17069 Heart Failure Understanding Heart Failure

Overview

Heart failure is a long-term condition where the heart is not pumping blood as well as it should. It does not mean the heart has stopped beating; it means the heart muscle is weak or stiff, so the body does not get all the oxygen and nutrients it needs. This can cause fluid to build up in the lungs, legs, and other parts of the body.

Yes. Heart failure is very common worldwide. It is estimated that millions of people live with heart failure, and the number continues to grow as populations age and as more people survive heart attacks.

Heart failure can affect anyone, but it is much more common in people over 65. It also occurs more often in people who have high blood pressure, coronary artery disease, a previous heart attack, diabetes, or obesity. Men tend to develop heart failure at a younger age than women, but women are affected too, especially after menopause.

Symptoms

Common symptoms

• Shortness of breath, especially during activity or when lying flat
• Feeling unusually tired or weak
• Swelling in the feet, ankles, legs, or abdomen
• Rapid weight gain from fluid buildup (for example, gaining 2–3 pounds in a day or 5 pounds in a week)
• Persistent cough or wheezing, sometimes with white or pink frothy phlegm
• Needing to urinate frequently at night

Symptoms in children

• Difficulty feeding or poor appetite
• Slow weight gain or failure to grow at expected rate
• Breathlessness, fast breathing, or grunting while feeding
• Unusual tiredness or sleepiness
• Swelling in the face, abdomen, or legs

Symptoms in older adults

• New or worsening confusion or difficulty thinking clearly
• Reduced ability to walk or do daily activities
• Increased fatigue and less interest in usual activities
• Swelling in both legs or the lower back
• Trouble breathing at night, needing extra pillows to sleep

Causes

Main causes

• Coronary artery disease — narrowed or blocked blood vessels that reduce blood flow to the heart muscle
• A previous heart attack — this can damage the heart muscle permanently
• High blood pressure — makes the heart work harder than usual
• Cardiomyopathy — a disease of the heart muscle itself, which can be inherited or caused by other factors
• Heart valve problems — faulty valves make the heart pump harder to move blood
• Certain viral infections or inflammation of the heart muscle (myocarditis)
• Excessive alcohol use over many years or the use of certain recreational drugs

Risk factors

• Age — the risk increases as you get older
• High blood pressure
• Diabetes
• Obesity or being overweight
• Smoking or tobacco use
• Having a family history of heart failure or other heart disease
• Long-term high alcohol consumption
• A sedentary lifestyle with little physical activity

When to see a doctor

See a doctor urgently if:

• Call your local emergency number right away if you have severe breathing trouble, chest pain that won't go away, fainting, or blue lips/skin.
• Contact your doctor or local same-day service the same day if you have a sudden weight gain of 2–3 pounds in one day or 5 pounds in a week, worsening swelling, or breathlessness that is getting worse.

Book a routine appointment if:

• Make an appointment with your doctor if you often feel unusually short of breath, tired, or have swelling in your legs or ankles that does not improve with rest.
• If you already have heart failure, keep all follow-up appointments and contact your care team if you notice any new or changing symptoms.

Diagnosis

A doctor may suspect heart failure based on your symptoms, medical history, and a physical exam. They will listen to your heart and lungs, check for swelling, and ask about your daily activities. To confirm the diagnosis, several tests may be arranged to see how well the heart is pumping and whether fluid is building up.

Tests that may be done

• Blood tests — check for strain on the heart, kidney and liver function, and other markers like B-type natriuretic peptide (BNP) or NT-proBNP, which rise when heart failure is present
• Electrocardiogram (ECG) — a quick, painless test that records the heart's electrical activity
• Echocardiogram (echo) — an ultrasound of the heart that shows its structure and how well it pumps blood
• Chest X-ray — looks for fluid in the lungs or an enlarged heart
• Exercise stress test — measures how the heart responds to activity
• Cardiac MRI — a detailed scan of the heart if more information is needed

What to expect at your appointment

The diagnosis process usually starts with your family doctor, who may refer you to a cardiologist (a heart specialist). Many tests are simple and painless. It may take a few weeks to get all the results. Your healthcare team will explain what the findings mean and work with you to create a treatment plan tailored to your needs.

Treatment

Heart failure is usually managed with a combination of medications, lifestyle changes, and sometimes devices or procedures. The goals of treatment are to reduce symptoms, improve quality of life, slow the progression of the condition, and help you live longer. Treatment works best when you are actively involved and follow your care plan.

