failure.

Your treatment may include:

• Getting vaccines. Your doctor may want you to get vaccines against pneumonia and the flu (influenza). These vaccines can keep you from getting infections that could put you in the hospital.
• Checking your weight. Your doctor will probably give you guidelines for watching fluid buildup and tell you how much weight gain is too much.
• Getting devices to fix heart rhythm problems. In some cases, your doctor may recommend a biventricular pacemaker that is placed in your chest to keep your heart beating at a normal rhythm. Or you may have an implantable cardioverter-defibrillator (ICD) to stop a deadly rhythm. In some cases, you may get a pacemaker that is combined with an ICD.
• Oxygen treatment. Your doctor may recommend oxygen therapy to reduce your shortness of breath and increase your ability to exercise.

Treatment if your condition gets much worse

In some cases when standard treatment doesn't help, you may have other treatments. These include:

• Heart transplant, which replaces your heart with a donor heart.
• Ventricular assist devices (VADs), which help the heart pump blood.

But these are options for only a very small number of people.

Palliative care

As your heart failure gets worse, you may want to think about palliative care. It's a kind of care for people who have illnesses that don't go away and often get worse over time. It's different than care to cure your illness. But some people combine both types of care.

Palliative care:

• May improve your quality of life—not just in your body, but also in your mind and spirit.
• May help you manage symptoms or side effects from treatment.
• Can help you cope with your feelings about living with a long-term illness.
• Can help you make plans around your medical care.
• Can help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life care

Because heart failure tends to get worse over time, it's important to think about what kind of care you would like at the end of your life. It's also important that your doctor and family know what you want.

An advance directive is a legal document that tells doctors how to care for you at the end of your life. For more information, see End-of-Life Decisions.

The best way to prevent heart failure is to:

• Lower your risk of getting heart disease by making lifestyle changes.
• Control certain health problems, such as high blood pressure and diabetes.

To reduce your risk:

• Don't smoke. If you smoke, quit. Smoking greatly increases your risk for heart disease. Avoid secondhand smoke too.
• Lower your cholesterol. If you have high cholesterol, follow your doctor's advice for lowering it. Eating a heart-healthy diet—such as the TLC diet —exercising, and quitting smoking will help keep your cholesterol low.
• Control your blood pressure. High blood pressure raises your risk of getting heart disease. Studies show that lowering blood pressure to normal levels in people who have high blood pressure could reduce the cases of heart failure by half.² Exercising, limiting alcohol, and controlling stress will help keep your blood pressure in a healthy range.
• Get regular exercise. Exercise will help control your weight, blood pressure, and stress. Controlling these things will help keep your heart healthy. Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week.³ One way to do this is to be active at least 10 minutes 3 times a day, 5 days a week. Talk to your doctor before starting an exercise program.
• Control diabetes. Take your medicines as directed, and work with your doctor to make a diet and exercise plan to control diabetes.
• Limit alcohol. If you drink alcohol, drink moderately. This means no more than 2 drinks a day for men and 1 drink a day for women. Heavy consumption of alcohol can lead to heart failure.

You can feel better when you have heart failure by taking your medicines as directed, having a healthy lifestyle, and avoiding things that make heart failure worse.

Taking medicines

• Take your medicines as directed. If you don't, your heart failure may get worse, or you may get sudden heart failure. For more information, see:

  Heart failure: Taking medicines properly.

• Try to avoid medicines that can make your heart failure worse. For more information, see:

  Heart failure: Avoiding medicines that make symptoms worse.

• Take a low-dose aspirin every day if your doctor advises it to prevent a stroke or heart attack. But higher doses of aspirin may make your heart failure worse. So talk to your doctor first about how much to take.

Having a healthy lifestyle

• Limit sodium.

  Heart failure: Eating less salt

  Low-salt diets: Eating out

• Exercise regularly. If you aren't already active, your doctor may want you to start exercising. You could do it in a program or on your own. Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week.³ One way to do this is to be active at least 10 minutes 3 times a day, 5 days a week. You can start slowly if you haven't exercised much before. For more information, see the topic Cardiac Rehabilitation. For information on starting and staying with an exercise program, see:

  Heart failure: Activity and exercise.

