Understanding treatment in each of the heart failure stages

Having heart failure doesn’t mean your heart is going to stop working immediately. There are different heart failure stages, and your symptoms will dictate the type of treatment you receive.

While “heart failure” may sound like a sudden health issue, in most cases, the disease is progressive, developing gradually over time. Heart failure, when the heart is unable to pump enough blood, is also called congestive heart failure.

Millions of people in the U.S. develop heart failure each year. According to the Centers for Disease Control and Prevention, nearly 6.7 million people have been diagnosed with the disease.

There are two types of heart failure—right-sided heart failure and left-sided heart failure:

• Right-sided heart failure affects the heart’s ability to pump blood to the lungs, where it is infused with oxygen.
• Left-sided heart failure, which is more common, describes the heart’s limited ability to pump blood to the rest of the body. Heart failure affecting the left side of the heart may also be categorized as heart failure with reduced ejection fraction, which references the heart’s pumping ability.

Both types of heart failure usually develop over time as the result of damage to the heart muscle due to medical conditions such as coronary artery disease. As you develop heart failure, you’ll move through four distinct stages.

What to know about the heart failure stages

Because heart failure is a progressive disease, it’s categorized based on how severe the damage is at any given point. The American Heart Association and American College of Cardiology identify four stages of heart failure:

• Stage A: People who are at risk of developing heart failure but are not yet experiencing symptoms and do not have heart disease
• Stage B: People who have structural heart disease, increased filling pressure in the heart or other risk factors but are not experiencing symptoms of heart failure
• Stage C: People who are experiencing symptoms of heart failure, including shortness of breath, coughing, or swelling and fluid buildup in the ankles or lower legs
• Stage D: People who have significant symptoms of heart failure that interfere with daily living or require frequent hospitalization

Heart failure in stages C and D is further divided into classes based on how many symptoms impact quality of life. Those in class I don’t experience fatigue or other symptoms with activity, while those in class IV often experience symptoms at rest that worsen during physical activity.

How treatment adapts as symptoms change

When heart failure develops, it disrupts the heart’s ability to pump enough blood. At first, the heart tries to make up for the deficit by getting bigger, building more heart muscle mass and pumping faster.

In addition to those changes in the heart, other parts of the body also attempt to compensate, with blood vessels narrowing to increase blood pressure and the kidneys retaining more salt and water to increase blood volume.

If you’ve been diagnosed with heart failure, a cardiologist will work closely with you to create a personalized treatment plan. This plan will be based on the type of heart failure you have, the symptoms you’re experiencing, and the severity of your condition.

In the early stages of heart failure, treatment usually includes a combination of medications, dietary changes and liquid restrictions. Lifestyle changes, such as quitting smoking, getting regular exercise and avoiding nonsteroidal anti-inflammatory drugs (NSAIDs), can play a significant role in managing your condition.

During stages A through C, the plan for treating heart failure will also include treating underlying health conditions that can worsen heart failure, such as cardiomyopathy or high blood pressure.

For heart failure in stages C and D, more advanced treatments may be necessary. These could include surgery to repair a congenital heart defect or the implantation of a device to assist your heart. Treatments such as an implantable cardioverter defibrillator, a biventricular pacemaker or a left ventricular assist device (LVAD) are available to provide hope and improve your quality of life.

An LVAD is used to mechanically support the left ventricle of the heart, either as a standalone treatment or until a heart transplant. A Touro provider may recommend a heart transplant for end-stage heart failure that isn’t improving with other treatments.

Touro Heart & Vascular Care is here to care for your heart. We offer specialized services for a full spectrum of cardiovascular conditions, including heart failure.