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Heart Failure

Overview

Heart failure occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.

Some heart conditions slowly leave the heart too weak or stiff to fill and pump blood properly. These conditions include narrowed arteries in the heart and high blood pressure.

Proper treatment may improve the symptoms of heart failure and may help some people live longer. Lifestyle changes can improve quality of life. Try to lose weight, exercise, use less salt and manage stress.

But heart failure can be life-threatening. People with heart failure may have severe symptoms. Some may need a heart transplant or a device to help the heart pump blood.

Heart failure also may be called congestive heart failure.

Facts about heart failure in the United States

In the United States, nearly 6.7 million adults 20 years old or older have heart failure.

In 2022, heart failure was mentioned on 457,212 death certificates (and responsible for 13.9% of all causes of death).

Heart failure cost the nation an estimated $30.7 billion in 2012. This total includes the cost of health care services, medicines to treat heart failure, and missed days of work.

Deaths from heart failure vary by geography

Heart failure is more common in some areas of the United States than in others.

The concentrations of counties with the highest heart disease death rates are located primarily in Mississippi, Louisiana, Arkansas, Oklahoma, Texas, Kentucky, Tennessee, Indiana, Illinois, and Wisconsin. Pockets of high-rate counties also were found in Oregon, Utah, Montana, South Dakota, and Nebraska.

Symptoms

If you have heart failure, your heart can't supply enough blood to meet your body's needs.

Symptoms may develop slowly. Sometimes, heart failure symptoms start suddenly. Heart failure symptoms may include:

Shortness of breath with activity or when lying down.

Fatigue and weakness.

Swelling in the legs, ankles and feet.

Rapid or irregular heartbeat.

Reduced ability to exercise.

Wheezing.

A cough that doesn't go away or a cough that brings up white or pink mucus with spots of blood.

Swelling of the belly area.

Very rapid weight gain from fluid buildup.

Nausea and lack of appetite.

Difficulty concentrating or decreased alertness.

Chest pain if heart failure is caused by a heart attack.

Risk factors

Diseases and conditions that increase the risk of heart failure include:

Coronary artery disease. Narrowed arteries may limit the heart's supply of oxygen-rich blood, resulting in weakened heart muscle.

Heart attack. A heart attack is a form of coronary artery disease that occurs suddenly. Damage to the heart muscle from a heart attack may mean the heart can no longer pump as well as it should.

Heart valve disease. Having a heart valve that doesn't work properly raises the risk of heart failure.

High blood pressure. The heart works harder than it has to when blood pressure is high.

Irregular heartbeats. Irregular heartbeats, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.

Congenital heart disease. Some people who develop heart failure were born with changes in the structure or function of their heart.

Diabetes. Having diabetes increases the risk of high blood pressure and coronary artery disease.

Sleep apnea. This inability to breathe properly during sleep results in low blood-oxygen levels and an increased risk of irregular heartbeats. These things can lead to a weakened heart.

Obesity. People who have obesity have a higher risk of developing heart failure.

Viral infections. Some viral infections can damage to the heart muscle.

Medicines that may increase the risk of heart failure include:

Some diabetes medicines. The diabetes medicines rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don't stop taking these medicines without first talking to your healthcare professional.

Some other medicines. Other medicines that may lead to heart failure or heart conditions include nonsteroidal anti-inflammatory drugs (NSAIDs) and some medicines used to treat high blood pressure, cancer, blood conditions, irregular heartbeats, nervous system diseases, mental health conditions, lung and urinary conditions, and infections.

Other risk factors for heart failure include:

Aging. The heart's ability to work decreases with age, even in healthy people.

Alcohol use. Drinking too much alcohol may weaken the heart muscle and lead to heart failure.

Smoking or using tobacco. If you smoke, quit. Using tobacco increases the risk of heart disease and heart failure.

Causes

Heart failure can be caused by a weakened, damaged or stiff heart.

If the heart is damaged or weakened, the heart chambers may stretch and get bigger. The heart can't pump out the needed amount of blood.

If the main pumping chambers of the heart, called the ventricles, are stiff, they can't fill with enough blood between beats.