Self-care at home

• Weigh yourself daily at the same time, in the morning, and record it — a sudden rise can mean fluid is building up
• Limit salt (sodium) in your diet to help reduce fluid buildup
• Monitor fluid intake if your doctor advises it because too much fluid can strain the heart
• Take rest when you need it, but also stay active within your limits, with your doctor's approval
• Stop smoking and avoid alcohol, or keep alcohol to the small amount your doctor allows
• Keep all appointments and ask questions when you don't understand something

Medical treatments

Medications are a key part of heart failure treatment. Different types of medicine may be used to ease the heart's workload, remove extra fluid, widen blood vessels, slow the heart rate, or protect the heart from further damage. Your doctor may also recommend devices like an implantable defibrillator or a pacemaker to help control the heart's rhythm. In some cases, procedures to open blocked arteries, repair valves, or a heart transplant may be considered. Your doctor will always explain the benefits and risks of each option so you can make an informed decision.

When is surgery considered?

Surgery is not needed for everyone with heart failure, but it may be recommended if tests show severe valve damage, blocked coronary arteries, or a dangerously abnormal heart rhythm. Procedures could include valve repair or replacement, bypass surgery, implantation of a defibrillator or pacemaker, or, in very advanced cases, evaluation for a heart transplant. Your specialist team will discuss if and when any surgery is appropriate for you.

Living with this condition

Living with heart failure means learning to manage symptoms and pace yourself. Keep a checklist of your daily weight, take your medications exactly as prescribed, and track any changes in how you feel. Plan activities at times when you have more energy, and break tasks into smaller steps. Ask your family and friends for help when you need it. Don't be afraid to talk to your care team about physical or emotional challenges.

Lifestyle tips

• Stay physically active with activities like walking or light stretching, as your doctor advises
• Eat a heart-healthy diet with plenty of vegetables, fruits, whole grains, and lean proteins
• Keep salt low — avoid processed and fast foods, and don't add salt to meals
• Limit fluids if your doctor suggests it, and track how much you drink
• Aim for a healthy weight and lose weight if recommended
• Stop smoking and avoid secondhand smoke
• Limit or avoid alcohol according to your doctor's advice
• Get enough rest and sleep, and manage stress with relaxation techniques or hobbies

Diet and exercise

A heart-friendly diet is rich in vegetables, fruits, whole grains, and lean proteins like fish, chicken, beans, and lentils. You should reduce salt, as too much sodium causes your body to hold onto fluid. If your doctor recommends limiting fluids, keep track of how much you drink. For exercise, start slowly — even short, gentle walks can help. Always check with your healthcare team before starting any new exercise program, especially if your weight changes quickly or you feel breathless.

Mental health and emotional wellbeing

Living with heart failure can bring about anxiety, depression, stress, and worry. It's natural to feel overwhelmed at times. Talk to your doctor or nurse about your emotional health — they can offer support or counselling. Connecting with others who understand, whether in support groups or with friends and family, can also make a big difference. Remember, your mental health needs attention just like your physical health.

Prevention

You can reduce your risk of developing heart failure by protecting your heart. Control high blood pressure, keep blood sugar in a healthy range if you have diabetes, avoid smoking, limit alcohol, eat a balanced diet, and stay physically active. If you already have heart disease, following your treatment plan and attending regular check-ups can help prevent heart failure from developing or getting worse.

Vaccines

Infections like flu and pneumonia can put extra strain on the heart and make heart failure worse. Getting recommended vaccinations, such as the flu vaccine, pneumococcal vaccine, and COVID-19 vaccines, is a safe and important way to protect your heart. Ask your doctor or pharmacist which vaccines are recommended for you.

Screening programmes

Routine health check-ups can catch risk factors like high blood pressure, high cholesterol, or diabetes early, which helps prevent heart failure. If you have a family history of heart conditions, tell your doctor — they may recommend earlier or more frequent checks. There is no routine screening test for heart failure in the general public, but your doctor may perform blood tests or an ECG if you have symptoms or risk factors.

Complications

If left untreated

• Fluid buildup in the lungs, causing severe breathing problems
• Kidney damage or kidney failure due to reduced blood flow
• Liver damage from chronic fluid buildup and congestion
• Abnormal heart rhythms (arrhythmias), which can be life-threatening
• Sudden cardiac arrest
• Heart failure that worsens and leads to disability or the need for urgent hospital care

Long-term outlook

A diagnosis of heart failure is serious, but it is not the end of the road. Many people live many years with heart failure by following their treatment plan, staying active, and keeping up with regular medical care. Some people's heart function even improves with the right medicines and lifestyle changes. Your outlook depends on the cause, how severe it is, and how well you manage it — and your care team is there to help you every step of the way.

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