Heart failure does not mean your heart has failed or stopped beating. It means that your heart, which is a muscle that pumps blood to all parts of your body, is not working as well as it should and cannot pump as much blood as your body needs. As your heart's pumping action lessens, blood may back up in your lungs, liver, or legs. This can cause shortness of breath, leg swelling (called edema), and other problems. In addition, organs in your body may not get the oxygen and nutrients they need to function properly.

Heart failure is a chronic (ongoing) condition that develops over time. It is usually caused by underlying conditions, such as high blood pressure or heart disease. These conditions damage your heart, making the heart muscle stiff or thick. The damaged muscle either cannot relax properly to let the pumping chambers of the heart, the ventricles, fill with enough blood, or it cannot contract properly to let the ventricles pump out enough blood. The left ventricle is the main pumping chamber, and heart failure usually starts on the left side. When the left ventricle cannot contract enough, it is called systolic heart failure. When the left ventricle cannot fill with enough blood, it is called diastolic heart failure. You can have a combination of both types of heart failure.

Although some conditions that cause heart failure are irreversible, you can manage the condition and improve your health and quality of life with a combination of lifestyle changes and medications.

People with heart failure should be under the care of a cardiologist.

You may experience one or more of the following symptoms of chronic heart failure:

• Swollen feet, ankles, and sometimes abdomen
• Weight gain from fluid retention
• Shortness of breath and cough
• Racing or skipping heartbeat (palpitations)
• Stomach upset, nausea and vomiting, and loss of appetite
• Difficulty sleeping
• Fatigue, weakness, and a reduced ability to exercise
• Lightheadedness
• Difficulty concentrating or staying alert

The more advanced your heart failure, the more likely you are to have symptoms.

Acute heart failure occurs when something suddenly damages your heart (such as a heart attack, blood clot in the lungs, allergic reaction, or severe infection). Symptoms are similar to those for chronic heart failure, but they are more serious and get worse quickly. Acute heart failure is life threatening and requires immediate emergency medical attention.

The most common causes of heart failure are high blood pressure and coronary artery (heart) disease. Other causes of heart failure include:

• Heart attack
• Damaged heart valves (valves separate the chambers of the heart and keep blood flowing in the right direction)
• Cardiomyopathy (weakening of the heart muscle, which may be from infection, diseases such as rheumatoid arthritis or lupus, alcohol or drug abuse, or unknown reasons)
• Congenital heart disease (heart defects at birth)
• Myocarditis (inflammation of the heart from a virus)
• Abnormal heart rhythms (arrhythmias)

You are at risk for developing heart failure if you:

• Have high blood pressure
• Have diabetes
• Have had a heart attack or have heart disease of any kind
• Have high blood pressure or diabetes
• Are overweight
• Have sleep apnea
• Take certain medications, including bisphosphonates
• Abuse alcohol, smoke cigarettes, or use cocaine
• Post traumatic stress disorder

Your health care provider will take a detailed medical history and perform a physical exam. Your provider will examine your heart and lungs, checking for enlargement of the heart and fluid in the lungs. Other signs of heart failure that your provider will look for include enlarged neck veins, swelling in your legs or abdomen, and tenderness of the liver. A chest x-ray can help determine if there is fluid on your lungs or enlargement of your heart, two factors that often go along with heart failure.

After the initial diagnosis, your provider will look for the underlying cause of heart failure. Your provider may order these tests:

• Blood tests, to check kidney or thyroid function
• Echocardiogram, to determine systolic heart failure or diastolic heart failure
• Ejection fraction, to see how much blood your heart is pumping out
• Electrocardiogram (ECG), to look for heart rhythm problems
• Coronary catheterization (angiogram), to look for narrowed arteries

With proper treatment, you can control symptoms of heart failure and improve your health. Lifestyle changes, such as losing weight, cutting down on salt, and exercising regularly, can improve your condition. Medications are also available to help your heart better pump blood. Complementary and alternative therapies can be helpful, too, when used along with standard medical treatment. Heart failure is a serious condition and you should always seek medical care. DO NOT take any herbs or supplements without your doctor's supervision.

