Can Heart Failure Be Reversed?

If you’ve been diagnosed with heart failure, you might worry about what the future holds. After all, this chronic condition usually gets worse over time. However, there’s hope: The condition is treatable, and for some people, heart failure can even be reversed. This means that the organ regains its ability to function normally.

“Treating heart failure successfully has become much more of a reality in the last ten years,” says cardiologist Joshua Hare, M.D., a professor of medicine at the University of Miami Miller School of Medicine in Miami, FL. Here’s what you need to know about the causes of heart failure and how this condition can be turned around.

For some people, the answer is yes, and it’s becoming more common.

Reversing your heart failure means that the organ regains its ability to function normally. In other words, it becomes able again to pump an adequate amount of oxygen-rich blood to the rest of your body.

In some cases, that means your heart failure can be effectively treated so that your heart works well, says Dr. Hare. But in other cases, if you treat the disease that’s causing the heart failure, you can effectively cure it. “If heart failure is due to an isolated cause that can be treated effectively, then there is a better chance of reversibility,” says Jim Liu, M.D., a cardiologist at The Ohio State University Wexner Medical Center in Columbus, OH.

For example, if high blood pressure has caused your heart failure, getting your blood pressure back to the healthy range can improve your heart’s ability to pump blood, says Dr. Liu.

“Likewise, if heart failure is due to a heart valve problem that gets addressed or an arrhythmia that is controlled, ejection fraction can return to normal,” Dr. Liu continues. “Cessation of alcohol or illicit substances can also reverse heart failure.”

Your heart is constantly filling with blood and pumping it out. In heart failure, also called congestive heart failure, your heart can no longer pump an adequate amount of blood to meet the needs of your body. There are two types:

• Systolic heart failure. In this type, also known as heart failure with reduced ejection fraction, your heart has become too weak to pump, or eject, a normal amount of blood with each beat. Your heart’s ejection fraction (EF) is the amount of blood it pumps out with each beat, written as a percentage of the total amount of blood in your heart. If your heart pumps out half of its blood supply, for example, your heart’s EF is 50% A healthy EF ranges from about 50% to 70%. When your heart’s ejection fraction drops below 40%, you have heart failure, according to the Cleveland Clinic.

• Diastolic heart failure. With this type of heart failure, also known as heart failure with preserved ejection fraction, your heart remains strong enough to pump normally, but stiffness and thickness prevent it from relaxing fully between beats. For that reason, it can’t fill with a normal amount of blood, so there’s less blood to pump.

Heart failure is considered a lifelong condition, according to the American Heart Association (AHA); you can’t just get a bout of it and be done. But with timely diagnosis and treatment, the heart can regain much—or even all—of its normal function, and you can live a full, enjoyable life with heart failure, the AHA says. Although this condition is chronic, it is manageable. Taking your prescribed medications and living a healthy lifestyle can help maximize your quality of life and keep heart failure from progressing.

The key to reversing heart failure is early treatment. While many diseases can cause heart failure in the short term, they can also permanently harm your heart over time, says Dr. Hare.

“There can be a transition from acute heart failure to chronic heart failure,” he says. “For example, if you’ve got hyperthyroidism that’s gone undiagnosed and untreated for years, and the heart has become involved, then at that point [heart failure] might be permanent.”

This happens because the underlying causes of heart failure can often result in scarring of the heart muscle.

“Once [scarring] is present, it generally doesn’t go away, and if too much has formed over time, then the ejection fraction may not improve even with therapy,” explains Dr. Liu. Here are some ways that heart failure is treated.

Medications for Heart Failure

Heart failure causes your sympathetic nervous system, which helps regulate your heart rate, to become overactive. It also leads your adrenal gland to release excessive amounts of hormones into your bloodstream. Over time, both processes will damage your heart and worsen your heart failure, says Dr. Liu.

“The medications we use to treat heart failure are aimed at stopping this cycle,” he explains. “The heart’s pumping function may improve with long term use of these medications.”

