GoodRx Guide
Heart Failure: Your GoodRx Guide
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Heart failure is a medical condition in which the heart does not pump as well as it once did. Your heart’s job is to push blood forward into your blood vessels, so it can deliver oxygen and nutrients to every organ in your body. When your heart isn’t strong enough to push blood forward, fluid starts to build up in your body. This leads to symptoms, limitations on your activity, and even a shorter life expectancy.
The heart has two sides: right and left. The left side of the heart is stronger and pumps blood to most parts of the body. The right side pumps blood from the rest of the body to lungs, where it picks up oxygen from the air you breathe. Either side — or both sides — can fail.
One way to measure how well your heart is working is the ejection fraction (EF). This is a measure of how much blood in the heart is being pumped with each beat. Your EF should be around 50% or higher, meaning your heart pumps out at least half of the blood inside of it with each beat.
Left-sided heart failure can be divided into two different types, depending on the EF:
Heart failure with reduced EF (HFrEF): The EF is lower than normal, meaning that your heart is pumping out only a small amount of the blood inside of it with each beat. This happens because the heart muscle isn’t strong enough to push the normal amount of blood out.
Heart failure with preserved EF (HFpEF): The heart isn’t able to push enough blood forward even though it is squeezing like normal. This happens because the heart isn’t able to fill up completely in between heart beats, usually because the heart muscle is too stiff.
Symptoms
The signs and symptoms of heart failure are mainly due to fluid building up where it’s not supposed to be. If the left side is failing, the lungs will collect fluid because they are behind the left side of the heart in the bloodstream. If the right side is failing, fluid will build up in the rest of the body, like the legs or abdomen.
Common signs and symptoms of heart failure include:
Shortness of breath that usually worsens with activity or while lying flat
Swelling (called edema) of the feet, legs, and abdomen
Sudden weight gain
Fatigue
Feeling lightheaded or dizzy
Nausea or loss of appetite
Not everyone will have the same symptoms of heart failure. Some people might get more swelling, and others might have more shortness of breath.
Heart failure can have a huge impact on your life. Shortness of breath and fatigue can make even simple, daily activities — such as dressing and bathing — seem exhausting. Swelling of the legs can be uncomfortable and painful, and it can make walking and dressing difficult.
Causes
Many conditions can lead to heart failure. Although we don’t always know what causes it, we do know about many factors that lead to heart failure.
Conditions that cause direct damage to the heart can weaken it. Examples include:
Viral infections
Alcohol and drugs
Problems with the heart’s structure can make it inefficient. Some examples are:
Damage to heart valves, which can prevent blood flowing in the right direction
Birth defects that some people are born with
Conditions that cause the heart to work harder can wear it out over time, such as:
Right-sided heart failure is usually due to left-sided heart failure, but other conditions that can lead to right heart failure include:
Blood clots in the lungs
Pulmonary hypertension (high blood pressure of the blood vessels in the lungs)
Lung disease
Knowing if you are at risk of heart failure is important. Although some risk factors, like getting older, can’t be changed, many are treatable — and addressing them can lower your risk for heart failure.
Diagnosis
Getting a diagnosis begins with a visit to your healthcare provider. The evaluation will involve a conversation about your symptoms and medical history, followed by a physical exam. Your provider may recommend further testing.
A blood test called B-type natriuretic peptide (BNP) is often elevated in people with heart failure. Other blood work can also look for evidence of heart attacks or damage to other organs.
A chest X-ray can show signs of fluid collecting in the lungs from heart failure. It can also check for other causes of shortness of breath, such as pneumonia.
An echocardiogram is the main test that’s used to diagnose heart failure. This is an ultrasound of the heart that can measure EF and how well the heart valves are working.
Stages of heart failure
Heart failure is divided into stages based on severity and symptoms. Stages matter because guidelines recommend treatment on the basis of heart failure stage, symptoms, and other medical conditions.
Stage A
You are at high risk for heart failure, but there’s no evidence of heart failure on your tests.
Stage B
Testing shows heart failure, but you don’t have any symptoms yet.
Stage C
You have symptoms of heart failure. These symptoms are divided into classes:
Class I: no symptoms with normal daily activity
Class II: mild symptoms with normal activity
Class III: symptoms limit your activity, and you’re only comfortable at rest
Class IV: severe symptoms with activity and symptoms at rest
Stage D
You get severe symptoms even if you are resting or doing very little, and they don’t get better with normal treatment.
Medications
When it comes to medications for heart failure treatment, there are a few different types. Not everyone will need to take all types of these medications.
Medications that reduce symptoms work by getting rid of extra fluid in your body are:
Diuretics, like furosemide (Lasix), torsemide (Demadex), or bumetanide (Bumex), help your body remove extra fluid through urination.
