Heart failure

Diagnosis

To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. Your health professional checks to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes.

No single test diagnoses every case of congestive heart failure. Tests help find the cause and rule out other conditions.

Your health professional listens to your lungs and heart with a device called a stethoscope. A whooshing sound called a murmur may be heard when listening to your heart. Your health professional may look at the veins in your neck and check for swelling in your legs and belly.

Tests

Tests that may be done to diagnose heart failure may include:

• Blood tests. Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood vessels. The protein is called N-terminal brain natriuretic peptide (NT-proBNP). In heart failure, the level of this protein goes up.
• Chest X-ray. X-ray images can show the condition of the lungs and heart.
• Electrocardiogram (ECG or EKG). This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart is beating.
• Echocardiogram. Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow through the heart.
• Ejection fraction tests, such as echocardiogram and cardiac MRI. Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. This measurement is taken during an echocardiogram. The result helps classify heart failure and guides treatment. An ejection fraction of 50% or higher on the left side of the heart is considered ideal. But you can still have heart failure even if your ejection fraction is over 50%. Your healthcare team considers the result along with your symptoms, physical exam and other tests.
• Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests can show how the heart responds to physical activity. If you can't exercise, you might be given medicines.
• CT scan of the heart. Also called a cardiac CT scan, this test uses X-rays to create cross-sectional images of the heart.
• Heart MRI scan, also called a cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart.
• Coronary angiogram. This test helps spot blockages in the heart arteries. The healthcare professional inserts a long, thin flexible tube called a catheter into a blood vessel, usually in the groin or wrist. It's then guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.
• Myocardial biopsy. In this test, a healthcare professional removes very small pieces of the heart muscle for examination. This test may be done to diagnose certain types of heart muscle diseases that cause heart failure.

Treatment

Treatment of congestive heart failure may depend on the cause. Treatment often includes lifestyle changes and medicines. Heart failure is not always curable. But if another health condition is causing the heart to fail, treating it may reverse heart failure.

Some people with heart failure need surgery to open blocked arteries or to place a device to help the heart work better.

With treatment, symptoms of heart failure may improve.

Even when symptoms and ejection fraction improve, heart failure may return or worsen. Continue your medicines and follow-up care unless your healthcare professional changes your treatment plan.

Medications

A combination of medicines may be used to treat heart failure. The specific medicines used depend on the cause of heart failure and the symptoms. Medicines to treat heart failure include:

• Angiotensin-converting enzyme (ACE) inhibitors. These medicines relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis) and captopril.
• Angiotensin 2 receptor blockers (ARBs). These medicines have many of the same benefits as ACE inhibitors. They may be an option for people who can't tolerate ACE inhibitors. They include losartan (Cozaar), valsartan (Diovan) and candesartan (Atacand).
• Angiotensin receptor plus neprilysin inhibitors (ARNIs). This medicine uses two blood pressure medicines to treat heart failure. The combination medicine is sacubitril-valsartan (Entresto). It's used to treat some people with heart failure with reduced ejection fraction. It may help prevent the need for a hospital stay in those people.
• Beta blockers. These medicines slow the heart rate and lower blood pressure. They reduce the symptoms of heart failure and help the heart work better. If you have heart failure, beta blockers may help you live longer. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle) and bisoprolol.

• Diuretics. Often called water pills, these medicines make you urinate more frequently. This helps prevent fluid buildup in your body. Diuretics, such as furosemide (Lasix, Furoscix) and bumetanide (Bumex), also decrease fluid in the lungs, so it's easier to breathe.

Some diuretics make the body lose potassium and magnesium. Your healthcare professional may recommend supplements to treat this. If you're taking a diuretic, you may have regular blood tests to check your potassium and magnesium levels.

• Potassium-sparing diuretics. Also called aldosterone antagonists, these medicines include spironolactone (Aldactone, CaroSpir) and eplerenone (Inspra). They may help people who have severe heart failure with reduced ejection fraction (HFrEF) live longer.

Unlike some other diuretics, these medicines can raise the level of potassium in the blood to dangerous levels. Talk with your healthcare professional about your diet and potassium intake.