The heart muscle can be damaged by certain infections, heavy alcohol use, recreational drug use and some chemotherapy medicines. Your genes also can play a role.

Any of the following conditions also can damage or weaken the heart and cause heart failure.

Coronary artery disease and heart attack. Coronary artery disease is the most common cause of heart failure. The disease results from the buildup of fatty deposits in the arteries. The deposits narrow the arteries. This reduces blood flow and can lead to heart attack.A heart attack occurs suddenly when an artery feeding the heart becomes completely blocked. Damage to the heart muscle from a heart attack may mean that the heart can no longer pump as well as it should.

High blood pressure. Also called hypertension, this condition forces the heart to work harder than it should to pump blood through the body. Over time, the extra work can make the heart muscle too stiff or too weak to properly pump blood.

Heart valve disease. The valves of the heart keep blood flowing the right way. If a valve isn't working properly, the heart must work harder to pump blood. This can weaken the heart over time. Treating some types of heart valve disease may reverse heart failure.

Inflammation of the heart muscle, also called myocarditis. Myocarditis is most commonly caused by a virus, including the COVID-19 virus, and can lead to left-sided heart failure.

A heart condition that you're born with, also called a congenital heart defect. If the heart and its chambers or valves haven't formed correctly, the other parts of the heart have to work harder to pump blood. This may lead to heart failure.

Irregular heart rhythms, called arrhythmias. Irregular heart rhythms may cause the heart to beat too fast, creating extra work for the heart. A slow heartbeat also may lead to heart failure. Treating an irregular heart rhythm may reverse heart failure in some people.

Other diseases. Some long-term diseases may contribute to chronic heart failure. Examples are diabetes, HIV infection, an overactive or underactive thyroid, or a buildup of iron or protein.

Causes of sudden heart failure also include:

Allergic reactions.

Any illness that affects the whole body.

Blood clots in the lungs.

Severe infections.

Use of certain medicines.

Viruses that attack the heart muscle.

Heart failure usually begins with the lower left heart chamber, called the left ventricle. This is the heart's main pumping chamber. But heart failure also can affect the right side. The lower right heart chamber is called the right ventricle. Sometimes heart failure affects both sides of the heart.

Types of heart failure	Description
Right-sided heart failure	Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. When the left ventricle fails and can’t pump enough blood out, increased fluid pressure is transferred back through the lungs. This damages the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins.
Left-sided heart failure	In left-sided or left ventricular heart failure, the left side must work harder to pump the same amount of blood. The percentage of blood the heart can pump with each beat is measured by a unit called ejection fraction, or EF. A normal left ventricle ejects about 55% to 60% of the blood in it.
Heart failure with reduced ejection fraction (HFrEF) (systolic heart failure)	The left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation. This is also known as heart failure with reduced ejection, or HFrEF. When this occurs, the heart is pumping less than or equal to 40% EF.
Heart failure with preserved ejection fraction (HFpEF) (diastolic heart failure)	The left ventricle loses its ability to relax normally because the muscle has become stiff. The heart can't properly fill with blood during the resting period between each beat. This is also known as heart failure with preserved ejection, or HFpEF. When this occurs, the heart is pumping greater than or equal to 50%. EF heart failure with mid-range ejection fraction (HFmrEF) is a newer concept. In this type of heart failure, the left ventricle pumps between 41% and 49% EF. This places people with HFmrEF between the HFrEF and HFpEF groups.

Complications

If you have heart failure, it's important to have regular health checkups, even if symptoms improve. Your healthcare professional can examine you and run tests to check for complications.

Complications of heart failure depend on your age, overall health and the severity of heart disease. They may include:

Kidney damage or failure. Heart failure can reduce the blood flow to the kidneys. Untreated, this can cause kidney failure. Kidney damage from heart failure can require dialysis for treatment.

Other heart changes. Heart failure can cause changes in the heart's size and function. These changes may damage heart valves and cause irregular heartbeats.

Liver damage. Heart failure can cause fluid buildup that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for the liver to work properly.