Lifestyle

Carefully monitoring your health and helping to manage your condition makes a big difference in managing heart failure. The results of one study found that healthy lifestyle habits (normal body weight, not smoking, regular exercise, moderate alcohol intake, and consumption of breakfast cereals, and fruits and vegetables) were associated with a lower risk of heart failure. The highest risk was in men adhering to none of the 6 lifestyle factors, and the lowest was among men adhering to 4 or more healthy lifestyle factors. To do this, track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is getting worse. Make sure you weigh yourself at the same time each day and on the same scale.

Other important measures include:

• Take your medications as directed. Carry a list of medications with you wherever you go.
• Cut down on salt. People with heart failure should consume no more than 2,000 mg of sodium per day. Keep in mind that most salt in your diet does not come from the salt shaker. Most salt comes from processed foods that already contain high levels of sodium.
• If you smoke, quit.
• Exercise and stay active. Walk or ride a stationary bicycle, for example. One study showed that a walking program was safe for people with heart failure and helped improve symptoms. Another study found that a regular tai chi practice improved quality of life and mood in patients with chronic heart failure. Talk to your doctor before starting new exercise program.
• Lose weight if you are overweight.
• Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest, too. Keep your feet elevated to decrease swelling.
• Manage your stress and stay connected to others. One study found that patients who attend an 8-week support group that included mindfulness had less depression and anxiety and fewer physical symptoms a year later.
• Eat an antioxidant-rich diet. Studies show that diets high in antioxidants are associated with a lower risk of heart failure.

Tips to lower your sodium intake

• Look for foods labeled "low sodium," "sodium free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods.
• DO NOT cook with salt or add salt to what you are eating. Use pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (such as monosodium glutamate).
• Avoid foods that are naturally high in sodium, such as anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), olives, pickles, sauerkraut, soy and Worcestershire sauces, and cheese.
• Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
• Use oil and vinegar instead of bottled dressings on salads.
• Eat fresh fruit or sorbet when having dessert.

Medications

Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors widen blood vessels and make it easier for your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Fosinopril (Monopril)
• Lisinopril (Zestril)
• Enlapril (Vasotec)

Angiotension II receptor blockers (ARBs). ARBs also dilate blood vessels and may be used in people who cannot take ACE inhibitors. They include:

• Irbesartan (Avapro)
• Candesartan (Atacand)
• Losartan (Cozaar)
• Valsartan (Diovan)

A combination of ACE and ARB, called Entresto, is also available for a subset of patients. This new drug has shown promise in further reducing the risk of cardiac events among heart failure patients.

Digoxin (Lanoxin). Helps your heart pump more blood by increasing the strength of its contractions.

Beta-blockers. Slow heart rate and lower blood pressure. Beta-blockers include:

• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Bisoprolol (Zebeta)
• Carvedilol (Coreg)
• Propanolol (Inderal)
• Metoprolol (Lopressor, Toprol-XL)

Diuretics (water pills). Keep fluid from building up in your body by making you urinate more. There are different types of diuretics that can affect potassium and magnesium levels in your body, so your doctor will check your levels frequently.

Isosorbide dinitrate and hydralazine hydrochloride (BiDil). BiDil combines two drugs that dilate blood vessels. It is approved for use in African Americans who have heart failure as an addition to standard therapy.

Nutrition and Dietary Supplements

Heart failure is a serious medical condition and should be treated by conventional medicine. You should never add supplements or complementary and alternative medicine therapies to your regimen unless specifically instructed to do so by your physician. It is best to work with a health care provider trained in the use of nutritional medicine. Many people with heart conditions take multiple medications, including blood-thinning medications, blood pressure medications, and others. The supplements below can interact with these and many other medications and may not be right for people with certain medical conditions. You should use the supplements listed below only under the supervision of your cardiologist, and a doctor who understands the contraindications and interactions associated with these supplements.