These drugs include:

Aldosterone Receptor Antagonists

These drugs are diuretics, or water pills, which blunt the effects of certain adrenal gland hormones. They help you remove excess fluid and salt from your body by increasing the amount of urine you produce. Drugs in this group include Aldactone (spironolactone) and Inspra (eplerenone).

Angiotensin-Converting Enzyme (ACE) Inhibitors

These drugs help your blood vessels relax. This lowers your blood pressure and eases your heart’s workload. They include Capoten (captopril), Vasotec (enalapril), and many others.

Angiotensin Receptor/Neprilysin Inhibitors (ARNIs)

There is currently only one FDA-approved version of this class of drug: Entresto (sacubitril/valsartan). It lowers your blood pressure and helps remove excess fluid and salt from your body.

Beta Blockers

These drugs lower your blood pressure by lowering your heart rate so that your heart does not have to work so hard. They also reduce the impact of stress hormones, such as adrenaline, on your heart. Together, these changes help your heart pump more efficiently. Beta blockers prescribed for heart failure include Coreg (carvedilol), Lopressor (metoprolol), and others.

Hydralazine and Nitrates

These medications can be given together to improve outcomes with heart failure. Hydralazine dilates blood vessels, while nitrates widen your arteries. The combination is available under the brand name BiDil.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors

These are a type of drug developed to treat diabetes that also helps with heart failure (experts don’t yet fully understand why). Jardiance (empagliflozin) and Farxiga (dapagliflozin) are the two available SGLT-2 inhibitors.

ARNIs and SGLT2s are particularly effective, says Dr. Hare, who notes that it’s possible for people who take them to have a complete recovery.

Vericiguat (Verquvo)

This newer medication belongs to a class of drugs called soluble guanylate cyclase (sGC) stimulators. In a study of 5,050 people with chronic heart failure and an ejection fraction of less than 45%, published in the New England Journal of Medicine, taking vericiguat reduced the risk of death from cardiovascular causes or hospitalization for heart failure compared to taking a placebo.

Vericiguat works by relaxing the blood vessels in the lungs to allow blood to flow more easily, according to the National Library of Medicine.

Lifestyle Changes for Heart Failure

Making healthy lifestyle improvements is a key part of heart failure treatment. “It’s very important, both for potentially reversing heart failure and to prevent heart failure from getting worse,” says Dr. Liu. These changes include:

• Exercising

• Getting adequate, good quality sleep

• Quitting smoking if you smoke

Reducing the amount of salt in your diet. This is the number one lifestyle priority after a heart disease diagnosis because people with heart failure often retain fluid, and that makes symptoms worse, even to the point of requiring hospitalization, says Dr. Liu. Salt is a major contributor to fluid retention, so limiting your intake is critical.

Reducing your fluid intake. Like cutting back on salt, drinking a smaller amount of fluid will help reduce fluid retention.

Surgery for Heart Failure

If your heart failure becomes advanced enough, your doctor might recommend surgery in addition to medication to give your heart more help pumping. There are several surgical options for heart failure, according to the Cleveland Clinic. Let’s take a look at each of them.

Catheter Ablation

This minimally invasive procedure is done to treat an arrhythmia, which can be either a cause or a symptom of your heart failure. Your doctor will thread a thin, flexible tube called a catheter through one of your blood vessels to your heart. Once there, it will deliver cold or heat to the damaged parts of your heart that are causing it to beat irregularly. Fixing the arrhythmia can help your heart work more normally.

Coronary Artery Bypass Graft Surgery (CABG)

This procedure may be needed if you have a narrowing or blockage in the arteries that supply your heart, which happens as a result of the buildup of a substance called plaque on your artery walls. This makes your arteries unable to deliver an adequate amount of blood to your heart. Over time, your heart weakens and heart failure develops. In CABG surgery, your doctor will take a blood vessel from another part of your body and graft, or attach, it to the affected artery just below and above the narrowed spot. Blood now bypasses the troubled area and flows normally, which in turn helps ease your heart’s workload.