• Check your weight at the same time every day. For information, see:

  Heart failure: Checking your weight.

• Try to lose weight if you are overweight. Eating a heart-healthy diet and exercising regularly will help you lose weight. Even a few pounds can make a difference.
• Stop smoking. Smoking increases your risk for heart disease and makes it harder to exercise. Avoid secondhand smoke too. For more information, see Quitting Smoking.
• Avoidtoo much alcohol. This means drinking no more than 2 drinks a day for men and 1 drink a day for women.
• Limit your fluids if needed. For information, see:

  Heart failure: Watching your fluids.

• Oxygen treatment. Your doctor may recommend oxygen therapy to reduce your shortness of breath and increase your ability to exercise.

Avoiding things that make heart failure worse

Avoid triggers, such as too much salt (sodium) and certain medicines, that can cause sudden heart failure. For more information, see:

Heart failure: Avoiding triggers for sudden heart failure.

Treating your sleep problems

Many people with heart failure have trouble sleeping. Your doctor may be able to find out what is causing your sleep problems and help you get a good night's sleep.

For more information, see:

Should I have a sleep study to diagnose obstructive sleep apnea?

Insomnia: Improving your sleep.

Getting help for problems with sex

Most people with heart failure can still have an active sex life. But sexual problems are common. Your interest may drop, or you may have shortness of breath or other symptoms that limit your ability to have sex. Men may have erection problems.

Talk to your doctor. You can get help for erection problems or other sexual troubles. You also can follow some tips to make sex easier on your heart. For more information, see the topics:

• Erection Problems (Erectile Dysfunction).
• Sexual Problems in Women.

Other things you can do to take care of yourself

• Get help for depression and anxiety if you have them. Heart failure can be hard on your emotions. Many people with heart failure feel depressed or anxious. For more information on how to feel better, see Coping With Your Feelings.
• Try sometips for easier breathing.
• Avoid respiratory infections. Stay up-to-date on vaccines for flu and pneumonia.
• Learn how to make activities like work, exercise, and travel easier.
• Work with yourteam of health professionals.

Help for caregivers

It can be rewarding to help a loved one with heart failure. But it's also a lot of work. And it can be hard emotionally.

If you are taking care of a loved one, make sure that you also take care of yourself. This can mean taking breaks by getting help from family or friends. You also may be able to use respite care. These services provide someone who will stay with your loved one while you get out of the house for a few hours. For more information, see:

• Caring for someone with heart failure.
• Caregiver Tips.

Heart failure brings big changes to your life. You may struggle with sadness and worry. You may wonder if you'll still be able to enjoy your life. Coping with your feelings and seeking help when you need it can help you live better with heart failure.

Depression and anxiety

Heart failure can be hard on your emotions. You may feel depressed that you can't do some of the things you used to do. You may worry about your future. And symptoms of heart failure, such as shortness of breath, can make this anxiety worse.

These feelings are common. Talk to your doctor if you have symptoms of depression or are worried a lot. Depression and anxiety can be treated with counseling and medicine.

You also can help yourself feel better by changing your "self-talk." Those are the things you tell yourself about how you're coping. Negative thoughts can make you feel bad. Changing the way you think can change the way you feel. To learn how to think in a positive way, see:

Anxiety: Using positive thinking.

Depression: Using positive thinking.

Positive thinking: Stopping unwanted thoughts.

For more information, see the topics:

• Positive Thinking With Cognitive-Behavioral Therapy.
• Depression.
• Generalized Anxiety Disorder.

