The difference between a normal heart and one affected by heart failure.

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Though it sounds like a condition in which the heart stops beating altogether, heart failure is actually a problem that develops when the heart can no longer pump enough blood and oxygen to meet the body’s needs. It’s a serious and complicated health challenge. But if you and your physician follow certain heart failure guidelines approved by health experts, you may be able to maintain a decent quality of life and extend your lifespan.

Unlike a heart attack, which can present suddenly and with obvious symptoms, heart failure symptoms usually develop slowly. However, a condition called acute decompensated heart failure (ADHF) includes a sudden worsening of symptoms.

You may have had heart failure and not been aware of the condition until ADHF appears. Suddenly, you may have difficulty breathing and experience sudden edema. Obviously, if any such heart failure symptoms develop quickly, you should call 911, especially if you’ve had a heart condition such as a previous heart attack or valve disease or high blood pressure symptoms.

But in chronic heart failure, unlike ADHF, symptoms tend to get worse over a period of months or years. Among the most common symptoms of heart failure are the following:

• Shortness of breath, usually with exertion or when lying down. If there’s congestion in the lungs, lying flat will cause the fluid to spread out across the lungs (think of lying a bottle of water on its side as opposed to standing it upright). When more of the lungs are wet, it becomes harder to breathe.
• Swelling (edema), especially in the legs and feet. Swelling may also lead to weight gain.
• Persistent cough, sometime with pink-tinged phlegm.
• Fatigue and less energy for exercise.
• Racing or abnormal heartbeat.
• Nausea, sometimes with vomiting.
• Difficulty concentrating and staying alert.

If the coughing or shortness of breath worsen or you notice an abnormal heartbeat, you should see a doctor soon. And if any of these heart failure symptoms are accompanied by chest pain, you should definitely seek emergency medical care.

Treating Heart Failure

Depending on the severity and cause of your condition, heart failure guidelines for treatment can range from medications and lifestyle adjustments to artificial pumps implanted in the chest to compensate for the heart’s declining pumping ability. A heart that has grown too weak may need to be removed in favor of a transplanted heart.

Heart Failure Treatment: Early Stages

While in the early stages, heart failure is usually treated with medications, including angiotensin-converting enzyme (ACE) inhibitors. These drugs widen arteries to make blood flow easier. This helps reduce blood pressure and lessens the heart’s workload.

Heart failure guidelines also call for the use of beta blockers, which slow the heart down, can also be helpful. Diuretics, which help the body reduce fluid levels to lower blood pressure, are also commonly prescribed to heart failure patients. A powerful drug called Digoxin is also a mainstay of heart failure treatment. It strengthens each heart contraction, and is often used when the source of heart failure is an arrhythmia.

Can Heart Failure Be Reversed?

Treating the underlying cause of heart failure can sometimes be enough to halt symptoms and essentially reverse the heart failure. But for many people, heart failure is a chronic condition that can’t be cured. Medications are part of an effective treatment, but heart failure guidelines also cover certain procedures that may also be necessary.

For example, CABG may help improve heart failure symptoms if coronary artery disease (CAD) is the problem. Heart valve repair or replacement may also be helpful.

Certain cardiac devices, including a pacemaker and an implantable cardioverter device (ICD), may be needed to help keep the heart in a healthy rhythm and make sure it pumps as efficiently as possible.

Artificial Pump Options

If these treatments are no longer enough to keep blood circulating sufficiently, the next step is a ventricular assist device (VAD)—an artificial pump that takes over for the left ventricle. A VAD is surgically implanted in either the abdomen or the chest, and is attached to the heart to circulate blood throughout the body.

VADs used to be temporary measures to help patients get by while they waited for a heart transplant. But with improvements in technology, some heart failure patients are relying on VADs for long-term use.

A heart transplant is still a possibility for some people, but there are restrictions. These include the availability of donor hearts and the overall health of the recipient. Patients who are too frail to handle a heart transplant may not be eligible for this dramatic procedure.

These treatments may not help relieve all heart failure symptoms, but they may help keep your condition from worsening. If you can follow the heart failure guidelines for treatment and lifestyle adjustments, you may be able to live longer with a weaker heart.

Originally posted in May 2016 and updated.