Heart Valve Surgery

You have four valves in your heart that open and close tightly to control the flow of blood into, through, and out of your heart. If there is a problem with any of these valves—say, it doesn’t open widely enough or it doesn’t shut properly and leaks blood—your heart won’t be able to pump normally. If your heart has to work harder to compensate for a problem valve, heart failure can develop. Fortunately, surgeons can repair or replace damaged valves so that your heart can resume doing its job properly.

Coronary Angioplasty and Stent

If you have narrowed arteries that restrict the amount of blood that flows to your heart, your doctor may recommend this procedure. A catheter gets inserted into a blood vessel and moved to the trouble spot. Your doctor will push a tiny balloon through the catheter and inflate it. This widens the artery so that blood can flow more easily. Next, your doctor will use the catheter to install a small metal mesh, called a stent, that will keep the artery open after the balloon is deflated.

Surgically Implanted Devices

Your doctor might decide your heart needs an assist from a device in order to work normally. There are three options. Note that the first two do not actually reverse heart failure, while the third (cardiac resynchronization therapy) does have this capacity.

• Implantable cardioverter defibrillator (ICD). Some people with heart failure develop potentially deadly arrhythmias, such as ventricular tachycardia, that can cause your heart to stop if they last for more than a few seconds. That can quickly lead to death. An ICD detects abnormal heart rhythms and sends an electrical shock to your heart to return your heartbeat to normal. A surgeon will place the ICD under the skin of your chest, and wires from the device will connect directly to your heart.

• Left ventricular assist device (LVAD). Your heart’s lower left chamber, or left ventricle, pumps blood out of your heart, sending it on its way to the rest of your body. In heart failure, it can become weaker and weaker over time and eventually need help. An LVAD is an implantable mechanical device that helps your left ventricle pump blood. This device is for people who have reached what’s called end-stage heart failure. It’s recommended when medications, lifestyle changes, and other interventions no longer help. Some people will get an LVAD to keep their heart working until they can undergo a heart transplant. For others, such as those who are not candidates for a transplant, it’s a permanent implant.

• Pacemaker. If you have heart failure, your heart may beat too slowly. This is called bradycardia. A pacemaker is a permanently implanted device that helps speed up your heart rate. Several types of pacemakers exist, but for heart failure, your doctor will likely recommend what’s called a biventricular pacemaker, also known as a cardiac resynchronization device. It stimulates both of your heart’s lower chambers, or ventricles, in order to boost the strength of your heart, according to the Mayo Clinic.

Heart Transplant

In this procedure, your damaged heart is replaced with a healthy heart from an organ donor. It’s the final option if you have end-stage heart failure.

When your heart can’t pump effectively, blood backs up into the lungs, causing shortness of breath during activity or when lying down. Fluid also accumulates in your feet, ankles, legs, abdomen, and elsewhere, resulting in edema, or swelling.

Fatigue is another major symptom of heart failure, as is a decrease in the amount of exercise you’re able to do. For example, with heart failure, walking may leave you tired and winded.

Other symptoms of heart failure include:

• Coughing and wheezing, with white or pink blood-tinged mucus

• Loss of appetite

• Palpitations, or a racing heartbeat

• Rapid weight gain, due to fluid retention

There are many different causes of heart failure, says Dr. Liu. He breaks them down into two categories:

• Ischemic causes. Cardiac ischemia is a lack of blood flow to the heart, which can damage it. This typically occurs as a result of coronary artery disease (CAD), which can then lead to heart attack.

• Non-ischemic causes. This encompasses all causes other than CAD or heart attack, including:

Alcohol and Illicit Drugs

These substances have toxic effects on the body that can affect your heart. Long-term alcohol abuse can cause your heart to stretch and enlarge, which in turn causes the organ to weaken. This condition, called alcohol-induced cardiomyopathy, can eventually lead to heart failure. Cardiomyopathy means disease of the heart muscle.