Stress

The challenges of living with heart failure can increase your stress. And stress can make living with heart failure even harder. Stress also can disturb your sleep and make depression and anxiety worse. Here are some things that can help your body, mind, and spirit:

Doing progressive muscle relaxation

Managing your time

Reducing stress by being assertive

Breathing exercises for relaxation

Doing guided imagery to relax

Doing meditation

Practicing yoga to relax

Getting support

Emotional support from friends and family can help you cope with the struggles of heart failure. You might want to think about joining a heart failure support group. Ask your doctor about the types of support that are available where you live.

Meeting other people with the same problems can help you know you're not alone. If you're shy or aren't a joiner, you can look at an online support group. Even though people online aren't talking face-to-face, they're sharing their feelings and creating a community.

You probably will need to take several medicines to treat heart failure, even if you don't have symptoms yet. Medicines don't cure heart failure. But they can help your heart work better and improve any symptoms that you do have.

Medicines can:

• Relieve or control symptoms.
• Treat other health problems you have, such as coronary artery disease.
• Improve your daily quality of life.
• Slow the rate at which your heart failure gets worse.
• Reduce the chance of other problems from heart failure, such as stroke.
• Reduce hospital stays.
• Help you live as long as possible.

It's very important to take your medicines exactly as your doctor says. If you don't, your heart failure may get worse or you may get sudden heart failure. For more information, see:

Heart failure: Taking your medicines properly.

Medicine Choices

The medicines you take will depend on the type of heart failure you have. Some of the medicines treat the heart's pumping problems (systolic heart failure), while others treat problems with filling (diastolic heart failure). The most commonly used medicines are listed below.

Medicines for pumping problems (systolic heart failure)

These include:

• ACE inhibitors (angiotensin-converting enzyme inhibitors) to relax and widen blood vessels. This makes it easier for blood to flow.
• ARBs (angiotensin II receptor blockers) to make it easier for blood to flow through the vessels.
• Diuretics to make the kidneys remove more water and salt (sodium) from the body.
• Aldosterone receptor antagonists to make the kidneys get rid of extra salt and fluid and to help the body hold on to potassium.
• Digoxin to help the heart pump more blood with each beat.
• Beta-blockers to control symptoms of heart failure by slowing the heart rate and making the blood vessels wider so blood flows more easily.
• Vasodilators to lower blood pressure and reduce the workload on the heart.

Medicines for filling problems (diastolic heart failure)

These include:

• Beta-blockers.
• Diuretics.
• ACE inhibitors.
• ARBs.
• Calcium channel blockers to slow your heart rate and lower your blood pressure.
• Direct renin inhibitors to help blood flow more easily through your vessels and to lower your blood pressure.

Other medicines

You also may take other medicines for health problems that can cause heart failure or for problems caused by heart failure. These problems include irregular heart rhythms, poor blood flow to the heart, and high blood pressure.

The medicines include:

• Anticoagulants , such as warfarin, to make your blood less likely to clot. These drugs may help prevent strokes.
• Antiarrhythmics to prevent very fast and sometimes irregular heart rhythms.
• Antihypertensives to lower blood pressure.

What to Think About

Talk to your doctor before you take any over-the-counter medicines. Some of them might make your symptoms worse. For more information, see:

Heart failure: Avoiding medicines that make symptoms worse.

People who have heart failure may have surgery to:

• Open clogged arteries.Coronary artery bypass surgery or angioplasty may help some people who have heart failure with chest pain (angina) or who have had a heart attack.
• Fix problems that cause heart failure, such as damaged valves.
• Get a new heart. You have to meet certain conditions to get a heart transplant. But you may be able to have one if you have very bad, life-limiting symptoms.

Surgery Choices

• Heart transplant
• Surgery to get a pacemaker, implantable cardioverter-defibrillator (ICD), or ventricular assist devices (VADs). For more information, see Other Treatment.
• Coronary artery bypass surgery
• Angioplasty

For more information on bypass surgery and angioplasty, see the topic Coronary Artery Disease.

If you have heart failure, you may get a device to fix a deadly heart rhythm or to help your heart pump better.