Sudden cardiac death. If the heart is weak, there is a risk of dying suddenly due to a dangerous irregular heart rhythm.

Prevention

One way to prevent heart failure is to treat and control the conditions that can cause it. These conditions include coronary artery disease, high blood pressure, diabetes and obesity.

Some of the same lifestyle changes used to manage heart failure also may help prevent it. Try these heart-healthy tips:

Don't smoke.

Get plenty of exercise.

Eat healthy foods.

Maintain a healthy weight.

Reduce and manage stress.

Take medicines as directed.

Diagnosis

To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. Your care professional checks to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes.

Your care professional listens to your lungs and heart with a device called a stethoscope. A whooshing sound called a murmur may be heard when listening to your heart. Your care professional may look at the veins in your neck and check for swelling in your legs and belly.

Tests

Tests that may be done to diagnose heart failure may include:

Blood tests. Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood vessels. In heart failure, the level of this protein goes up.

Chest X-ray. X-ray images can show the condition of the lungs and heart.

Electrocardiogram (ECG or EKG). This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart is beating.

Echocardiogram. Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow through the heart.

Ejection fraction. Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. This measurement is taken during an echocardiogram. The result helps classify heart failure and guides treatment. An ejection fraction of 50% or higher is considered ideal. But you can still have heart failure even if the number is considered ideal.

Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests can show how the heart responds to physical activity. If you can't exercise, you might be given medicines.

CT scan of the heart. Also called a cardiac CT scan, this test uses X-rays to create cross-sectional images of the heart.

Heart MRI scan, also called a cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart.

Coronary angiogram. This test helps spot blockages in the heart arteries. The healthcare professional inserts a long, thin flexible tube called a catheter into a blood vessel, usually in the groin or wrist. It's then guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

Myocardial biopsy. In this test, a healthcare professional removes very small pieces of the heart muscle for examination. This test may be done to diagnose certain types of heart muscle diseases that cause heart failure.

During or after testing for heart failure, your healthcare professional may tell you the stage of disease. Staging helps determine the most appropriate treatment. There are two main ways to determine the stage of heart failure:

New York Heart Association (NYHA) classification

This system groups heart failure into four categories by number. You may see Roman numerals used for these category names.

Class 1 heart failure. There are no heart failure symptoms.

Class 2 heart failure. Everyday activities can be done without difficulty. But exertion causes shortness of breath or fatigue.

Class 3 heart failure. It's difficult to complete everyday activities.

Class 4 heart failure. Shortness of breath occurs even at rest. This category includes the most severe heart failure.

American College of Cardiology/American Heart Association classification

This stage-based classification system uses letters A to D. It includes a category for people who are at risk of developing heart failure.

Stage A. There are several risk factors for heart failure but no signs or symptoms.

Stage B. There is heart disease but no signs or symptoms of heart failure.

Stage C. There is heart disease and signs or symptoms of heart failure.

Stage D. Advanced heart failure requires specialized treatments.

Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options. Your care professional can help you interpret your stage.

Treatments

Treatment of heart failure may depend on the cause. Treatment often includes lifestyle changes and medicines. If another health condition is causing the heart to fail, treating it may reverse heart failure.

Some people with heart failure need surgery to open blocked arteries or to place a device to help the heart work better.

With treatment, symptoms of heart failure may improve.

Medications

A combination of medicines may be used to treat heart failure. The specific medicines used depend on the cause of heart failure and the symptoms.

Medicines to treat heart failure include:

Angiotensin-converting enzyme (ACE) inhibitors. These medicines relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart.

Commonly prescribed ACE inhibitors include:

Captopril (Capoten)

Enalapril (Vasotec)

Fosinopril (Monopril)

Lisinopril (Prinivil, Zestril)

Perindopril (Aceon)

Quinapril (Accupril)

Ramipril (Altace)

Trandolapril (Mavik)

Benazepril (Lotensin)

Moexipril (Univasc)

Angiotensin II receptor blockers (ARBs). These medicines have many of the same benefits as ACE inhibitors. They may be an option for people who can't tolerate ACE inhibitors.

