Congestive Heart Failure medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Congestive heart failure (CHF) sounds like your heart has completely stopped working. It actually refers to a condition where your heart doesn’t pump enough blood to meet your body’s needs. CHF is a common condition that affects nearly 6 million Americans. It is estimated that around 700,000 people are diagnosed with heart failure each year and it is the most common cause of hospitalization for people over the age of 65.

What is congestive heart failure?

Congestive heart failure is a chronic condition that progressively gets worse over time. Due to various causes, the heart muscle becomes less able to contract properly or has a limited ability to fill with blood. The blood flows through the heart and body at a slower rate, and the heart can become backed up. As a result, not enough oxygen-rich blood can get to your other major organs. Your body will try to compensate for this limited blood flow by speeding up your heart rate, increasing blood pressure by constricting your blood vessels, or releasing hormones to retain salt and water, which can cause fluid retention. These might temporarily mask the CHF but will eventually worsen the condition.

Congestive heart failure is mainly a condition of the left ventricle, but the right ventricle may also be affected.

CHF causes

CHF can be caused by a number of conditions that damage or weaken the heart. Some risk factors for heart failure include:

• Coronary artery disease
• Heart attack
• High blood pressure (hypertension)
• Diabetes
• Cardiomyopathy
• Myocarditis (inflammation of the heart muscle)
• Arrhythmias (abnormal heart rhythms)
• Obesity
• Smoking
• Excessive alcohol abuse
• Congenital heart defect (a heart problem you are born with)

How is congestive heart failure diagnosed?

To properly diagnose congestive heart failure, your doctor or cardiologist will look at your symptoms, review your medical history, perform a physical exam, and run some tests.

CHF symptoms

Symptoms can be mild at first so it may be hard to notice them. Some common heart failure symptoms include:

• Shortness of breath
• Fatigue
• Swelling (edema) in your feet, ankles
• Swelling in your abdomen
• Rapid or irregular heartbeats (palpitations)
• Rapid weight gain
• Decreased appetite
• Nausea
• Dry, hacking cough

After reviewing your symptoms and a physical exam, your doctor may order some further testing to be done including:

• Blood tests to look for signs of infection or disease.
• Electrocardiogram (ECG or EKG) to check for abnormal heart rhythms.
• Echocardiogram to measure ejection fraction (EF), which shows how well your heart is pumping and helps classify and treat your condition.
• Chest x-ray to look at the size of your heart and look for any fluid build-up around your heart or lungs.
• BNP blood test to measure the B-type natriuretic peptide (BNP). BNP is a hormone that is a marker of the severity and prognosis of heart failure.
• Stress test, which shows how well your heart responds during times when it’s working its hardest.

After reviewing your symptoms and running various tests, your doctor can then classify the severity of your condition. This will help guide the treatment for you. The 2 most common systems used to classify are:

New York Heart Association (NYHA). There are 4 classes in this system including:

• Class I – No symptoms with normal physical activity.
• Class II – Mild symptoms with normal physical activity.
• Class III – Moderate symptoms with less than normal physical activity. Comfortable only at rest.
• Class IV – Severe symptoms with minimal physical activity and at rest.

American College of Cardiology/American Heart Association. There are 4 stages of congestive heart failure in this system including:

• Stage A – High risk of heart failure but no structural heart disease or symptoms of heart failure.
• Stage B – Structural heart disease but no symptoms of heart failure
• Stage C – Structural heart disease and symptoms of heart failure
• Stage D – Advanced heart failure requiring specialized interventions

What are some congestive heart failure treatment options?

Your treatment plan for congestive heart failure can consist of lifestyle changes, medications, and in advanced cases surgery.

Medications. This is the primary congestive heart failure treatment and can include:

• Angiotensin-converting enzyme inhibitors (ACE inhibitors). These work by relaxing blood vessels to improve blood flow and reduce blood pressure. They include Zestril (lisinopril), Vasotec (enalapril), and Altace (ramipril).
• Angiotensin II receptor blockers (ARB). These can be used by people who cannot tolerate ACE inhibitors and include Cozaar (losartan), Diovan (valsartan), and Atacand (candesartan).
• Beta-blockers. These meds slow down your heart rate, lower your blood pressure and reduce the strength of your heart contractions to reduce further damage to your heart. They include Lopressor (metoprolol), Coreg (carvedilol), and Zebeta (bisoprolol).
• Diuretics. By increasing how often you urinate, these meds help reduce fluid retention to help with edema and shortness of breath. Loop diuretics like Lasix (furosemide) and Demadex (torsemide) are commonly used. Thiazide-like diuretics such as Zaroxolyn (metolazone) are added to loop diuretics if you are having severe edema. Potassium-sparing diuretics such as Aldactone (spironolactone) and Inspra (eplerenone) improves your chances of living longer if you have heart failure.
• Antiarrhythmics. Meds such as Lanoxin (digoxin) increase the strength of your heart’s muscle contraction and helps to maintain a normal heart rhythm.
• Inotropes. These are typically used in hospitalized patients with severe heart failure who are waiting for surgery or a heart transplant. These include Dobutrex (dobutamine) and Primacor (milrinone)
• BiDil (hydralazine and isosorbide dinitrate). This combination of medicine helps relax or widen blood vessels and is used typically if you have failed other treatments.
• Verquvo (vericiguat). This newer medication helps relax the smooth muscle in the heart and dilate blood vessels to treat chronic heart failure.