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines help lower blood sugar. They are often prescribed with diet and exercise to treat type 2 diabetes. But they're also one of the first treatments for heart failure. That's because several studies showed that the medicine lowered the risk of hospital stays and death in people with certain types of heart failure — even if they didn't have diabetes. These medicines include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

More medicines that may be used to treat heart failure include:

• Digoxin (Lanoxin). This medicine, also called digitalis, helps the heart squeeze better to pump blood. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in people with HFrEF. Someone with a heart rhythm disorder, such as atrial fibrillation, may be more likely to receive it.
• Hydralazine and isosorbide dinitrate (BiDil). This combination of medicines helps relax blood vessels. It may be added to your treatment plan if you have severe heart failure symptoms and ACE inhibitors or beta blockers haven't helped.
• Vericiguat (Verquvo). This medicine for chronic heart failure is taken once a day by mouth. It's a type of medicine called an oral soluble guanylate cyclase (sGC) stimulator. In studies, people with high-risk heart failure who took this medicine had fewer hospital stays for heart failure and heart disease-related deaths than those who got a pill with no medicine.
• Positive inotropes. These medicines may be given by IV to people with severe advanced heart failure who are in the hospital. Positive inotropes can help the heart pump blood better and maintain blood pressure. Long-term use of these medicines has been linked to an increased risk of death in some people. Talk with your healthcare professional about the benefits and risks of these medicines.
• Other medicines. Your healthcare professional may prescribe other medicines to treat specific symptoms. For example, some people may receive nitrates for chest pain, statins to lower cholesterol or blood thinners to help prevent blood clots.

Your healthcare professional may need to change your medicine doses frequently. This is more common when you've just started a new medicine or when your condition is getting worse.

Heart failure medicines can cause side effects. Depending on the medicine, these may include dizziness, low blood pressure, changes in kidney function or changes in potassium levels. Your healthcare team may check your blood pressure and do blood tests after you start a medicine or the dose changes. Tell your healthcare team if you have any side effects. Do not stop a medicine without talking with your healthcare professional.

Treatment during a flare-up

You may need to stay in the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive:

• Medicines to relieve your symptoms.
• More medicines to help your heart pump better.
• Oxygen through a mask or small tubes placed in your nose.

If you have severe heart failure, you may need to use supplemental oxygen for a long time.

Surgery or other procedures

Surgery or other procedures may be recommended to treat heart failure or the condition that led to it.

Surgery or other procedures for heart failure may include:

• Coronary artery bypass graft surgery. You may need coronary artery bypass graft surgery if severely blocked arteries are causing your heart failure. The surgery involves taking a healthy blood vessel from the leg, arm or chest and connecting it below and above the blocked arteries in the heart. The new pathway improves blood flow to the heart muscle.

• Heart valve repair or replacement. If a damaged heart valve causes heart failure, your health professional may recommend repairing or replacing the valve. There are many different types of heart valve surgery. The type needed depends on the cause of the heart valve disease.

  Heart valve repair or replacement may be done as open-heart, minimally invasive surgery or through a small puncture in a blood vessel.

• Implantable cardioverter-defibrillator (ICD). An ICD is used to prevent complications of heart failure. It isn't a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It's implanted under the skin in the chest with wires leading through the veins and into the heart.

  The ICD checks the heartbeat. If the heart starts beating at a dangerous rhythm, the ICD tries to correct the beat. If the heart stops, the device shocks it back into regular rhythm. An ICD also can work as a pacemaker and speed up a slow heartbeat.

• Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers aren't pumping in sync with each other. A device sends electrical signals to the lower heart chambers. The signals tell the chambers to squeeze in a more coordinated way. This improves the pumping of blood out of the heart. CRT may be used with an ICD.

• Ventricular assist device (VAD). A VAD helps pump blood from the lower chambers of the heart to the rest of the body. It's also called a mechanical circulatory support device. Although a VAD can be placed in one or both lower chambers of the heart, it's usually placed in the lower left chamber.

  Your healthcare professional may recommend a ventricular assist device if you're waiting for a heart transplant. Sometimes, a VAD is used as a permanent treatment for people who have heart failure but who aren't candidates for a heart transplant.

• Heart transplant. Some people have such severe heart failure that surgery or medicines don't help. These people may need a heart transplant.

  A heart transplant isn't the right treatment for everyone. A team of healthcare professionals at a transplant center helps determine whether the procedure may be safe and beneficial for you. The team looks at your overall health and how well your heart and other organs work. Not everyone with advanced heart failure can have a heart transplant.

  A ventricular assist device may be used while you wait for a transplant.

Possible complications depend on the procedure and your health. They may include:

• Bleeding.
• Infection.
• Blood clots.
• Stroke.
• An irregular heartbeat.
• Kidney issues.

Implanted devices can cause infection or have issues that require another procedure. A heart transplant also can lead to rejection of the donor heart. Your care team can talk with you about the benefits and risks of each option.

End-of-life care

Heart failure may get better for a time and then get worse again. No single symptom or test can predict exactly how long someone will live. The healthcare team looks at the overall pattern. This includes repeated severe episodes, how symptoms respond to treatment, how well other organs are working and how much strength the person has.