Commonly prescribed ARBs include:

Candesartan (Atacand)

Losartan (Cozaar)

Valsartan (Diovan)

Angiotensin receptor plus neprilysin inhibitors (ARNIs). This medicine uses two blood pressure medicines to treat heart failure. It's used to treat some people with heart failure with reduced ejection fraction. It may help prevent the need for a hospital stay in those people.

Commonly prescribed ARNIs include:

sacubitril-valsartan (Entresto)

Beta blockers. These medicines slow the heart rate and lower blood pressure. They reduce the symptoms of heart failure and help the heart work better. If you have heart failure, beta blockers may help you live longer.

Commonly prescribed beta-blockers include:

Bisoprolol (Zebeta)

Carvedilol (Coreg)

Carvedilol phosphate (Coreg CR)

Labetalol (Trandate)

Metoprolol succinate (Toprol XL and Kapspargo Sprinkle)

Metoprolol tartrate (Lopressor)

Nebivolol (Bystolic)

Propranolol (Inderal, Inderal LA, and InnoPran XL)

Diuretics. Heart failure can cause excess fluid retention. Diuretics or “water pills” cause the body to rid itself of excess fluids and sodium through urination. It decreases fluid buildup in the lungs and other parts of the body, such as the ankles and legs. This can help to relieve the heart’s workload. Different diuretics remove fluid at varied rates and through different methods.

The most commonly prescribed diuretics for heart failure include:

Furosemide (Lasix)

Bumetanide (Bumex)

Torsemide (Demadex)

Other diuretics that you may see:

Metolazone (Zaroxolyn)

Chlorothiazide (Diuril)

Amiloride (Midamor)

Chlorthalidone (Hygroton)

Hydrochlorothiazide or HCTZ (Esidrix, Hydrodiuril)

Indapamide (Lozol)

Triamterene (Dyrenium)

Aldosterone Antagonists Aldosterone antagonists (also called mineralocorticoid receptor antagonists or MRAs) are a type of water pill that also help to lower high blood pressure. However, this medication has been shown to help improve heart function in people with heart failure, even if blood pressure is normal or if they do not have extra fluid in their body.

Commonly prescribed aldosterone antagonists include:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines help lower blood sugar. They are often prescribed with diet and exercise to treat type 2 diabetes. But they're also one of the first treatments for heart failure. That's because several studies showed that the medicine lowered the risk of hospital stays and death in people with certain types of heart failure — even if they didn't have diabetes.

SGLT2 inhibitors that are specifically approved for heart failure include:

Dapagliflozin (Farxiga)

Empagliflozin (Jardiance)

Sotagliflozin (Inpefa)

Digoxin (Lanoxin). This medication might strengthen the heart’s pumping action and reduce a heart rate that’s too fast. The level of digoxin in the body must be checked using a blood test. If too much digoxin builds up in the blood, side effects may occur, including loss of appetite, nausea, vomiting and headaches. The heart rhythm can also become too fast or too slow. Always report any side effects of this medication to your health care professional right away.

Hydralazine and isosorbide dinitrate (BiDil). These medications are vasodilators, which widen blood vessels. When blood vessels widen, blood flows more easily and the heart doesn’t have to work as hard. Some vasodilators, such as nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate), mainly make the veins wider but also widen coronary arteries. Others (hydralazine) work mostly on the arteries. You may need to take two vasodilators if your blood pressure is high or if your symptoms keep you from doing your usual activities. Research has shown that these medications, when added to standard therapy, can reduce death, hospitalization and improve quality of life for people with a reduced ejection fraction, particularly those of African ancestry. These drugs can be prescribed as two separate medications (hydralazine and isosorbide dinitrate) or as a single pill containing both medications (BiDil).

Vericiguat (Verquvo). This medicine for chronic heart failure is taken once a day by mouth. It's a type of medicine called an oral soluble guanylate cyclase (sGC) stimulator. In studies, people with high-risk heart failure who took this medicine had fewer hospital stays for heart failure and heart disease-related deaths compared with those who got a dummy pill.

