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Heart Failure Management

Comprehensive, Evidence-Based Care for a Stronger Heart

Heart failure (HF) is a chronic condition in which the heart cannot pump blood efficiently. With the right medical care, lifestyle changes, and regular monitoring, most patients can lead active and meaningful lives.

Heart failure management today follows guideline-directed medical therapy (GDMT) from international societies (AHA/ACC/ESC/ISH). Our approach combines the latest evidence with personalized care.

What is Heart Failure?

Heart failure occurs when the heart becomes too weak or too stiff to pump blood. It may affect:

  • The left ventricle (most common)

  • The right ventricle

  • Both sides of the heart

Types of heart failure:

  • HFrEF: Heart Failure with Reduced Ejection Fraction (EF < 40%)

  • HFmrEF: EF 41–49%

  • HFpEF: Heart Failure with Preserved EF (EF ≥ 50%)

  • Acute Heart Failure: Sudden worsening of symptoms

  • Chronic Heart Failure: Long-term condition needing continuous care

Symptoms of Heart Failure

  • Shortness of breath

  • Leg swelling

  • Fatigue and weakness

  • Rapid heart rate

  • Abdominal bloating

  • Difficulty sleeping flat

  • Persistent cough

  • Sudden weight gain

Heart Failure Management: Our Comprehensive Approach

Modern HF care includes medications, device therapy, lifestyle changes, and close monitoring.

Guideline-Directed Medical Therapy (GDMT)

The 4 Pillars of Heart Failure Treatment (HFrEF)

We follow evidence-based therapies proven to reduce mortality and hospitalizations:

✔ ARNI (Sacubitril-Valsartan)

First-line therapy for suitable patients to improve symptoms and EF.

✔ Beta Blockers

  • Carvedilol

  • Bisoprolol

  • Metoprolol succinate

They slow the heart, protect the heart muscle, and improve survival.

✔ Mineralocorticoid Receptor Antagonists (MRA)

  • Spironolactone

  • Eplerenone

Help reduce fluid retention and fibrosis.

✔ SGLT2 Inhibitors

  • Dapagliflozin

  • Empagliflozin

Work for both HFrEF and HFpEF, regardless of diabetes status.

Device Therapy

Devices improve survival in selected patients:

✔ ICD (Implantable Cardioverter Defibrillator)

Prevents sudden cardiac death in patients with low EF.

✔ CRT (Cardiac Resynchronization Therapy)

Improves heart function in patients with wide QRS or dyssynchronous ventricles.

✔ CRT-D (Resynchronization + Defibrillator)

For patients needing both pacing and shock protection.

✔ LVAD (Left Ventricular Assist Device)

For advanced heart failure not responding to medications.

Interventional & Surgical Treatments

  • Coronary angiography & revascularization

  • Mitral/tricuspid valve repair or replacement

  • TAVI in selected cases

  • Pericardiocentesis (if effusion is contributing)

  • Management of myocarditis or cardiomyopathies

Lifestyle Management

Diet

  • Low salt (<2 g/day)

  • Fluid restriction (1.5–2 L/day in advanced HF)

  • Avoid alcohol & smoking

  • High-fiber, heart-healthy diet

Exercise

  • Cardiac rehabilitation

  • Regular walking

  • Strength training under supervision

  • Avoid sudden intense exertion

Weight Monitoring

  • Daily morning weight

  • Report gain of >2 kg in 2–3 days

Sleep & Stress

  • Evaluate for sleep apnea

  • Stress reduction techniques

  • Adequate rest

Dr. Ritesh Acharya is a well-known Interventional Cardiologist and Cardiac Electrophysiologist based in Bhubaneswar. 

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