A lot of people with heart failure do something quietly brave every day: they take medications.
Even when the pills make them dizzy. Even when they’re peeing all night. Even when their stomach feels off, their energy feels low, or they’re nervous that “this can’t be normal.” Then the side effects start to feel like a choice between two hard options: feel miserable, or stop taking the medicine.
That’s the moment this article is for. Because heart failure medications are often lifesaving, and we understand that the goal is almost never “just stop.” The goal is to adjust dose, timing, or the specific medication so you can stay on treatment and stay out of the hospital.
In the U.S., nearly 6.7 million adults live with heart failure.1 Knowing how to talk about side effects is a practical survival skill.
What Heart Failure Is, In Plain Language
Heart failure does not mean the heart has stopped. It means the heart is not pumping blood as well as it should.1 When the heart can’t keep up, blood flow slows and fluid can build up in the lungs, legs, belly, or feet.1 That’s why shortness of breath and swelling are common symptoms.1
Heart failure can happen because the heart muscle is weak (it can’t squeeze well), stiff (it can’t fill well), or both. Treatment aims to reduce strain on the heart, remove extra fluid, and help the heart work more efficiently over time.1
Early Signs Of Heart Failure To Take Seriously
Heart failure often announces itself through everyday changes that may seem like “just getting older” or being out of shape. It occurs when the heart cannot pump enough blood to meet the body’s needs, leading to fluid backup and oxygen deprivation in vital organs.2 Common symptoms include:
Shortness of breath (Dyspnea):
- The Sign: Feeling breathless during activity or even while at rest.2
- The Red Flag: Needing to prop yourself up with several pillows at night to breathe comfortably, or suddenly waking up gasping for air.2
- Why it happens: Blood “backs up” in the veins that return blood from the lungs to the heart, causing fluid to leak into the lungs.2
Fatigue and Leg Weakness:
- The Sign: A constant feeling of tiredness or difficulty with simple tasks like grocery shopping, climbing stairs, or walking.2
- The Red Flag: Feeling exhausted after a meal or noticing your legs feel heavy and weak during a short walk.2
- Why it happens: The heart can’t pump enough blood to the muscles. To compensate, the body diverts blood away from “less vital” areas (like the limbs) to protect the heart and brain.2
Swelling (Edema) and Rapid Weight Gain:
- The Sign: Swelling in the legs, ankles, feet, or abdomen.2
- The Red Flag: Your shoes feel too tight, or you notice “pitting” (when you press your skin and the indentation stays for a few seconds). A sudden weight gain of 2–3 pounds in a day or 5 pounds in a week is also a major warning sign.2
- Why it happens: As blood flow out of the heart slows, blood returning to the heart gets backed up, forcing fluid into the surrounding tissues.2
Persistent Coughing or Wheezing:
- The Sign: A cough that won’t go away or produces white or pink (blood-tinged) mucus.2
- Why it happens: This is another result of fluid buildup in the lungs.2
Lack of Appetite or Nausea:
- The Sign: Feeling “full” or sick to your stomach even if you haven’t eaten much.2
- Why it happens: The digestive system receives less blood flow, which interferes with normal digestion.2
Confusion or Impaired Thinking:
- The Sign: Memory loss, disorientation, or a general “fogginess”.2
- Why it happens: Changing levels of sodium in the blood and reduced blood flow to the brain can affect mental clarity.2
Note: Often, a caregiver or family member will notice this change before the patient does.
Increased Heart Rate:
- The Sign: Feeling like your heart is racing, throbbing, or “skipping a beat”.2
- Why it happens: To make up for the loss in pumping power, the heart beats faster to try and keep up with the body’s demand for blood.2
The Most Common Heart Failure Medication Types and Their Side Effects
Doctors tailor meds to your type of heart failure and your other conditions. If you recognize some of the names below, that’s normal. Many people take more than one medication at the same time.
1) Diuretics (“water pills”)
Common names you might see include furosemide (Lasix), torsemide (Demadex), and bumetanide (Bumex).3
What they do: help your kidneys remove extra salt and water so swelling and shortness of breath improve.3
Common side effects: peeing more often (sometimes at night), dehydration, dizziness when standing, and muscle cramps if electrolytes shift.3
How to talk to your doctor about side effects:
- “I’m getting dizzy when I stand up, especially after my diuretic.”
- “I’m up all night urinating. Can we adjust timing?”
- “Are we checking my electrolytes and kidney function soon?”
2) ACE inhibitors (ACE-I)
Common names include lisinopril, enalapril, ramipril, and others.
What they do: relax blood vessels and reduce strain on the heart.3
Common side effects: dry cough and dizziness, and angioedema. Angioedema (swelling of the face, lips, tongue, or throat) can be dangerous and needs urgent care if it affects breathing.3
How to talk to your doctor about side effects:
- “This cough started after the ACE inhibitor. Can we discuss alternatives?”
