Preventative Treatment

  1. Bed rest. The patient must rest in bed but not for prolonged periods of time, because this may favor the development of pulmonary thromboembolism, bronchopulmonary infections, decubitus. In elderly patients, it may even favor the development of osteoporosis, and in patients suffering from prostate conditions, it may favor the development of urinary retention. The patient should lay in a half-upright position, leaning against pillows. This is done in order to avoid the development of decubitus. It is recommended to keep a rubber ring-pillow under the sacral gluteal region. The patient should defecate regularly, since defecating forcefully may become a cause for embolisms. 

  2. Diet. It is very important to cease the consumption of salt. At the very beginning, the diet should categorically not include salt. The diet must also be hypocaloric. It is recommended to consume vegetables and very little protein. However, extreme, rigorous diets are not recommended for long-term consumption, seeing that they may be poor in calories or protein. With the passage of time, more food types may be added to enrich the diet, but it must always cater to the special prerequisites for these patients. It is also recommended to limit the consumption of sodium, ceasing tobacco consumption (if they are a smoker), ceasing alcohol consumption, take medication to treat anemia or thyroid dysfunction, if present, and losing weight for patients who are overweight or obese. Patients are recommended to become immunized against the flu and pneumonia and to exercise regularly. In this way, patients can improve their lifestyle, and lower their risk for developing complications. 

Drug-based treatment

Drug-based treatments vary across different stages, symptoms and various patients belonging to various age groups and specifications. Treatment is usually complex and involves utilizing drug combinations. 

Treatment should be tailored to each individual patient according to the stage of the disease they are suffering from:

  • For heart failure of the first stage, it is enough to expand the amounts of time spent resting or relaxing for a few days, consuming a saltless diet and taking sedatives like bromide, valium, etc. 
  • For heart failure Stage 2A and 2B, cardiotonic drugs should be used, as well as thiazide diuretics in conjunction with kalichloratin or combined with spironolactone or Lasix (furosemide). 
  • For heart failure of Stage 3, in addition to digitalis treatment and diuretics, liquid removal from the serous cavities should be performed periodically. Lipotropic substances and vitamins are also used, etc. 
  • For cardiac asthma and especially for acute pulmonary edema emergency measures must be taken from the very onset, even if the patient is at home.

Several relevant drug classes include:

Vasodilators, diuretics, digoxin, anticoagulants, antiarrhythmic drugs, beta blockers and calcium pump inhibitors in cases when they are necessary. Treatment aims at curing the symptoms. 

  1. Cardiotonics such as lanatoside C
  2. Digoxin
  3. Thiazide diuretics such as hydrochlorothiazide
  4. Loop diuretics such as furosemide
  5. Metoprolol, corvidolol
  6. Sorbides, nitrosorbide, isosorbide
  7. Warfarin, sintrom, rivaroxaban
  8. Injection fraction enhancer when the injection is under 45% concentrated, sacubitril (entresto) 

Surgery is sometimes used in order to treat certain symptoms. Common procedures utilized include myotomy, myectomy, myocardial bridging, substituting or repairing the mitral valve, implantation of a defibrillator in the heart, heart transplant, implantation of a pacemaker, etc. 

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body.

Examples of ACE inhibitors include ramipril, captopril, enalapril, lisinopril and perindopril.

The most common side effect of ACE inhibitors is a dry, irritating cough. If you have a troublesome cough, an ACE inhibitor may be switched to an ARB.

ACE inhibitors can also cause your blood pressure to fall too low, and they may cause kidney problems. Your GP will monitor this.


Beta-blockers work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline, "fight or flight" chemicals produced by the body.

There are several different beta-blockers, but the main ones used to treat heart failure in the UK are bisoprolol, carvedilol, and nebivolol.

Possible side effects of beta-blockers include dizziness, tiredness, and blurred vision.

But most people taking them have either no or very mild side effects that become less troublesome with time.

Angiotensin receptor blockers (ARBs)

Angiotensin receptor blockers (ARBs) work in a similar way to ACE inhibitors, by relaxing blood vessels and reducing blood pressure.

They tend to be used as an alternative because they don't usually cause a cough, although they may not be quite as effective as ACE inhibitors.

Examples of ARBs include candesartan, losartan, telmisartanand valsartan.

Side effects of ARBs can include low blood pressure and high levels of potassium in your blood. Your doctor will carry out regular blood tests to monitor your potassium level.

Hydralazine with nitrate

Hydralazine in combination with nitrate can help relax and open up the blood vessels.

These medicines are sometimes prescribed by heart specialists (cardiologists) for people who are unable to take an ACE inhibitor or ARB.

Side effects can include headaches, a fast heartbeat, and a pounding, fluttering or irregular heartbeat (palpitations).


Diuretics(water pills) make you pass more urine, and help relieve ankle swelling and breathlessness caused by heart failure.

There are many different types of diuretic, but the most widely used for heart failure are furosemide (also called frusemide) and bumetanide.

Possible side effects of diuretics include dehydration and reduced levels of sodium and potassiumin the blood.

Aldosterone antagonists

Aldosterone antagonists work in a similar way to diuretics, but they don't cause reduced potassium levels. The most widely used aldosterone antagonists are spironolactone and eplerenone.

Spironolactone may cause enlarged breasts (gynecomastia) in men, and breast tenderness and increased hair growth in women. Eplerenone can cause sleeping difficulties, dizziness, and headaches.