Your healthcare professional may recommend special medical care to reduce symptoms and improve quality of life. This is called palliative care. Anyone who has a serious or life-threatening illness can benefit from this type of care. It can be used to treat symptoms of the disease or to ease the side effects of treatment.

In some people with heart failure, medicines no longer work and a heart transplant or device isn't an option. If this occurs, special end-of-life care may be recommended. This is called hospice care.

Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort you. Hospice care is available in your home or in nursing homes and assisted living centers.

Hospice care provides the following for those who are sick and those who care for them:

• Emotional support.
• Psychological support.
• Spiritual support.

Although it can be hard, discussing end-of-life issues with your family and healthcare team is important. Part of this discussion will likely involve an advance care directive. This is a general term for spoken and written instructions you give concerning your medical care if you can't speak for yourself.

If you have an ICD, also discuss whether and when to turn off the device so that it can't give shocks near the end of life.

Prognosis

Prognosis means what may happen over time. It also is called outlook. It is an estimate of what will happen. But it doesn't say what exactly will happen. The outlook for people with heart failure is different for everyone.

Your outlook depends on many things, including your age and whether you have other conditions, such as kidney disease or diabetes. The outlook also depends on details about your heart failure, including:

• The cause of heart failure and whether it can be treated.
• The type and stage of heart failure.
• How your symptoms limit your activity.
• How well treatment is working.

Other things that play a role in your outlook include:

• How well your heart and kidneys work.
• Test results.
• Recent emergency visits or hospital stays.

Life expectancy

It is understandable to wonder about life expectancy with congestive heart failure. Survival rates can offer a general picture, but they are based on large groups of people. They cannot tell exactly how long you will live.

Healthcare professionals use survival rates along with information about your health and treatment to discuss life expectancy and plan care. The rates are only one part of that discussion.

In general, life expectancy tends to be shorter at older ages. But age alone cannot predict how long a person with heart failure will live. Your overall health, heart function and response to treatment also matter.

On average, people with heart failure with preserved ejection fraction (HFpEF) may have a lower risk of death than people with HFrEF. Both types can be serious, and ejection fraction alone cannot predict life expectancy.

Across large groups of people with chronic or stable heart failure, about 57% live five years after diagnosis. About 35% live 10 years after diagnosis. These numbers do not mean that a person will live for only five or 10 years. Some people live longer than these estimates suggest. Others live for less time.

These estimates are based partly on people who received heart failure care years ago. Because care changes over time, the numbers may not fully reflect the outlook for people receiving treatment today.

Heart failure often is a long-term condition and is not always curable. When a treatable condition causes it, treatment may improve or sometimes reverse the heart failure. Many people still need ongoing care.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Self-care

Some people with heart failure may be told to take omega-3 fatty acid supplements. Some research shows that the supplements may help reduce the need for hospital stays.

Making certain lifestyle changes often improves heart failure symptoms. Lifestyle changes may even stop the condition from getting worse.

The following changes are recommended to improve heart health:

• Don't smoke. Smoking damages the blood vessels and raises blood pressure. It lowers blood oxygen levels and speeds up the heartbeat. Quitting is the best way to reduce the risk of heart disease. If you need help quitting, talk with your healthcare professional. Smoking or any type of tobacco use can prevent a person from being listed for a heart transplant. Transplant programs generally require a period without smoking before a person can be placed on the transplant list. Also avoid secondhand smoke.
• Check your legs, ankles and feet for swelling. Do this every day. Call your healthcare professional if the swelling worsens.
• Weigh yourself. Ask your healthcare professional how often you should do this. Weight gain may mean your body is holding onto fluid. You may need a change in treatment. Call your health professional if you gain 5 pounds (2.3 kilograms) or more within a few days.
• Manage weight. Being overweight increases the risk of heart disease. Ask your healthcare professional what weight is right for you. Even losing a small amount of weight can help improve heart health.
• Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins. Limit saturated or trans fats.

• Limit salt. Too much salt, also called sodium, can make the body hold onto water. This is called water retention. It makes the heart work harder. Symptoms include shortness of breath and swollen legs, ankles and feet.

  Ask your healthcare professional if you should follow a no-salt or low-salt diet. Remember that salt is already added to prepared foods.

• Limit alcohol. Alcohol can interfere with certain medicines. It also weakens the heart and increases the risk of irregular heartbeats. If you have heart failure, your healthcare professional may recommend that you don't drink alcohol.
• Ask how much fluid you can drink. If you have severe heart failure, your health professional may suggest that you limit the amount of fluids you drink. Drinking more water or other fluids than your healthcare professional recommends can worsen fluid buildup for some people. A strict fluid limit may not be needed for everyone whose heart failure is controlled. Ask how much fluid is right for you.
• Stay as active as possible. Moderate exercise helps keep the heart and body healthy. But be sure to talk with your healthcare professional about an exercise program that's right for you. If you have heart failure, your health professional may suggest a walking program or a cardiac rehabilitation program at your local hospital.