Pacemakers

Biventricular pacemakers make the heart’s lower chambers (ventricles) pump in the right order. This type of pacemaker can help you feel better so you can be more active. It also can help keep you out of the hospital and help you live longer.⁴ For more information on pacemakers, see:

Should I get a pacemaker for heart failure?

If you get a pacemaker, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe. For more information, see:

Heart problems: Living with a pacemaker or ICD.

A pacemaker may be used alone or along with an implantable cardioverter-defibrillator (ICD) for heart failure.

Implantable defibrillators (ICDs)

Implantable cardioverter-defibrillators (ICDs) can prevent sudden death from an abnormal heart rhythm and may help you live longer. An ICD checks the heart for very fast and deadly heart rhythms. If the heart goes into one of these rhythms, the ICD shocks it to stop the deadly rhythm and returns the heart to a normal rhythm. For more information, see:

Should I get an implantable cardioverter-defibrillator (ICD) for heart failure?

If you get an ICD, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe. For more information, see:

Heart problems: Living with a pacemaker or ICD.

An ICD may be used alone or along with a pacemaker for heart failure.

Ventricular assist devices (VADs)

Ventricular assist devices (VADs), also known as heart pumps, are placed into the chest to help the heart pump more blood. VADs can keep people alive until a donor heart is available for transplant. In rare cases, VADs may also be used as an alternative to heart transplant for long-term treatment.

Other treatments

In some cases you might have:

• Enhanced external counterpulsation (EECP). It's sometimes used to treat heart failure.
• Cardiac rehabilitation. This is often recommended before or after you get a pacemaker or have other heart procedures. For more information, see the topic Cardiac Rehabilitation.
• An intra-aortic balloon pump. This is sometimes used to help the heart pump more blood during sudden heart failure.

Supplements

Talk to your doctor before you take any over-the-counter medicine or supplement. There's no strong evidence that vitamins or other supplements can help treat heart failure.

But you may still hear about supplements that might improve heart failure symptoms. Examples include coenzyme Q10 and hawthorn.

• Only some of the studies of coenzyme Q10 showed that it helps heart failure symptoms.⁵
• Hawthorn is an herb that is sometimes used in Europe and Asia to try to increase blood flow to the heart.

Neither of these supplements has been shown to relieve heart failure or help you live longer.

Heart failure tends to get worse over time. So you need to decide what kind of care you want at the end of your life.

It can be hard to have talks with your doctor and family about the end of your life. But making these decisions now may bring you and your family peace of mind. Your family won't have to wonder what you want. And you can spend your time focusing on your relationships.

You will need to decide if you want life-support measures if your health gets very bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life. You also can say where you want to have care. And you can name someone who can make sure your wishes are followed.

For more information, see the topics:

• Care at the End of Life.
• Writing an Advance Directive.
• Choosing a Health Care Agent.

• Alcohol Abuse and Dependence
• Aortic Valve Regurgitation
• Aortic Valve Stenosis
• Atrial Fibrillation
• Cardiac Rehabilitation
• Care at the End of Life
• Congenital Heart Defects
• Coronary Artery Disease
• Dealing With Medicine Side Effects and Interactions
• Family Life Cycle
• Heart Attack and Unstable Angina
• High Blood Pressure (Hypertension)
• High Cholesterol
• Quitting Smoking
• Reducing Medication Costs

Citations

1. Levy D, et al. (2002). Long-term trends in the incidence of and survival with heart failure. New England Journal of Medicine, 347(18): 1397–1443.

2. Yusef S, et al. (2002). A lifetime of prevention: The case of heart failure. Circulation, 106(24): 2997–2998.

3. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.

4. McAlister FA, et al. (2007). Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: A systematic review. JAMA, 297(22): 2502–2514.

5. Coenzyme Q10 (2006). Medical Letter on Drugs and Therapeutics, 48(1229): 19–20.

Other Works Consulted

• American Heart Association and American College of Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]

• Hunt SA, et al. (2009). 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 119(14): e391–e479.

• Schocken DD, et al. (2008). Prevention of heart failure: A scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation, 117(19): 2544–2565.