Heart failure treatments differ from person to person and also depend on the severity of your condition. Early treatment can help slow the progression of heart failure and also improve the overall quality of life.
Treatments range from lifestyle modification to medicine and special device treatments. In advanced cases, patients may be offered a heart transplant.
Making a few lifestyle changes can help you lead a normal life. Here are a few notable habits that you can incorporate. Please see the image below.
Monitor Your Weight
Weight gain can worsen your symptoms, especially breathlessness. For this reason, it is important to keep a close eye on your weight.
A sudden increase in your weight could also be because of water accumulation in your body.
It is recommended that you check your weight at the same time every day; preferably first thing in the morning and on an empty stomach.
As you monitor your weight, maintain a record of it in a diary and bring it along for your doctor appointments. In case you notice a sudden increase in your weight (within a day or over a week), please inform your doctor immediately; your medications may require modification.
Control Your Fluid Intake
It is important to monitor your fluid intake. Keep a record of how much fluid you are consuming daily.
This includes water, tea, coffee, juice, or any other form of liquid in your diet (including foods like rasam, sambar, etc).
The more fluid you consume the harder it is for your heart to pump excess fluid through your body. Your doctor will advise on an acceptable amount of fluid intake per day.
Ideally, it is recommended to consume only 800 ml to 1200 ml per day. This can be increased in the summer upon consulting with your doctor.
Decrease Your Salt And Oil Intake
If you eat too much salt, your body will hold on to water. Because of this, it is important to cut down on how much salt you eat every day.
The amount of salt you should have each day is around 2.5 grams. Please note that this is the amount of salt you should eat for the whole day, not just one meal.
Also, you should avoid pickles, papad, and other foods that have been stored for a long time. Rock salt (potassium salt) and fancy salts like pink Himalayan salt, sea salt, etc., should not be used.
It may take some time to get used to food with less salt, but there are other ways to make food taste good. By adding a variety of spices, you can hide the fact that your food has less salt.
It is also important to cut down on foods that are oily or deep-fried. Carbohydrates and foods that are high in saturated fats should also be avoided.
Instead, try to reach for salads, fruits, and pulses. Non-vegetarians must avoid red meat; they can, however, consume lean meats like chicken and fish.
Mild to moderate exercises like walking 30 minutes to an hour a day or simple aerobic exercises can significantly improve blood flow to the heart.
Over time, this can strengthen your heart muscle and increase your overall physical fitness. Exercise in combination with a healthy diet can help you maintain a healthy weight.
People with heart failure have gotten many benefits from exercise training and cardiac rehabilitation, such as better exercise capacity and quality of life, as well as better clinical outcomes.
Exercise has also been shown to be safe and possible for people with heart failure, and some studies have shown that exercise therapy makes managing heart failure more cost-effective.
Monitor Your Blood Pressure
An increase in your blood pressure will strain your heart and your heart has to work harder to pump blood through the narrow vessels. Therefore, it is important to keep your blood pressure under control.
There are a number of medicines needed to treat heart failure. These are prescribed for a long period of time as they support the heart.
Medication is used to treat most people with heart failure. You may have to take two or three different medicines.
Some of the most common drugs used to treat heart failure are:
- ACE inhibitors
- Angiotensin-2 receptor blockers (ARB)
- Mineralocorticoid receptor antagonists
- SGLT-2 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 your body.
Examples of ACE inhibitors include ramipril, enalapril, lisinopril, and perindopril.
Most people who take ACE inhibitors end up with a dry, annoying cough. If this side effect occurs, the medicine will likely be changed.
ACE inhibitors can also lower your blood pressure too much and may hurt your kidneys. Your doctor will keep an eye on itby performing blood tests from time to time.
Angiotensin-2 Receptor Blockers (ARBs)
Angiotensin-2 receptor blockers (ARBs) relax blood vessels and lower blood pressure in the same way that ACE inhibitors do.
They are often used instead of ACE inhibitors because they don’t cause coughing, but they may not work as well as ACE inhibitors.
Examples of ARBs include candesartan, losartan, telmisartan, olmesartan and valsartan.
Some of the side effects of ARBs are low blood pressure and a high potassium level in the blood. Your doctor will periodically check your blood to monitor your potassium levels.
Beta-blockers slow down your heart and protect it from the effects of adrenaline and noradrenaline, which normally increase heart rate and cardiac stress.
By blocking this effect, they relax the heart, making it work at a slow and steady pace.
Beta-blockers also slow down the heart rate. It is therefore common to see a slow pulse rate when taking this drug.
There are many different beta-blockers including metoprolol, bisoprolol, carvedilol, and nebivolol are the ones most often used to treat heart failure.
Some of the possible side effects are feeling dizzy, tired, and having blurry vision. However, these are rare.
Mineralocorticoid Receptor Antagonists (MRAs)
MRAs make you urinate more, lower blood pressure, and get rid of fluid around the heart. They are potassium-sparing diuretics, so they don’t lower potassium levels.
Spironolactone and eplerenone are the two MRAs that are used the most.
Spironolactone may make men’s breasts bigger (gynecomastia) and cause women’s breasts to hurt and cause more hair to grow.
Eplerenone can make it hard to sleep, make you feel dizzy, and give you headaches.
The most dangerous thing these medicines can do is raise the amount of potassium in your blood to dangerously high levels. Your doctor will monitor this with regular blood tests.