• Reduce stress. Strong emotions such as anxiety or anger can make the heart beat faster. Breathing becomes heavier and blood pressure goes up. These changes can make heart failure worse.

  Find ways to reduce emotional stress. Practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress.

• Get better sleep. Heart failure can cause shortness of breath, especially when lying down. Try sleeping with your head propped up using a pillow or a wedge. If you snore or have trouble sleeping, ask about a test for sleep apnea.
• Get recommended vaccinations. Ask your healthcare professional about getting influenza, pneumonia and COVID-19 vaccinations.

Coping and support

Managing heart failure requires open communication between you and your healthcare professional. Be honest about any challenges concerning your diet, lifestyle and medicine use. Pay attention to your body and how you feel. Tell your healthcare professional when you're feeling better or worse. This helps guide your treatment.

These steps may help you manage heart failure:

• Take medicines as directed. If side effects or costs are a concern, ask your health professional about options. Don't stop taking your medicines without talking to your health professional. Also, go to all scheduled health appointments. Reschedule any that you miss.
• Use caution with other medicines and supplements. Some medicines available without a prescription to treat pain and swelling can make heart failure worse. They include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some diet pills and supplements also may not be safe if you take medicines for heart failure. Always tell your healthcare professional about all the medicines you take, including those you take without a prescription.
• Weigh yourself daily. If your healthcare professional asks you to weigh yourself every day, do it after you wake up and urinate, before you eat or drink, and at about the same time each day. Write your weight down in a notebook. Bring the notes to your medical checkups. An increase in weight can be a sign of fluid buildup.
• Check your blood pressure at home. Write down your numbers and bring them to your health checkups. This helps your health professional know if treatment is working or your condition is getting worse. Home blood pressure monitors are available at stores and pharmacies.
• Know how to contact your healthcare professional. Keep your health professional's phone number, the hospital's phone number, and directions to the hospital or clinic on hand. You'll want easy access to this information if you have health questions or if you need to go to the hospital.
• Ask for help. Sticking to treatment and lifestyle changes may be challenging. It may help to ask your friends and family to help you meet your goals.

Talk with your healthcare team if you need help managing stress, anxiety or depression. Counseling and support groups may help.

Preparing for your appointment

If you are worried about your heart failure risk, make an appointment with your healthcare professional. You may be referred to a doctor trained in heart diseases. This type of doctor is called a cardiologist. If heart failure is found early, treatment may be easier and more effective.

Appointments can be brief. Because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready.

Getting ready

• Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a while before some tests.
• Write down any symptoms you're having, including any that may seem unrelated to heart failure.
• Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes. Find out if anyone in your family has had heart failure. Some heart conditions that cause heart failure run in families. Knowing as much as you can about your family history can be helpful.
• Make a list of all medicines, vitamins or supplements that you're taking. Include doses. Bring this list with you to all health checkups.
• Take someone along, if possible. Sometimes it can be difficult to remember all the information given to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional. For example, if you have heart failure you might ask if it's safe for you and your partner to have sex. Most people with heart failure can continue having sex once symptoms are under control. If you have questions, talk with your healthcare professional.

Your time with your health professional is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart failure, some basic questions to ask your healthcare professional include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available? Which do you recommend for me?
• What foods should I eat or avoid?
• What's an appropriate level of physical activity?
• Do I have any activity restrictions?
• How often should I be screened for changes in my condition?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic available for the medicine you're prescribing for me?
• Do my family members need to be screened for conditions that may cause heart failure?
• Is there any information that I can take home with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare professional is likely to ask many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your health professional may ask:

• When did you first notice your symptoms?
• Do your symptoms occur all the time, or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• Does anything make your symptoms worse?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure from starting or worsening.

Following your treatment plan

Following your treatment plan can help manage symptoms and support your health.

• Take medicines as directed.
• Continue healthy habits, including fluid control, salt control and daily weight checks.
• Take daily blood pressure readings if recommended by your healthcare professional.
• Keep follow-up appointments.

Ask what changes should prompt a call to your healthcare professional.

Safe activity and cardiac rehabilitation can improve fitness, symptoms and quality of life. Ask your healthcare professional what type and amount of activity are right for you.

Ask your healthcare professional what the survival numbers may mean for your life expectancy. No number or test can predict the future with certainty. Your healthcare professional can use information about your health, treatment and goals to discuss a more personal outlook.

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