Positive inotropes. These medicines may be given by IV to people with certain types of severe heart failure who are in the hospital. Positive inotropes can help the heart pump blood better and maintain blood pressure. Long-term use of these medicines has been linked to an increased risk of death in some people. Talk with your healthcare professional about the benefits and risks of these medicines.

Ivabradine (Corlanor). This medication is known as an If channel blocker. This drug slows the heart rate differently from beta-blockers, without lowering blood pressure.

Your healthcare professional may need to change your medicine doses frequently. This is more common when you've just started a new medicine or when your condition is getting worse.

You may need to stay in the hospital if you have a flare-up of heart failure symptoms.

While in the hospital, you may receive:

Medicines to relieve your symptoms.

More medicines to help your heart pump better.

Oxygen through a mask or small tubes placed in your nose.

If you have severe heart failure, you may need to use supplemental oxygen for a long time.

Other medications that might be prescribed

Your health care professional may also prescribe other medications for additional health conditions that may occur with heart failure. These include:

Potassium and magnesium supplements: Diuretics can remove potassium and magnesium from the body. Your health care professional may prescribe potassium and/or magnesium supplements to ensure these levels remain normal while you are being treated.

Anticoagulants (also known as blood thinners): Anticoagulants are used in heart failure patients with atrial fibrillation, an artificial heart valve, blood clots or in people at high risk for blood clots. They help prevent blood clots from forming and blocking blood flow. Clots may form in the legs, lungs or heart. If a clot breaks off and gets stuck inside a blood vessel that supplies the brain, a stroke can result.

Cholesterol-lowering drugs (statins): Your health care professional may prescribe this class of medication if you have high cholesterol or have had a heart attack. They are not used to treat heart failure but other conditions as indicated. These medications help prevent the formation of plaque, which helps reduce the risk of heart attack and stroke.

Oxygen therapy delivers concentrated oxygen to the lungs. This helps increase the amount of oxygen that can get into the blood. Oxygen therapy can improve shortness of breath and increase a person’s ability to be physically active.

Surgery or other procedures

Surgery or other treatment to place a heart device may be recommended to treat the condition that led to heart failure.

Surgery or other procedures for heart failure may include:

Coronary artery bypass graft surgery. You may need this surgery if severely blocked arteries are causing your heart failure. The surgery involves taking a healthy blood vessel from the leg, arm or chest and connecting it below and above the blocked arteries in the heart. The new pathway improves blood flow to the heart muscle.

Heart valve repair or replacement. If a damaged heart valve causes heart failure, your care professional may recommend repairing or replacing the valve. There are many different types of heart valve surgery. The type needed depends on the cause of the heart valve disease.Heart valve repair or replacement may be done as open-heart or minimally invasive surgery.

Implantable cardioverter-defibrillator (ICD). An ICD is used to prevent complications of heart failure. It isn't a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It's implanted under the skin in the chest with wires leading through the veins and into the heart.The ICD checks the heartbeat. If the heart starts beating at a dangerous rhythm, the ICD tries to correct the beat. If the heart stops, the device shocks it back into regular rhythm. An ICD can also work as a pacemaker and speed up a slow heartbeat.

Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers aren't pumping in sync with each other. A device sends electrical signals to the lower heart chambers. The signals tell the chambers to squeeze in a more coordinated way. This improves the pumping of blood out of the heart. CRT may be used with an ICD.

Ventricular assist device (VAD). A VAD helps pump blood from the lower chambers of the heart to the rest of the body. It's also called a mechanical circulatory support device. Although a VAD can be placed in one or both lower chambers of the heart, it's usually placed in the lower left one.Your healthcare professional may recommend a VAD if you're waiting for a heart transplant. Sometimes, a VAD is used as a permanent treatment for people who have heart failure but who aren't good candidates for a heart transplant.

Heart transplant. Some people have such severe heart failure that surgery or medicines don't help. These people may need to have their hearts replaced with a healthy donor heart.A heart transplant isn't the right treatment for everyone. A team of healthcare professionals at a transplant center helps determine whether the procedure may be safe and beneficial for you.