Aldosterone receptor blockers are special diuretics that are recommended for people with low EF. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
Other medications work by reducing how fast or hard your heart is working:
Beta-blockers, like metoprolol (Lopressor or Toprol XL) or carvedilol (Coreg), decrease how hard your heart is working and prevent heart failure from worsening.
Vasodilators, like hydralazine (Apresoline) and isosorbide dinitrate (Isordil) lower your blood pressure, which decreases how hard your heart has to work.
Ivabradine (Corlanor) slows your heart rate.
Some medications actually prolong your life, including the following:
Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) lower your blood pressure and prevent heart failure from worsening. Some examples are lisinopril (Zestril), enalapril (Vasotec), or losartan (Cozaar), but there are many more.
Sacubitril/valsartan (Entresto) is a combination of an ARB and another medication that helps prevent heart-damaging substances from building up in the body.
Digoxin (Lanoxin), does not neatly fit into the other categories, but it helps the heart pump more efficiently and improves EF.
Treatments
Many treatment options exist for heart failure. It can be overwhelming at first, but your healthcare team will help you decide which options are the best for you, depending on your stage of heart failure, other medical conditions, and echocardiogram results.
Lifestyle changes are usually the first place to start for anyone with heart failure. These include starting a heart-healthy diet and exercise, as well as quitting smoking. It also helps to track your fluid and salt intake. Medications are often recommended with lifestyle changes to help manage conditions such as high blood pressure and diabetes.
Other treatment options include cardiac rehabilitation, which is a monitored exercise program for people with heart disease, and implantable devices. An implanted cardioverter–defibrillator can correct life-threatening abnormal rhythms that it detects. It can also improve the timing of heart squeezes (called cardiac resynchronization therapy), helping your heart work more efficiently if it’s beating out of sync.
Some people need a surgical procedure to treat their heart failure. They aren’t for everyone, though, so you’ll need to work with a specialist to figure out if these procedures will be a good option for you. Examples include revascularization procedures, placement of ventricular assist devices (VADs), and heart transplantation.
Our heart failure treatment guide provides more information on each treatment type, as well as which treatments may be recommended for each stage of heart failure.
Prevention
If you have a diagnosis of heart failure, you might be wondering what you can do to stop it from getting worse. If you are at risk for heart failure, you might be wondering how to lower your risk and prevent heart failure from developing.
Healthy lifestyle changes are a great place to start. The Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diet are often recommended, as is 150 minutes of exercise per week. These changes can help with cholesterol, diabetes, and blood pressure, and can lead to weight loss.
Seeing a healthcare provider regularly can help you keep tabs on your medical risk factors, including:
Diabetes
High blood pressure
High cholesterol
Sleep apnea
Tobacco, alcohol, and drug use also increase your risk. Your healthcare provider can help you find the right resources to cut back or quit — it’s difficult to try to do it all on your own.
Be sure to speak with your provider if treatment costs are a problem or you’re feeling overwhelmed with the number of options. Help and support are available.
Common concerns
Many of the symptoms of heart failure come from fluid building up behind the heart. Because the heart is less effective at pushing blood out, fluid starts to build up in the big veins that drain into the heart. Since gravity pulls that fluid downward, it’s common for the legs to swell. This fluid can also build up in your abdomen and cause swelling there, because it can’t drain into the veins leading into the heart. The veins in your neck might also swell from this fluid backing up.
Many people can recover from heart failure, but it depends on how severe your heart failure is. People with mild heart failure, such as stage A or stage B, can prevent their heart disease from getting worse by treating any conditions they have that can contribute to heart failure (such as diabetes and high blood pressure) and making healthy lifestyle changes. In these stages, recovery is possible.
If you have heart failure that is more serious (stage C), it’s possible to recover, but it’s a little more difficult. Getting the right medications and staying on them can help keep fluid out of your body so that you feel OK and function at your best. Cardiac rehab can improve your heart health and ability to do daily activities. Stage D heart failure is the tipping point — at this stage, recovery isn’t likely with treatment.
Heart failure is a chronic condition, meaning it’s never fully cured. There’s always the risk that symptoms might get worse again, so a long-term commitment to a healthy lifestyle is a big part of recovery.
Since heart failure is a serious condition, you might be wondering how heart failure will affect your lifespan. This depends on a lot of factors, such as your age and other medical conditions you might have.
According to studies, if you are younger than 50 years old, your remaining lifespan may be 20 years or longer. Life expectancy decreases thereafter with age.
How severe your heart failure is also plays a role. For example, people with mild heart failure (such as stage B) may have near-normal lifespans. But life expectancy is shorter for people with more severe heart failure (stage C or D).
These numbers probably sound scary. But remember, there’s a lot you can do to improve your symptoms, and getting the right treatment could make your lifespan longer. You're taking a great first step by learning about your heart failure, so you can know what treatment to focus on to be as healthy as possible and feel your best.
References
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