Cocaine has a similar impact, leading over time to a form of cardiomyopathy called dilated cardiomyopathy, in which the heart changes shape and becomes less efficient at pumping. In time, this can evolve to become heart failure, per the National Library of Medicine. Stimulant drugs such as amphetamines also can lead to heart failure by damaging your heart muscle.

Arrhythmias

To pump blood efficiently, your heartbeat must remain steady. Arrhythmias, which are irregular heart rhythms, make that impossible. For example, atrial fibrillation, the most common arrhythmia requiring treatment, causes your heart to beat erratically, too fast, or both. That strains your heart and weakens it over time, Dr. Liu explains, leading to heart failure.

High Blood Pressure (Hypertension)

High blood pressure causes your arteries to narrow and become less elastic. This in turn forces your heart to pump harder so that it can keep up with your body’s demands for oxygen-rich blood. In time, that extra work will cause your heart to thicken and grow larger. This makes it less able to pump blood efficiently, resulting in heart failure.

Other Causes

Other causes of heart failure include:

• Genetic heart abnormalities

• Heart valve problems

• Inflammatory diseases, such as rheumatoid arthritis and lupus

• Myocarditis, or inflammation of the heart

• Some chemotherapy drugs

• Thyroid disorders

Many tests exist to diagnose heart failure. But first, you will have a physical examination and a discussion with your doctor about your symptoms and your medical history. This will help reveal whether you have any heart failure risk factors, such as high blood pressure, coronary artery disease, or diabetes.

Tests your doctor might order to check for heart failure include:

• Blood tests. You will likely have a test to measure your level of a hormone called brain natriuretic peptide (BNP). The amount of BNP rises when you have heart failure. Other blood tests will look for underlying conditions, such as diabetes and anemia, which contribute to heart failure or make it worse.

• Cardiac computed tomography (CT) scan. This test provides your doctor with several x-ray images of your heart, taken from different angles, to reveal abnormalities.

• Cardiac magnetic resonance imaging (MRI). This test uses magnet fields and radio waves to create a detailed, 3D picture of your heart to evaluate how well it’s functioning as well as look for the presence of scar tissue.

• Chest X-ray. This will reveal changes to the shape and size of your heart as well as the buildup of fluid in the lungs. Both are signs of heart failure.

• Coronary angiogram. In this test, your doctor inserts a catheter into a vein and moves it to your heart. An x-ray device called a fluoroscope then gets pushed through the catheter to your heart, where it provides images of your heart’s chambers. A chemical called a contrast agent gets pumped through the catheter and into your heart. This makes it easier to see any blockages.

• Echocardiogram. This imaging test shows how much blood your heart pumps out with each beat to determine your ejection fraction, a measure of how well your heart’s working.

• Electrocardiogram (ECG or EKG). This test measures your heart’s electrical activity. It will reveal abnormalities in your heartbeat, called arrhythmias. It can also indicate if your heart has thickened or enlarged and whether it’s getting enough blood and oxygen, according to NYU Langone Health.

• MUGA scan. A multigated acquisition (MUGA) scan uses a camera and a special chemical to take pictures of your heart at work. It’s used to measure your ejection fraction.

• Stress test. During this test, you will walk on a treadmill or ride a stationary bike to get your heart rate up. This shows how well your heart responds to stress, an indicator of its health.

Yes and no. The greatest heart failure risk factor, says Dr. Hare, is one you cannot change: age. The older you get, the likelier you are to develop it. Fortunately, you do have control over many other major contributors to heart failure.

“Pay attention to all your cardiovascular risk factors, like high blood pressure, smoking, high cholesterol, diabetes, and obesity,” Dr. Hare recommends. “These are things you can do something about.”

If you do develop heart failure, know that the advances in treating this condition mean you can not only live many years with it, but potentially reverse it. By working closely with your doctor, you can maximize your chances of a healthy, strong future for your heart and your overall health.