• Magnesium. Magnesium is essential to heart health. This mineral is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium. For this reason, your doctor may recommend a supplement. Magnesium can interact with a number of heart medications. Always ask your doctor before taking a magnesium supplement if you have heart failure.
• Carnitine. Some studies suggest that L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure. Carnitine is a nutrient that helps the body convert fatty acids into energy. This energy is used primarily for muscular activities throughout the body. Most studies used a special form of carnitine called propionyl-L-carnitine. Carnitine may affect thyroid medication, and may interact with blood-thinning medications, such as coumadin (Warfarin), aspirin, and others. Speak with your physician.
• Coenzyme Q10 (CoQ10). Levels of CoQ10 can be low in people with heart failure. Several studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure. However, not all studies agree. More research is needed to see if CoQ10 has any real benefit. In the meantime, talk to your doctor about whether this supplement is right for you. CoQ10 may negatively interact with blood-thinning medications, such as coumadin (Warfarin), aspirin, and others, as well as blood pressure medications and chemotherapy agents.
• Creatine. Creatine is a naturally-occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with heart failure, injections of creatine (in addition to standard medical care) improved heart function and ability to exercise compared to those who received placebo. Taking creatine orally improved muscle function and endurance. More studies are needed to determine whether oral creatine has any benefit for people with heart failure. People with kidney issues, or those who take medications that are potentially harmful to the kidneys, should use caution when taking creatine. Speak to your physician.
• Vitamin B1 (Thiamine). Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight, including muscle mass (called cachexia), and become deficient in many nutrients, including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine. Talk to your doctor about measuring your level of vitamin B1 and whether you should take thiamine.

Amino acids. A few small studies suggest these amino acids might be helpful for heart failure. More research is needed:

• Arginine (needed for the body to make nitric oxide, which helps blood flow). Arginine can lower blood pressure, and may be unsafe to take with blood pressure medications. It may also interact negatively with medications that increase blood flow, such as nitrates, as well as medications used to treat erectile dysfunction.
• Taurine (helps the heart muscle contract). Taurine can interact with lithium, and may be unsafe in people with bipolar disorder.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider. Many people with heart conditions take blood-thinning medications and blood pressure medicines, among others. The supplements below can interact with these and many other medicines, and may not be right for people with certain conditions. These should be used only under the supervision of your cardiologist, and a doctor who understand the contraindications and interactions associated with these supplements.

• Hawthorn. Hawthorn (Crataegus spp.), a member of the rose family, was used by physicians in the early 1800s to treat circulation and respiration (breathing) problems. The flowers and berries have been used traditionally to treat irregular heartbeat, high blood pressure, chest pain, atherosclerosis (hardening of the arteries), and heart failure. Several scientific studies suggest that hawthorn improves the heart's ability to pump blood in people with heart failure. It also significantly improved symptoms (like reduced shortness of breath and fatigue) and helped people exercise longer. There is not enough research to determine definitively whether hawthorn can work safely with other medications, or how it compares to drugs such as ACE inhibitors. Hawthorne may potentially interact with a variety of medications. Talk to your doctor to see if hawthorn is right for you.
• Berberine. Berberine, an active ingredient of goldenseal (Hydrastis canadensis) and other herbs, can dilate blood vessels. In one study, people who took berberine for 8 weeks had better heart function and were more able to exercise than those who took placebo. A few other studies suggest that when berberine is combined with standard medicines for heart failure, it can improve heart function and quality of life. Talk to your doctor about whether it is safe and appropriate for you to take berberine in addition to your usual care. Berberine can potentially interact with a number of medications.

Prognosis and Complications

Heart failure is a serious disorder that leads to a lower life expectancy. It is generally a chronic illness. But many forms of heart failure can be controlled by treating the underlying causes, making lifestyle changes, and taking medication.

Potential complications include:

• Pulmonary edema (fluid buildup in the lungs)
• Total failure of the heart to function (circulatory collapse or shock)
• Arrhythmias (irregular heart rhythm) including fatal arrhythmias
• Cognitive impairment is common in older adults hospitalized for heart failure

Al-Hasso. Coenzyme Q10: a review. Hosp Pharm. 2001;36(1):51-66.

Bleske BE, Zineh I, Hwang HS, Welder GJ, Ghannam MM, Boluyt MO. Evaluation of hawthorn extract on immunomodulatory biomarkers in a pressure overload model of heart failure. Med Sci Monit. 2007 Dec;13(12):BR255-8.