Symptom care and end-of-life care

Your healthcare professional may recommend special medical care to reduce symptoms and improve quality of life. This is called palliative care. Anyone who has a serious or life-threatening illness can benefit from this type of care. It can be used to treat symptoms of the disease or to ease the side effects of treatment.

In some people with heart failure, medicines no longer work and a heart transplant or device isn't an option. If this occurs, special end-of-life care may be recommended. This is called hospice care.

Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one. Hospice care is available in your home or in nursing homes and assisted living centers.

Hospice care provides the following for those who are sick and their loved ones:

Emotional support.

Psychological support.

Spiritual support.

Although it can be difficult, discussing end-of-life issues with your family and medical team is important. Part of this discussion will likely involve an advance care directive. This is a general term for spoken and written instructions you give concerning your medical care, should you become unable to speak for yourself.

If you have an ICD, one important consideration to discuss with your family and healthcare team is whether the ICD should be turned off so that it can't deliver shocks to make your heart continue beating.

When to see a doctor

See your healthcare professional if you think you might have symptoms of heart failure. Call 911 or emergency medical help if you have any of the following:

Chest pain.

Fainting or severe weakness.

Rapid or irregular heartbeat with shortness of breath, chest pain or fainting.

Sudden, severe shortness of breath and coughing up white or pink, foamy mucus.

These symptoms may be due to heart failure. But there are many other possible causes. Don't try to diagnose yourself.

At the emergency room, healthcare professionals do tests to learn if your symptoms are due to heart failure or something else.

Call your healthcare professional right away if you have heart failure and:

Your symptoms suddenly get worse.

You develop a new symptom.

You gain 5 pounds (2.3 kilograms) or more within a few days.

Such changes could mean that existing heart failure is getting worse or that treatment isn't working.

Lifestyle and home remedies

Some people with heart failure may be told to take omega-3 fatty acid supplements. Some research shows that the supplements may help reduce the need for hospital stays.

Making certain lifestyle changes often improve heart failure symptoms. They may even stop the condition from getting worse.

The following changes are recommended to improve heart health:

Don't smoke. Smoking damages the blood vessels and raises blood pressure. It lowers blood oxygen levels and speeds up the heartbeat. Quitting is the best way to reduce the risk of heart disease. If you need help quitting, talk with your care professional. You can't be considered for a heart transplant if you continue to smoke. Also avoid secondhand smoke.

Check your legs, ankles and feet for swelling. Do this every day. Call your healthcare professional if the swelling worsens.

Weigh yourself. Ask your healthcare professional how often you should do this. Weight gain may mean your body is holding onto fluid. You may need a change in treatment. Call your care professional if you gain 5 pounds (2.3 kilograms) or more within a few days.

Manage weight. Being overweight increases the risk of heart disease. Ask your healthcare professional what weight is best for you. Even losing a small amount of weight can help improve heart health.

Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins. Limit saturated or trans fats.

Limit salt. Too much salt, also called sodium, can make the body hold onto water. This is called water retention. It makes the heart work harder. Symptoms include shortness of breath and swollen legs, ankles and feet.Ask your healthcare professional if you should follow a no-salt or low-salt diet. Remember that salt is already added to prepared foods.

Limit alcohol. Alcohol can interfere with certain medicines. It also weakens the heart and increases the risk of irregular heartbeats. If you have heart failure, your healthcare professional may recommend that you don't drink alcohol.

Ask how much fluids you can drink. If you have severe heart failure, your care professional may suggest that you limit the amount of fluids you drink.

Stay as active as possible. Moderate exercise helps keep the heart and body healthy. But be sure to talk with your healthcare professional about an exercise program that's right for you. If you have heart failure, your care professional may suggest a walking program or a cardiac rehabilitation program at your local hospital.

Reduce stress. Strong emotions such as anxiety or anger can make the heart beat faster. Breathing becomes heavier and blood pressure goes up. These changes can make heart failure worse.Find ways to reduce emotional stress. Practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress.

Get better sleep. Heart failure can cause shortness of breath, especially when lying down. Try sleeping with your head propped up using a pillow or a wedge. If you snore or have had other sleep challenges, make sure you get tested for sleep apnea.

