Congestive Heart Failure Treatments and Medications

Heart failure, also referred to as congestive heart failure (CHF), is a complex, progressive condition in which the heart does not pump enough blood to the rest of the body. The heart chambers that pump blood out are called the ventricles.  The right ventricle pushes blood into the lungs, where it picks up oxygen. The left ventricle pushes oxygenated blood out to the rest of the body to supply cells and tissues with needed oxygen. Congestive heart failure is largely a condition of the left ventricle, but the right ventricle might also be affected, usually as a result of left ventricular dysfunction. Early diagnosis and treatment are crucial. When treated promptly, heart failure symptoms can often be managed effectively, with some cases improving significantly over time.

How is congestive heart failure diagnosed?

Congestive heart failure is diagnosed primarily from a history and a physical examination, typically by a primary care physician or cardiologist. 

A medical history will help identify risk factors such as high blood pressure, smoking, obesity, lack of exercise, and diabetes. 

A physical exam is an important diagnostic tool for heart failure. Heart failure symptoms include:

• Shortness of breath (dyspnea), especially when lying down (orthopnea)

• Weakness

• Fatigue

• Swelling in the legs and ankles (edema) or abdomen (ascites)

• Heart palpitations

• Unexplained weight gain

• Nausea

• Lowered appetite

The healthcare provider will also take your pulse and listen to your heart to identify distinctive symptoms of heart failure:

• Alternating weak and strong pulses

• A shift in the location of the maximum pulse that can be felt on the chest surface

• A sound called the S3 gallop

In addition to a physical exam, the cardiologist may use tests to confirm the diagnosis:

• Blood tests

• An electrocardiogram (EKG) 

• A chest X-ray 

• An echocardiogram 

The diagnosis will also include identifying the severity of the condition. The most commonly used scale is the New York Heart Association (NYHA), which classifies the condition based on the amount of physical activity the patient can perform:

• Class I: No limitations on physical activity

• Class II: Mild limitations on physical activity

• Class III: Moderate limitations on physical activity, but comfortable at rest

• Class IV: Symptoms occur at rest; no physical activity is possible without discomfort

Treatment will depend on the condition’s stage.

Congestive heart failure treatment options

Congestive heart failure treatments consist of lifestyle changes, medications, and, in more advanced cases, device therapy, surgery, or heart transplantation. If heart failure is due to an underlying cause, the treatment plan will also focus on treating or managing that cause.

Lifestyle changes

All heart failure treatments will typically involve lifestyle modifications, including:

• Dietary changes

• Restrictions on salt intake

• Fluid intake restrictions 

• Exercise, as tolerated

• Avoiding cigarettes, alcohol, and recreational drugs

Device therapy

People with more advanced heart failure may require an implanted device such as a pacemaker or implantable cardioverter defibrillator (ICD). These devices help improve heart function or treat abnormal heart rhythms. 

Surgery

Advanced heart failure may eventually require surgical interventions such as: 

• Coronary revascularization, such as coronary artery bypass surgery or angioplasty, to improve blood flow to the heart

• Ventricular assist devices are implanted mechanical pumps that help the heart pump blood

• A heart transplant is the surgical replacement of the diseased heart with a healthy donor heart. 

Medications

Medications can help manage symptoms and reduce strain on the heart. Diuretics (water pills) reduce fluid retention and swelling, blood pressure medications reduce blood pressure, and beta blockers slow down the heartbeat. 

Types of congestive heart failure medication

Medications are, in most cases, the primary treatment for heart failure. CHF medications are used in combination to manage the effects of heart failure, such as fluid retention, swelling, vasoconstriction, and increased heart rate. 

Diuretics

Diuretics (water pills) reduce fluid retention by increasing the amount of sodium, and with it water, excreted by the body through the kidneys. These drugs are excellent for managing signs and symptoms due to fluid retention, including edema and/or difficulty breathing.  Loop diuretics, such as torsemide, bumetanide, or furosemide, are commonly used. Thiazide-like diuretics, such as metolazone, may be used in conjunction with loop diuretics in patients who require additional fluid removal.  

ACE inhibitors and ARBs

Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) are commonly used to lower blood pressure and reduce strain on the heart. Examples of ACE inhibitors include lisinopril, ramipril, and enalapril, and examples of ARBs include valsartan, losartan, and candesartan.

GLT2 inhibitors

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are commonly used for heart failure and may also help with blood sugar control in people with diabetes. Examples of SGLT2 inhibitors include Farxiga (dapagliflozin) and Jardiance (empagliflozin). 

Mineralocorticoid receptor antagonists

Mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone, work by blocking a hormone called aldosterone. They help reduce strain on the heart and may improve outcomes in people with heart failure. 

Beta blockers

Beta blockers, such as carvedilol, metoprolol, or bisoprolol, are commonly used in heart failure patients. They lower blood pressure, slow heart rate, and reduce strain on the heart.

Entresto

Entresto is a combination of valsartan (an ARB) and sacubitril (a neprilysin inhibitor). Entresto decreases strain on the heart, reduces sodium retention, and improves blood flow. 

Vasodilators

Vasodilators, such as isosorbide dinitrate or hydralazine, lower blood pressure by widening blood vessels. 

Corlanor

Corlanor (ivabradine) may be used to slow the heart rate, but without significantly lowering blood pressure.

Digoxin

Lanoxin (digoxin) may be used to slow the heart rate and help the heart pump more effectively. When taking digoxin, patients need regular blood tests. 

Verquvo

Verquvo (vericiguat) may be used to widen blood vessels and reduce the heart’s workload.

Other medications

Healthcare providers may also prescribe or recommend other medications or supplements to people with heart failure, depending on individual circumstances, such as:

• Blood thinners

• Statins for cholesterol

• Potassium or magnesium supplements

Most heart failure patients will be prescribed a diuretic, ACE inhibitor, and beta blocker to manage the effects of heart failure. Drug treatment, however, will be tailored to the patient’s age, symptoms, stage of heart failure, and tolerance for side effects.

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