Surgery and other procedures. If you don‘t respond to medications or the medications aren‘t effective, surgery or other procedures may be required to manage your CHF. These procedures include:

• Angioplasty. Angioplasty involves the use of a tiny balloon to widen the artery. A tiny wire-mesh tube (stent) is then inserted into the artery to prevent the artery from closing.
• Heart valve replacement. If you have a faulty heart valve that is the cause of your CHF, your doctor may want to repair or replace it to help it open and close correctly.
• Implantable cardioverter-defibrillators (ICDs). While these devices do not treat heart failure, they are used to prevent complications. It is similar to a pacemaker and helps keep your heart at a normal rhythm.
• Ventricular assist devices (VADs). VADs are implanted mechanical devices that help pump blood from the lower chambers of your heart (ventricles) to the rest of your body. They partially or totally replace the function of your heart’s ventricles.
• Cardiac resynchronization therapy. This procedure which is also called biventricular pacing helps your ventricle pump in sync which helps improve the blood flow out of your heart.
• Heart transplant. Sometimes in severe heart failure, medications and other procedures fail. Your doctor may then recommend replacing your heart with a healthy heart from a donor.

What is the best medication for congestive heart failure?

The best medication for congestive heart failure will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with congestive heart failure medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter congestive heart failure medications approved by the Food and Drug Administration (FDA).

Best medications for congestive heart failure

Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of congestive heart failure medications?

As with all medicines, those used for congestive heart failure will have some side effects, depending on the class you are taking:

• ACE inhibitors and ARBs can commonly cause low blood pressure, headache, dizziness, and high blood potassium levels. ACE inhibitors are also notorious for a dry and often bothersome cough that recent studies show may develop in around 10% of the patients on them. In half of these patients, the ACE inhibitor has to be discontinued. ARBs also carry the risk of a cough but it is significantly lower than that related to ACE inhibitors.
• Diuretics increase the amount of water and salt your body gets rid of so you commonly see electrolyte imbalances, dehydration, dizziness, and fatigue.
• Beta-blockers can cause low blood pressure, low heart rate, headache, fatigue, and dizziness.
• Meds that contain a vasodilator like BiDil commonly cause flushing, low blood pressure, and headache.
• Verquvo (vericiguat) is a newer class of medication called soluble guanylate cyclase stimulators. It can cause birth defects so pregnancy should be ruled out before starting this medication. It can commonly cause low blood pressure and anemia.

What are some home remedies for congestive heart failure?

Along with medications, lifestyle changes are an important piece of your treatment plan for heart failure. They can help improve your heart health, slow the progression of your heart failure, or if diagnosed early may even reverse your condition.

CHF prevention

• Stop smoking. Smoking can damage your blood vessels, raise your blood pressure, reduce the amount of oxygen in your blood, and makes your heart beat faster.
• Monitor your weight and lose weight if necessary.
• Exercise regularly.
• Eat a heart-healthy diet. This can include fruits, vegetables, low-fat dairy, lean protein such as chicken, whole grains, and “good” fats in foods such as olive oil, fish, and avocadoes.
• Monitor your symptoms and notify your doctor if you have any unexplained weight gain or if you have increased swelling.
• Avoid foods high in salt and saturated or trans fat.
• Avoid alcohol and illegal drugs.
• Monitor and treat any related or underlying condition that can cause or worsen your heart failures such as high cholesterol, high blood pressure, or diabetes.

Frequently asked questions about congestive heart failure

How common is CHF?

It’s estimated that about 6.5 million Americans have heart failure. That number is expected to rise dramatically in the next decade as the population gets older.  The lifetime risk of getting heart failure is 20% for all Americans older than 40 years of age.  Over 650,000 new cases of heart failure are diagnosed each year.

Can you reverse or cure CHF?

If you are diagnosed with an early stage of heart failure, it is possible that your heart failure can be reversed. This is especially true if you have an underlying cause for your heart failure and effectively treat it.

Can you have CHF and not know it?

It’s common for people to be in the early stages of heart failure and not realize it. In the early stages, there may be no symptoms because the body and heart can often compensate for the deficits. Early symptoms can include shortness of breath, racing heartbeat, extreme fatigue, and weakness which resembles many other conditions.

What is the outlook if you have CHF?

Experts say if you have heart failure, you will have a life span 10 years shorter than those who don’t. It is estimated that the mortality rate is 22% in the first year and 43% in the first five years following diagnosis.

What foods should I avoid if I have CHF?

If you have been diagnosed with CHF, making some simple adjustments to your diet can improve your quality of life. You will also need to reduce or eliminate certain foods and drinks from your diet that can increase fluid retention, increase your blood sugar, or lead to obesity. Foods/drinks to reduce or avoid include:

• Alcohol
• Foods high in salt
• Foods high in fat and cholesterol
• Highly processed grains such as white bread and white rice
• Processed foods
• Caffeine
• Foods high in carbohydrates such as potato chips, crackers, and cookies.

What medications should I avoid if I have CHF?

Certain meds should be avoided if you have CHF including:

• Calcium channel blockers such as Cardizem (diltiazem) and Calan SR (verapamil)
• NSAIDs such as Advil (ibuprofen) or Aleve (naproxen)
• Some antiarrhythmics such as Multaq (dronedarone)
• COX-2 selective inhibitors such as Celebrex (celecoxib)
• Decongestants such as Sudafed (pseudoephedrine)

Related resources for congestive heart failure

• What is heart failure? Cleveland Clinic
• Heart failure overview. MayoClinic
• Congestive heart failure and heart disease. WebMD
• Congestive heart failure: prevention, treatment, and research. HopkinsMedicine
• Congestive heart failure. National Library of Medicine
• What is heart failure? Heart.org
• Treatment of congestive heart failure. JamaNetwork
• Congestive heart failure drugs to avoid. WikiDoc