Get recommended vaccinations. Ask your healthcare professional about getting influenza, pneumonia and COVID-19 vaccinations.

Coping and support

Managing heart failure requires open communication between you and your healthcare professional. Be honest about any challenges concerning your diet, lifestyle and medicine use. Pay attention to your body and how you feel. Tell your care professional when you're feeling better or worse. This helps your healthcare professional know what treatment works best for you.

These steps may help you manage heart failure:

Take medicines as directed. If side effects or costs are a concern, ask your care professional about options. Don't stop taking your medicines without first talking to a care professional. Also, go to all scheduled health appointments. If you miss one, ask your healthcare professional how and when to reschedule.

Use caution with other medicines and supplements. Some medicines available without a prescription to treat pain and swelling can make heart failure worse. They include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some diet pills and supplements also may be unsafe if you take medicines for heart failure. Always tell your healthcare professional about all the medicines you take, including those bought without a prescription.

Weigh yourself daily. Do this when you first wake up, after breakfast and after peeing. Write your weight down in a notebook. Bring the notes to your medical checkups. An increase in weight can be a sign of fluid buildup.

Check your blood pressure at home. Write down your numbers and bring them with you to your health checkups. Doing so helps your care professional know if treatment is working or if your condition is getting worse. Home blood pressure monitors are available at local stores and pharmacies.

Know how to contact your healthcare professional. Keep your care professional's phone number, the hospital's phone number, and directions to the hospital or clinic on hand. You'll want easy access to this information if you have health questions or if you need to go to the hospital.

Ask for help. Sticking to treatment and lifestyle changes may be challenging. It may help to ask your friends and family to help you meet your goals.

Preparing for your appointment

If are worried about your heart failure risk, make an appointment with your healthcare professional. You may be referred to a doctor trained in heart diseases. This type of doctor is called a cardiologist. If heart failure is found early, treatment may be easier and more effective.

Appointments can be brief. Because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a while before some tests.

Write down any symptoms you're having, including any that may seem unrelated to heart failure.

Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes. Find out if anyone in your family has had heart failure. Some heart conditions that cause heart failure run in families. Knowing as much as you can about your family history can be helpful.

Make a list of all medicines, Vitamins or supplements that you're taking. Include doses. Bring this list with you to all health checkups.

Take someone along, if possible. Sometimes it can be difficult to remember all the information given to you during an appointment. Someone who goes with you may remember something that you missed or forgot.

Write down questions to ask your healthcare professional. For example, if you have heart failure you might ask if it's safe for you and your partner to have sex. Most people with heart failure can continue having sex once symptoms are under control. If you have questions, talk with your healthcare professional.

Your time with your care professional is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart failure, some basic questions to ask your healthcare professional include:

What's the most likely cause of my symptoms?

Are there other possible causes for my symptoms?

What kinds of tests will I need? Do these tests require any special preparation?

What treatments are available? Which do you recommend for me?

What foods should I eat or avoid?

What's an appropriate level of physical activity?

Do I have any activity restrictions?

How often should I be screened for changes in my condition?

I have other health conditions. How can I best manage these conditions together?

Is there a generic available for the medicine you're prescribing for me?

Do my family members need to be screened for conditions that may cause heart failure?

Is there any information that I can take home with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare professional is likely to ask many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your care professional may ask:

When did you first notice your symptoms?

Do your symptoms occur all the time, or do they come and go?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

Does anything make your symptoms worse?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure from starting or worsening.

One Final Note..

If you have heart failure, you can take steps to improve your heart health. Take your medications, follow a low-sodium diet, stay active, take notice of sudden changes in your weight, keep your follow-up appointments and track your symptoms. If you have questions or concerns about your medications, lifestyle changes or any other part of your treatment plan, talk to your provider. They’re there to help you manage your heart failure.

Additional Resources

Million Hearts ®

MedlinePlus

National Heart, Lung, and Blood Institute

Heart Failure Society of America

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Most recent revision June 30, 2025 08:08:46 PM

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