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Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve and the heart sometimes becomes stronger. Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, the treatment of heart failure involves a balance of the right medications, and in some cases, devices that help the heart beat and contract properly.

Heart Transplant:Some people have such severe heart failure that surgery or medications don’t help. They may need to have their diseased heart replaced with a healthy donor heart. Heart transplants can dramatically improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait months or years before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.

Heart Pumps (left ventricular assist devices, or LVADs):These mechanical devices are implanted into the abdomen or chest and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart.

LVADs are now sometimes used as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with severe heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart.

Cardiac Resynchronization Therapy:Cardiac resynchronization therapy (CRT) or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles), so that they pump in a more efficient, coordinated manner. As many as half the people with heart failure have problems with their heart’s electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.

Implantable Cardioverter-Defibrillators (ICDs):An ICD is a device implanted under the skin and attached through the veins in your chest to your heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to shock it back into normal rhythm.

Heart Valve Repair or Replacement:If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons also can repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty). Valve replacement is done when valve repair isn’t possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.

Coronary Bypass Surgery:If severely blocked arteries are contributing to your heart failure, your doctor may recommend coronary artery bypass surgery. In this procedure, a vein from your leg, arm or chest replaces a blocked vein in your heart to allow blood to flow through your heart more freely.

As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.

If you have heart damage and severe heart failure symptoms, you may need a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).

In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart’s pumping. To correct this problem, your doctor may implant a CRT device (a type of pacemaker) near your heart. This device helps both sides of your heart contract at the same time, which may decrease heart failure symptoms.

Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, the problem can cause sudden cardiac arrest. Your doctor may implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.

People who have severe heart failure symptoms at rest, despite other treatments, may need:

1.Experimental treatments. Studies are under way to see whether open-heart surgery or angioplasty (a procedure used to open clogged heart arteries and improve blood flow) can reduce heart failure symptoms.

2.Heart transplant. A heart transplant is an operation in which a person’s diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed.

3.A mechanical heart pump, such as a left ventricular assist device. This device helps pump blood from the heart to the rest of the body. You may use a heart pump until you have surgery or as a long-term treatment.

You may be eligible for an implantable heart device called cardiac resynchronization therapy (CRT). CRT is a clinically proven treatment option for treating some individuals with heart failure. A CRT heart device sends tiny electrical pulses to the lower chambers of your heart to help them beat in a more coordinated or “synchronized” fashion. This may help improve the pumping efficiency of the heart.

Heart Surgery:If your heart failure is caused or made worse by a weak valve, your doctor may consider heart surgery to repair or replace the valve. If the heart failure is serious and irreversible, heart transplant surgery may be considered.

Ongoing treatment

You will keep following your lifestyle changes, such as limiting sodium, not smoking, and being active.

Your doctor will add other medicines and other treatments as you need them. Your doctor also will try to prevent or treat problems-such as fever, arrhythmia, and anemia-that can lead to sudden heart failure.

Your treatment may include:

Oxygen treatment:Your doctor may recommend oxygen therapy to reduce your shortness of breath and increase your ability to exercise.

Getting devices to fix Heart Rhythm Problems. In some cases, your doctor may recommend a biventricular pacemaker that is placed in your chest to keep your heart beating at a normal rhythm. Or you may have an implantable cardioverter-defibrillator (ICD) to stop a deadly rhythm. In some cases, you may get a pacemaker that is combined with an ICD.

Checking your weight:Your doctor will probably give you guidelines for watching fluid buildup and tell you how much weight gain is too much.

Getting vaccines:Your doctor may want you to get vaccines against pneumonia and the flu (influenza). These vaccines can keep you from getting infections that could put you in the hospital.