- “If I ever have swelling of my lips or throat, what should I do immediately?”
3) ARBs (Angiotensin II receptor blockers)
Common names include losartan, valsartan, and candesartan.
What they do: similar job to ACE inhibitors (blood vessel relaxing), often used if an ACE inhibitor causes cough.3
Side effects can include: dizziness and changes in potassium or kidney function (your team may monitor labs).3
How to talk to your doctor about side effects:
“If we switch, what labs do you want me to get and when?”
4) ARNI (Angiotensin Receptor-Neprilysin Inhibitor)
Most common name: sacubitril/valsartan (Entresto).
What it does: improves heart failure outcomes and reduces harmful hormone signaling involved in heart failure.3
Common side effects: low blood pressure symptoms (dizziness, faintness) and possible potassium/kidney changes.3
How to talk to your doctor about side effects:
- “I feel faint since starting this. Can we review my blood pressure goals and adjust safely?”
- “When are we rechecking labs?”
5) Beta blockers
Common names: carvedilol (Coreg), metoprolol succinate (Toprol XL), bisoprolol.
What they do: slow the heart rate and reduce stress hormones so the heart can work more efficiently over time.3
Common side effects: fatigue and feeling slowed down at first, and sometimes dizziness.3
How to talk to your doctor about side effects::
- “My fatigue worsened after starting this. Is this an expected adjustment period or do we need a dose/timing change?”
- “What heart rate is too low for me?”
6) Mineralocorticoid receptor antagonists (MRAs)
Common names: spironolactone (Aldactone), eplerenone (Inspra).
What they do: help reduce salt and water retention and protect the heart; they can raise potassium, so labs matter.3
Common side effects: higher potassium and kidney changes. Spironolactone can also cause breast tenderness or breast enlargement (gynecomastia).3
How to talk to your doctor about side effects::
- “When should we recheck potassium and kidney function?”
- “I’m having breast tenderness/swelling. Can we switch to eplerenone or another option?”
7) SGLT2 (sodium-glucose cotransporter 2) inhibitors
Common names: dapagliflozin (Farxiga), empagliflozin (Jardiance).
What they do: help the body remove extra glucose and sodium through urine, and they improve outcomes in many heart failure plans.3
Common side effects: more urination and higher risk of genital yeast infections for some people. Other warning symptoms include a rare ketoacidosis (nausea, vomiting, stomach pain, tiredness, trouble breathing) that requires urgent care.3
How to talk to your doctor about side effects:
- “I think I’m getting a yeast infection since starting this. What’s the prevention and treatment plan?”
- “What symptoms mean I should stop and get urgent care?”
8) Vasodilators
Common names: hydralazine, isosorbide dinitrate, or the combination pill BiDil.
What they do: relax blood vessels and reduce workload on the heart. This combination is used in specific situations, including as part of guideline-directed therapy for some patients.3
Common side effects: headaches, dizziness, low blood pressure symptoms.3
How to talk to your doctor about side effects:
- “These headaches/dizziness are affecting my day. What’s the safest adjustment we can try?”
- One catch-all question that protects you across every class: “Can you tell me the top three side effects to watch for with this medicine, and which ones are urgent?”
Why This Matters For Black And Brown Communities
Heart failure does not land evenly. Research shows that racial and ethnic minorities are more likely to develop heart failure, live with the condition, and be hospitalized because of it.4 These differences in health outcomes are often caused by unequal access to standard medications and advanced medical treatments.4
The American Heart Association has also highlighted the heavy burden at younger ages, noting that Black adults account for over 50% of heart failure hospitalizations among U.S. adults under 50.4
That’s why side-effect conversations matter. If meds make you feel awful and nobody adjusts them, people are more likely to stop treatment, skip doses, or avoid follow-up. The system may call that “nonadherence.” The truth is often untreated side effects and poor communication. You deserve a plan that works in your real body and real life.4
A Call to Action for the NOWINCLUDED Community
You don’t have to choose between side effects and survival. Inside the NOWINCLUDED app, bring your symptoms and questions before your next appointment. Use the community to learn what others asked, what helped, and how to describe symptoms in a way that gets action.
Then take one step today: write down your top two side effects, when they happen, and one question you want answered.
That’s how you turn a hard medication experience into a safer plan.
References
- CDC. (2024, May 15 15). About Heart Failure. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/heart-disease/about/heart-failure.html
- AHA. (2025, May 29). Heart Failure Signs and Symptoms. Retrieved from American Heart Association: https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure
- AHA. (2025, June 17). Medications Used to Treat Heart Failure. Retrieved from American Heart Association: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure
- AHA. (2025 , February 7). Cardiovascular health risks continue to grow within Black communities, action needed. Retrieved from American Heart Association: https://newsroom.heart.org/news/cardiovascular-health-risks-continue-to-grow-within-black-communities-action-needed