Diuretics also called “water pills,” make you pass urine more often and can help people with heart failure who have swollen ankles or trouble breathing.
There are many different kinds of diuretics, but furosemide (also called frusemide) and torsemide are the ones most often used to treat heart failure.
Diuretics might cause you to lose water and have less sodium and potassium in your blood. It is important to monitor your salt levels through blood tests when taking this tablet.
Ivabradine is a drug that can make your heart beat slower. It has no effect on blood pressure.
It’s a good replacement for beta blockers if you can’t take them or if they make you feel bad.
It can also be used with beta-blockers if they don’t slow the heart rate down enough on their own.
Headaches, dizziness, and blurred vision are some of the possible side effects.
Sacubitril-valsartan is one tablet that contains both an ARB and a neprilysin inhibitor. It is a revolutionary drug that has greatly enhanced the quality of life of patients with heart failure.
It’s good for people with more severe heart failure whose hearts can only pump a small amount of oxygenated blood around the body, even though they’re taking other drugs.
In addition to improving the pumping function of the heart, this medicine can also help improve quality of life and lowers hospitalization rates.
Most people who take sacubitril-valsartan end up with low blood pressure, high potassium levels, and problems with their kidneys. A small number of people may have a reaction to the drug, so your doctor will monitor you closely when you start it.
Hydralazine and Nitrate Combination
When hydralazine is taken with nitrate, it can help relax the blood vessels and make them wider. These medicines are not the first line in the treatment of heart failure but are prescribed to people who can’t take an ACE inhibitor or ARB.
Some side effects include headaches, a fast heartbeat, and a pounding, fluttering, or irregular heartbeat (palpitations).
Digoxin can help you feel better by making your heart muscle contractions stronger and by slowing your heart rate.
It is usually only given to people who still have symptoms after taking ACE inhibitors, ARBs, beta-blockers, and diuretics.
Some of the possible side effects are feeling dizzy, having blurry vision, feeling sick, having diarrhea, and having an irregular heartbeat.
Digoxin is not prescribed as a daily dose, but rather as a 5-a-week dose. This is because high levels of digoxin in the blood can have side effects.
Tablets called SGLT2 inhibitors can help lower your blood sugar. They are prescribed to patients with diabetes. However, they can also be used in patients without diabetes to improve their heart function.
SGLT2 inhibitors include empagliflozin, canagliflozin, and dapagliflozin. They can be used with other medicines to treat some kinds of heart failure.
The drug works by allowing sugar and water to be excreted in the urine. Studies show that with long-term use, the heart is protected and people live longer.
Possible side effects include fungal urine infections, having to go to the bathroom more often than usual, a mild rash, and back pain.
Many new treatments have emerged in the management of heart failure over the years. Medicine and lifestyle changes are not just the only options.
In this section, I will cover some of the advanced treatment options that you may be offered to manage your heart.
An Implantable Cardioverter-Defibrillator, also called an ICD, is a specialized pacemaker-like device that helps prevent sudden cardiac death in patients with heart failure.
It is implanted under the skin in a small pouch made under the collarbone. The device constantly monitors your heart rhythm, 24 hours a day. If at any point the heart rhythm becomes erratic and too fast, it delivers a tiny shock that ‘switches’ the irregular rhythm back to a normal one.
An ICD is a life-saving device and may be offered as a treatment option even if you are feeling fine. This is because abnormal heart rhythms are a common occurrence in heart failure, and many of these irregularities are associated with sudden cardiac death.
Please note that an ICD will not improve the function of your heart. It only prevents sudden death.
An ICD device can cost between Rupees 5 lakhs to 8 lakhs in India.
Cardiac Resynchronisation Therapy
Also called CRT, Cardiac Resynchronisation Therapy is a specialized treatment of heart failure that also involves the implantation of a pacemaker-like device. However, it functions in a very different way from regular pacemakers.
A CRT device is sometimes called a biventricular pacemaker.
It works on the premise that the conduction of electricity through the wiring in the heart is faulty. When faulty, the heart contracts in an odd manner, with some parts beating out of sync with other parts. This ‘dyssynchrony’ is responsible for worsening heart failure.
By correcting the way electricity flows through the heart, CRT can help improve heart function and symptoms. It also improves the ejection fraction of the heart by around 5-15%.
Not everyone is a candidate for a CRT device. There are specific criteria that have to be met to ensure it works as a treatment.
Sometimes, CRT devices can be programmed to work as both CRT and ICD. This is called a CRT-D device and is often used in the treatment of heart failure.
CRT devices can cost between Rupees 5 lakhs to 10 lakhs in India.
Ventricular Assist Devices
These are specialized pumps that are implanted into the body to reduce strain on the heart and support the heart as a pump.
They are a last resort treatment that is used as a ‘bridge’ to a heart transplant. This means that if you are being considered for a heart transplant, chances are your cardiologist will recommend this device for the time you are waiting for a donor’s heart.
Ventricular assist devices are of different types and can be very expensive. Device implantation at a cardiac center can cost up to Rs 1 crore. It is not for everyone due to the cost it bears, and not many organizations offer this up at a discount.
When all else fails, patients are considered for a cardiac transplant. Strict criteria have to be met to receive a new heart. I will discuss this in another segment.