Caminiti G, Volterrani M, Marazzi G, Cerrito A, Massaro R, Arisi A, Franchini A, Sposato B, Rosano G. Tai chi enhances the effects of endurance training in the rehabilitation of elderly patients with chronic heart failure. Rehabil Res Pract. 2011;2011:761958.

Chatterjee K, Rame J.E. Systolic heart failure: Chronic and acute syndromes. Critical Care Medicine. 2008;36(1).

Churbasik S. Evidence of the effectiveness of hawthorn extract. Am J Med. 2003;115(7):585; author reply 585-6.

Degenring FH, Suter A, Weber M, Saller R. A randomized double blind placebo controlled clinical trial of standardized extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine. 2003;10:363-9.

Djousse L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394-400.

Dodson JA, truong TT, Towle VR, Kerins G, Chaudhry SI. Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes. Am J Med. 2013;126(2):120-6.

Eaton LJ, Kinkade S. Hawthorn extract improves chronic heart failure. J Fam Pract. 2003;52(10):753.

Evangeliou A, Vlassopoulos D. Carnitine metabolism and deficit -- when supplementation is necessary? Curr Pharm Biotechnol. 2003;4(3):211-9.

Feinstein MJ, Jhund P, Kang J, et al. Do statins reduce the risk of myocardial infarction in patients with heart failure? A pooled individual-leavel reanalysis of CORONA and GISSI-HF. Eur J Heart Fail. 2015;17(4):434-41.

Ferri: Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Fong HH, Bauman JL. Hawthorn. J Cardiovasc Nurs. 2002;16(4):1-8.

Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiology. 2000;3:24-32.

Fumagalli S, Fattirolli F, Guarducci L, Cellai T, Baldasseroni S, Tarantini F, Di Bari M, Masotti G, Marchionni N. Coenzyme Q10 terclatrate and creatine in chronic heart failure: a randomized, placebo-controlled, double-blind study. Clin Cardiol . 2011;34(4):211-7. doi: 10.1002/clc.20846.

Gao ZY, Xu H, Shi DZ, Wen C, Liu BY. Analysis on outcome of 5284 patients with coronary artery disease: The role of integrative medicine. J Ethnopharmacol. 2011. [Epub ahead of print].

Gavagan T. Cardiovascular disease. Primary Care. 2002;29(2):323-38, vi.

Grove EL, Abrahamsen B, Vestergaard P. Heart failure in patients treated with bisphosphonates. J Intern Med. 2013; 274(4):342-50.

Hodges P. Heart failure: epidemiologic update. Crit Care Nurs Q. 2009;32(1):24-32.

Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE) – rationale, study design and study protocol. Eur J Heart Fail. 2000;2(4):431-7.

Houston MC. Treatment of hypertension with nutraceuticals, vitamins, antioxidants and minerals. Expert Rev Cardiovasc Ther. 2007 Jul;5(4):681-91.

Ince C, Schulman SP, Quigley JF, et al. Usefulness of magnesium sulfate in stabilizing cardiac repolarization in heart failure secondary to ischemic cardiomyopathy. Am J Cardiol. 2001;88(3):224-9.

Khatta M, Alexander BS, Krichten CM, Fisher ML, Freudenberger R, Robinson SW et al. The effect of conenzyme Q10 in patients with congestive heart failure. Ann Int Med. 2000;132(8):636-40.

Koh SG, Brenner DA, Korzick DH, Tickerhoof MM, Apstein CS, Sauper KW. Exercise intolerance during post-MI heart failure in rats: prevention with supplemental dietary propionyl-L-carnitine. Cardiovas Drugs Ther. 2003;17(1):7-14.

Lau CW, Yao XQ, Chen ZY, Ko WH, Huang Y. Cardiovascular actions of berberine. [review]. Cardiovasc Drug Rev. 2001;19(3):234-44.

Lenneman AJ, Birks EJ. Treatment strategies for myocardial recovery in heart failure. Curr Treat Options Cardiovasc Med. 2014; 16(3):287.

Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Elsevier Saunders: Philadelphia, PA. 2007;chap 23.

Mant J, Al-Mohammad A, Swain S, et al. Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute for Health and clinical excellence guideline. Ann Intern Med. 2011;155(4):252-9.