The most serious side effect of these medicines is that they can cause the level of potassium in your blood to become dangerously high. Your doctor will carry out regular blood tests to check for this.

Sacubitril valsartan

Sacubitril valsartan is a new heart failure medication recommended by NICE. It's a single tablet that combines an ARB and a medication called a neprilysin inhibitor.

It's suitable for people with more severe heart failure, whose heart is only able to pump a reduced amount of oxygenated blood around the body despite taking other medication.

The most common side effects of sacubitril valsartan are low blood pressure, high potassium levels, and kidney problems.

You can read more about sacubitril valsartan for treating chronic heart failure on the NICE website.


Ivabradine is a medicine that can help slow your heart down and is a useful alternative to beta-blockers if you can't take them or they cause troublesome side effects.

It can also be used alongside beta-blockers if they don't slow the heart enough.

Possible side effects include headaches, dizziness, and blurred vision.


Digoxin, derived from the foxglove plant, can improve your symptoms by strengthening your heart muscle contractions and slowing down your heart rate.

It's normally only recommended for people who have symptoms despite treatment with ACE inhibitors, ARBs, beta-blockers and diuretics.

Possible side effects include dizziness, blurred vision, feeling and being sick, diarrhea, and an irregular heartbeat.

Devices for heart failure

Some people with heart failure will need to have a procedure to implant a small device in their chest that can help control their heart's rhythm.

The most commonly used devices are:


You may need to have a pacemaker fittedif your heart beats too slowly.

A pacemaker monitors your heart rate continuously, and sends electrical pulses to your heart to keep it beating regularly and at the right speed.

The pacemaker is implanted under the skin by a cardiologist, usually under local anesthetic.

You will usually need to stay in the hospital overnight to check it's working properly. Serious complications are unusual.

Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic.

You will also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.

You can also find out more about pacemakers on the British Heart Foundation website.

Cardiac resynchronization therapy

In some people with heart failure, the walls of the main pumping chamber(the left ventricle) do not work together and contract out of sync with each other.

Cardiac resynchronization therapy (CRT) is a special type of pacemaker that can correct the problem by making the walls of the left ventricle all contract at the same time. This makes the heart pump more efficiently.

Most pacemakers only have one or two wires to the heart, but CRT requires an extra wire that is a bit harder to get into place than the other wires.

Implantable cardioverter defibrillators (ICDs)

People who have, or are at high risk of developing, an abnormal heart rhythm may need to have a device known as an implantable cardioverter defibrillator (ICD) fitted.

An ICD constantly monitors the heart rhythm. If the heart starts beating dangerously fast, the ICDwill try to bring it back to normal by giving it a small, controlled electrical shock (defibrillation). If this fails, the ICD will deliver a larger shock.

As with pacemakers, ICDs are implanted in hospital, usually under local anesthetic. Like pacemakers, you will need to avoid things that can interfere with the way the ICD works, such as airport security systems.

The type of surgery you have will depend on what is wrong with the valve and how serious the problem is. Your doctor will discuss this with you.

Read about aortic valve replacement and surgery for mitral valve problems.

Angioplasty or bypass

If your heart failure is related to coronary heart disease, your doctor may recommend a:

  • coronary angioplasty where a tiny balloon is used to stretch open a narrowed or blocked artery
  • coronary artery bypass graft (CABG) where a blood vessel from another part of the body is used to divert blood around narrowed or clogged parts of an artery

These procedures will help make it easier for your heart to pump blood around your body.

Left ventricular assist devices

Left ventricular assist devices (LVADs) are mechanical pumps that can help if your left ventricle isn't working properly and medication alone isn't helping.

They may be used as a permanent treatment if you can't have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

There's also a shortage of hearts for transplantation, so some people have to wait years for a suitable donor heart to become available.

Prognosis and prophylaxis

Given that rheumatism, hypertonic disease and atherosclerosis are the most common causes which lead to heart failure, treating these conditions individually means simultaneously preventing heart failure. In addition to the primary conditions, any bronchopulmonary infections, influenza infections, streptococcal infections, etc., must also be treated and cured, since they can cause cardiac disease and patients to not be able to compensate. It is of high importance to maintain proper hygiene and diet. Patients must forego physical exertion and psychological stresses. Their diet should be adapted to be easily digestible, rich in vitamins (especially the vitamin B complex kinds), and it should not contain more than 0.5 - 2.0 g of sodium taken per day. These individuals can be treated as outpatients but still remain under continuous medical supervision.  

Prognosis is a matter upon which limited remarks can be made. It is intrinsically connected to the nature of the cardiomyopathy that caused the heart failure. The prognosis is less favorable for patients suffering from infarction of the myocardium, hypertonic disease or aortic defects than it is for patients suffering from stenosis or mitral ailments. This occurs because, in the aforementioned severe conditions, the main pressure falls on the left ventricle, which is constructed of thicker muscular walls, and can resist damage for longer periods of time. When the left ventricle can no longer compensate, the disease worsens and it is difficult to recover. In the case of less severe conditions, the right ventricle sustains most of the damage, which means it decompensation occurs faster, but the patients can recover (compensate) faster as well. Prognosis may worsen with the advent of complications such as embolisms and pulmonary infarctions, etc. The prognosis is more favorable for constrictive pericarditis which disappears after a pericardiectomy. 




Content supplied by the NHS Website

Medically Reviewed by a doctor on 5 Aug 2016