Diagnosed with heart failure? Here’s what you need to know

Learning you have heart failure or congestive heart failure is understandably frightening. But thanks to recent medical advancements, there are multiple treatment options available that can help ensure you live a full, healthy life.

“Heart failure sounds like the end of everything, but it’s not,” says Gurusher Panjrath, MD, chair of the American College of Cardiology’s Heart Failure and Transplant Section. He is also the director of George Washington University’s Heart Failure Program. “Today’s treatments can often do more than stabilize the heart function—they can make the heart stronger.” 

While some people can live with heart failure for months without noticing any symptoms, there are a handful of common warning signs it’s important to be aware of:  

• Shortness of breath when you’re active or resting
• Difficulty breathing when lying down
• Waking up tired or anxious/restless
• Coughing that produces white or pink mucus
• Swelling in the feet, ankles, legs, or belly
• Overall tiredness, difficulty with everyday activities
• Feeling full or nauseous 
• Heart racing or throbbing

If you are worried you might be experiencing a heart attack, call 911 immediately. 

What types of treatments are available? 
Dr. Panjrath says that most heart failure patients require a multipronged approach or plan: taking medicines prescribed by your doctor, making changes to your eating and exercise habits, managing stress, and quitting smoking.

Medicines 
You may need to take more than one medicine after recent heart failure, according to Dr. Panjrath, as each one plays a slightly different role in easing the heart’s workload. Also, even if your heart stabilizes or strengthens, you’ll likely need to stay on medication to maintain the improvements. Some of the common classes of medications include:

• ACE inhibitors (angiotensin-converting enzyme inhibitors) to help relax and widen blood vessels, lower blood pressure and decrease the oxygen demand from the heart
• ARB blockers (angiotensin II receptor blockers) to relax and widen blood vessels and reduce blood pressure
• ARNIs (angiotensin-receptor neprilysin inhibitors) to ease strain on the heart muscle
• Beta blockers (beta-adrenergic blocking agents) to control heart rhythm and lower blood pressure
• Aldosterone receptor antagonists to block the reabsorption of sodium
• Hydralazine and isosorbide dinitrate to relax blood vessels (most commonly prescribed for African-American patients)
• Diuretics (water pills) to remove excess fluids and sodium
• Cholesterol-lowering drugs (statins)

Before you start taking a new drug, it’s important to talk with your doctor about any negative (or counteracting) effects it might have on medicines you’re already taking. Be sure to bring an up-to-date list of these prescriptions and over-the-counter drugs to each appointment.  

Diet
In addition to following a heart-healthy eating plan with plenty of vegetables and fruits, whole grains, lean sources of protein (such as beans, fish, and poultry), and healthy fats, you’re also wise to carefully watch how much salt (and surprisingly, fluids) you consume. Your doctor will be able to give you safe daily limits of both fluids and sodium. But for help with meal planning, consider working with a registered dietitian. 

And be sure to step on the scale regularly. “Weight gain is something your doctor will want you to keep a close eye on,” Dr. Panjrath says. “A sudden uptick in weight could signal that you have fluid buildup and decompensation.” 

Exercise
Dr. Panjrath says regular walks and strength training—with your doctor’s OK—can improve the oxygen supply to your heart, boost your circulation, and help your overall physical fitness. A 2016 review of 20 clinical trials found that heart failure patients who exercised regularly had an increased lifespan and fewer hospitalizations compared with those who didn’t. 

Implants or surgery
If you were diagnosed with heart failure, your doctor may recommend a surgical implant, like a defibrillator. It delivers an electric countershock to the heart whenever a life-threatening abnormal rhythm occurs. In addition, a pacemaker that delivers a treatment known as cardiac resynchronization therapy can normalize the contractions of the heart’s ventricles. 

Surgery is sometimes also necessary if the heart failure is due to blockages in blood vessels of the heart. In a procedure called angioplasty, a small balloon is inflated in the diseased artery until it is reopened. A stent is sometimes inserted afterward to hold the opening. Your doctor might also recommend other surgical options like a heart pump, valve replacement, coronary artery bypass, and a heart transplant, but those are rare cases.