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Treatment

Heart failure is usually a chronic condition that will require management for life. With proper management, the condition can improve. Sometimes, this requires treating an underlying condition that is causing heart failure, like arrhythmias or abnormal heart rhythms, blocked arteries that deliver blood to the heart or valve problems. But for most patients, treatment requires lifestyle changes as well as the use of the right medications and/or devices to help the heart beat as efficiently as possible.

Lifestyle changes

If you are diagnosed with heart failure, you will likely need to make a number of changes in your lifestyle. These may include:

  • Quit smoking
  • Limit or Avoid alcohol
  • Lose weight if you are overweight
  • Reduce stress & get enough rest
  • Eat a low salt and heart healthy diet
  • Do not drink excessive fluids of more than 2 liters daily
  • Exercise with guidance from your doctor
  • Monitor your weight

Medications

Heart failure is typically treated with a number of medications. These include:

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) which make it easier for the heart to pump
  • Beta-blockers to help slow down the progression of the disease and relax the heart
  • Diuretics to remove excess fluid and salt from the body
  • Digitalis to help improve the heart's pumping ability

Implantable Devices

If you have heart failure, you may be helped by the implantation of one of several types of implantable devices. In some cases, such devices are used to address an underlying problem; other devices actually help the heart pump.

Implantable Cardioverter- Defibrillator (ICD)

The device is programmed to detect life-threatening abnormal heart rhythms called arrhythmias and correct it by delivering a jolt of electricity.

I mplantation of an ICD is similar to that of a pacemaker. The device includes electrode wires which pass through a vein to the right chambers of the heart.

The differences between pacemakers and ICD's:

  • Pacemakers are generally designed to consistently correct bradycardia or slow heart rate, while ICDs are often permanent protection against sudden arrhythmic abnormalities.
  • Pacemaker monitors electrical impulses, while an ICD monitors heart rhythms.

The devices are roughly the same size and are implanted in the same area by the upper chest area below the shoulder.

Cardiac Resynchronization Therapy (CRT)

This involves implantation of a biventricular pacemaker to send timed electrical impulses to the heart's lower chambers (the ventricles) to help them pump in a synchronized manner. It can improve heart failure symptoms.

Left Ventricular Assist Device (LVAD)

This is a mechanical pump that can be implanted in your chest or abdomen. It temporarily assists your heart's pumping. The pump may take over the function of either or both ventricles (lower chambers) of your heart. These devices were first used only for patients awaiting heart transplants. More recently, they have emerged as long-term treatment options.

Surgery


Coronary Bypass Surgery

When heart failure is a result of blocked coronary arteries, correcting the blockages often makes the heart pump better which helps improve symptoms of heart failure.

Heart Valve Surgery

When heart failure is caused by defective or diseased heart valves, correcting the valve problem often helps make the heart pump better and helps improve symptoms.

Heart Transplantation

This is reserved for the most serious cases of heart failure where there are no other treatment options. The operation involves removing a diseased heart and replacing it with a healthy heart from a donor who has died. More than 2,000 heart transplants are performed each year in the United States.

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-8800

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