Heart failure

  • Alternative Names

    CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - Cor pulmonale


    Treatment

    MONITORING AND SELF CARE

    If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

    You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weigh yourself at the same time each day and on the same scale, with little to no clothes on.

    Weight gain can be a sign that your body is holding onto extra fluid and your heart failure is worsening. Talk to your doctor about what you should do if your weight goes up or if you develop more symptoms.

    Other important measures include:

    • Take your medications as directed. Carry a list of medications with you wherever you go.
    • Limit salt intake.
    • Do not smoke.
    • Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for your degree of heart failure. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
    • Lose weight if you are overweight.
    • Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

    Here are some tips to lower your salt and sodium intake:

    • Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
    • Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
    • Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
    • Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
    • Use oil and vinegar, rather than bottled dressings, on salads.
    • Eat fresh fruit or sorbet when having dessert.

    MEDICATIONS

    Your doctor may prescribe the following medications:

    • ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart
    • Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)
    • Digitalis glycosides to help the heart muscle to contract properly and help treat some heart rhythm disturbances
    • Angiotensin receptor blockers (ARBs) such as losartan and candesartan for those who have side effects with ACE inhibitors
    • Beta-blockers such as carvedilol and metoprolol, which may be helpful for some patients

    Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms.

    SURGERIES AND DEVICES

    Heart valve surgery, coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.

    The following devices may be recommended for certain patients with heart failure:

    • A pacemaker to help treat slow heart rates or other heart signaling problems
    • A biventricular pacemaker to help the both sides of your heart contract at the same time; it is also called cardiac resynchronization therapy.
    • An implantable cardioverter-defibrillator that recognizes life-threatening, abnormal heart rhythms and sends an electrical pulse to stop them.

    Severe heart failure may require the following treatments when other therapies no longer work. They are often used when a person is waiting for a heart transplant:

    • Intra-aortic balloon pump (IABP)
    • Left ventricular assist device (LVAD)

    Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.


    Support Groups


    Expectations (prognosis)

    Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress.

    Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder.


    Complications
    • Irregular heart rhythms (can be deadly)
    • Pulmonary edema
    • Total heart failure (circulatory collapse)

    Possible side effects of medications include:

    • Cough
    • Digitalis toxicity
    • Gastrointestinal upset (such as nausea, heartburn, diarrhea)
    • Headache
    • Light-headedness and fainting
    • Low blood pressure
    • Lupus reaction
    • Muscle cramps

    Calling your health care provider

    Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.

    Go to the emergency room or call the local emergency number (such as 911) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat (particularly if other symptoms accompany a rapid and irregular heartbeat).