McCarty MF, O'Keefe JH, DiNicolantonio JJ. Red Yeast Rice Plus Berberine: Practical Strategy for Promoting Vascular and Metabolic Health. Altern Ther Health Med. 2015; 21 Suppl 2:40-5.

Mendoza CE, Rodriquez F, Rosenberg DG. Reversal of refractory congestive heart failure after thiamine supplementation: a report of a case and review of literature. J Cardiovas Pharmacol Ther. 2003;8(4):313-6.

Mills G, Chambers C. Effective Strategies to Improve the Management of Heart Failure. Primary Care: Clinics in Office Practice. Philadelphia, PA: W. B. Saunders: 2012;39(2).

Mingorance C, Rodríguez-Rodríguez R, Justo ML, Alvarez de Sotomayor M, Herrera MD. Critical update for the clinical use of L-carnitine analogs in cardiometabolic disorders. Vasc Health Risk Manag. 2011;7:169-16.

Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. [Review]. Am Fam Physician. 2000;62(6):1325-30.

Orea-Tejeda A, Orozco-Gutiérrez JJ, Castillo-Martínez L, Keirns-Davies C, Montano-Hernández P, Vázquez-Díaz O, Valdespino-Trejo A, Infante O, Martínez-Memije R. The effect of L-arginine and citrulline on endothelial function in patients in heart failure with preserved ejection fraction. Cardiol J. 2010;17(5):464-70.

Pauly DF, Pepine CJ. The role of carnitine in myocardial dysfunction. Am J Kidney Dis. 2003;41(4 Suppl 4):S35-S43.

Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114(8):665-74.

Rautiainen S, Levitan EB, Mittleman MA, Wolk A. Total antioxidant capacity of diet and risk of heart failure: a population-based prospective cohort of women. Am J Med. 2013;126(6):494-500.

Reddersen LA, Reddersen LA, Keen C, Nasir L, Berry D. Diastolic heart failure: state of the science on best treatment practices. J Am Acad Nurse Pract. 2008;20(10):506-14.

Rizos I. Three-year survival of patients with heart failure caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J. 2000;139:S120-3.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:231-5.

Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. 2002;59(5):417-22.

Roy SS, Foraker RE, Girton RA, Mansfield AJ. Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. AM J Public Health. 2015;105(4):757-63.

Sarter B. Coenzyme Q10 and cardiovascular disease: a review. J Cardiovasc Nurs. 2002;16(4):9-20.

Serati AR, Motamedi MR, Emami S, Varedi P, Movahed MR. L-carnitine treatment in patients with mild diastolic heart failure is associated with improvement in diastolic function and symptoms. Cardiology. 2010;116(3):178-82.

Shechter M. Magnesium and cardiovascular system. Magnes Res. 2010;23(2):60-72.

Singh U, Devaraj S, Jialal I. Coenzyme Q10 supplementation and heart failure. Nutr Rev. 2007 Jun;65(6 Pt 1):286-93. Review.

Sole MJ, Jeejeebhoy KN. Conditioned nutritional requirements: therapeutic relevance to heart failure. Herz. 2002;27(2):174-8.

Smith L. Diagnosis and Management of Chronic Heart Failure in Adults. American Family Physician. 2007;75(5).

Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, Johnson D, Krucoff MW, Rosenberg B, Bosworth HB, Adams K, Cuffe MS. The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J . 2009 Jan;157(1):84-90.

Susic D, Frohlich ED. Salt consumption and cardiovascular, renal, and hypertensive diseases: clinical and mechanistic aspects. Curr Opin Lipidol. 2011. [Epub ahead of print].

Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. 2002;143(5):910-5.

Weeks SG, Glantz SA, De Marco T, et al. Secondhand smoke exposure and quality of life in patients with heart failure. Arch Intern Med. 2011;171(21):1887-93.

Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol. [Review]. 2001;37(7):1765-74.

Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. 2011;171(8):750-7.

Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2003;92(2):173-6.

Zenuk C, Healey J, Donnelly J, Vaillancourt R, Almalki Y, Smith S. Thiamine deficiency in congestive heart failure patients receiving long term furosemide therapy. Can J Clin Pharmacol. 2003 Winter;10(4):184-8.