Heart Failure
Heart Failure
Heart failure is a condition in which the heart is unable to pump enough blood to meet the body’s needs. This does not mean the heart has stopped working. Instead, the heart may become too weak to pump effectively or too stiff to fill properly with blood.
When the heart cannot function efficiently, blood flow slows down and fluid can build up in different parts of the body, including the lungs, abdomen, legs and feet. This may lead to symptoms such as shortness of breath, fatigue, and swelling.
Heart failure is a long-term (chronic) condition, but with early diagnosis, proper treatment, and lifestyle modifications, many patients can continue to live active and fulfilling lives.
Types of Heart Failures
Heart failure is commonly classified based on how well the heart pumps blood. This is measured using Left Ventricular Ejection Fraction (LVEF), which represents the percentage of blood pumped out of the heart with each heartbeat.
- LVEF ≤ 40%
- The heart muscle becomes weakened and cannot pump blood efficiently
- One of the most commonly recognised forms of heart failure
- LVEF 41–49%
- Considered an intermediate group between reduced and preserved heart function
- Patients may have features of both HFrEF and HFpEF
- LVEF ≥ 50%
- The heart muscle pumps normally but becomes stiff and does not relax properly
- This affects the heart’s ability to fill adequately with blood
- Symptoms may be similar to other types of heart failure
- Previously LVEF ≤ 40%, now improved to > 40% with treatment
- Indicates recovery or improvement in heart function
Causes & Risk Factors of Heart Failure
Several medical conditions can increase the workload on the heart or affect its ability to function normally. Common causes include:
- Coronary artery disease (narrowed heart arteries).
- Previous heart attacks causing damage to the heart muscle.
- High blood pressure (hypertension)
- Heart valve disease.
- Cardiomyopathy (diseases affecting the heart muscle)
- Irregular heart rhythms (arrhythmias)
- Congenital heart conditions (heart problems present from birth)
- Infections or inflammation affecting the heart muscle.
Several factors may increase the risk of developing heart failure, including:
- Diabetes
- Obesity or excess body weight
- Smoking
- Sedentary lifestyle or lack of physical activity
- High cholesterol levels
- Excessive alcohol intake
- Increasing age
- Family history or heart disease
Symptoms of Heart Failure
Heart failure symptoms can develop gradually over time or appear suddenly, depending on the underlying cause and severity of the condition. Symptoms occur when the heart is unable to pump blood efficiently, leading to fluid buildup and reduced blood supply to the body. Common symptoms of heart failure include:
- Shortness of breath, especially during physical activity or when lying flat
- Swelling of the ankles, feet, legs, or abdomen
- Fatigue or reduced ability to perform daily activities or exercise
- Rapid or irregular heartbeat
- Persistent tiredness or weakness
- Difficulty sleeping due to breathing discomfort
- Reduced exercise tolerance
How to Diagnose Heart Failure
Diagnosing heart failure involves a combination of medical history, physical examination, blood tests, and imaging studies to determine how well the heart is functioning.
A detailed evaluation, including:
- Medical history and symptoms such as breathlessness, fatigue, or swelling
- Physical examination
- Basic investigations including:
- Electrocardiogram (ECG)
- Blood tests
- Chest X-ray (if indicated)
An important blood test used in suspected heart failure measures specific heart failure markers released when the heart is under stress. Elevated levels may suggest increased strain on the heart and support the diagnosis of heart failure.
- NT-proBNP > 125 pg/mL
- BNP > 35 pg/mL
An echocardiogram (heart ultrasound) is one of the most important tests used to confirm heart failure. This test provides important information for determining the type and severity of heart failure.
It helps to:
- Assess how effectively the heart pumps blood (ejection fraction)
- Evaluate heart size and structure
- Assess heart valve function
- Identify possible underlying causes of heart failure
Further investigations may be recommended depending on the clinical findings and suspected cause of heart failure. These tests help identify the underlying cause and guide personalised treatment planning such as:
- Stress testing
- Coronary angiography
- Cardiac MRI
- CT coronary angiography
- Holter monitoring for heart rhythm assessment
Stages of Heart Failure Treatment
Heart failure is classified into four stages (A–D), reflecting disease progression from risk to advanced disease. Each stage has specific treatment goals.
Patients at this stage with risk factors such as hypertension, diabetes, obesity, or coronary artery disease but no structural heart disease or symptoms. Treatment goals:Control risk factors and underlying medical conditions
- Adopt a heart-healthy lifestyle
- Stop smoking and maintain regular exercise
- Manage blood pressure, cholesterol, and blood sugar levels
- Consider preventive therapies in selected high-risk patients
Patients have structural heart abnormalities but do not yet have symptoms of heart failure such as reduced heart pumping function (reduced ejection fraction), previous heart attack, heart valve disease or enlargement of the heart. Treatment goals:
- Prevent progression to symptomatic heart failure
- Manage underlying heart disease
- Optimise medical treatment
- Consider device therapy (Implantable Cardiac Defibrillator) in selected patients
Treatment may include medications such as:
- ACE inhibitors or ARBs
- Beta-blockers
- Cholesterol-lowering medications where appropriate
Patients have structural heart disease and experience current or previous symptoms of heart failure such as breathlessness, fatigue, or fluid retention. Treatment goals:
- Improve symptoms and quality of life
- Reduce hospital admissions
- Slow disease progression
- Improve long-term survival
Treatment may include:
- Guideline-directed medical therapy (GDMT)
- Diuretics to reduce fluid retention
- Lifestyle modifications
- Cardiac rehabilitation
- Device therapy such as pacemakers or implantable devices when indicated
Patients have severe symptoms despite receiving optimal medical treatment and often experience repeated hospital admissions. Symptoms may significantly affect daily activities and quality of life. Treatment goals:
- Improve symptom control and quality of life
- Reduce recurrent hospitalisation
- Consider advanced treatment options which include:
- Mechanical circulatory support devices
- Heart transplantation in suitable patients
- Intravenous medications for symptom support
- Palliative and supportive care when appropriate
Living with heart failure requires ongoing care and active participation in daily management. Simple measures such as monitoring your weight regularly, limiting salt intake, following fluid restrictions when advised, staying physically active within your limits, taking medications as prescribed, and attending regular follow-up appointments can help improve symptom control and reduce the risk of complications.
With early diagnosis, appropriate treatment, and consistent self-care, many patients with heart failure can manage their condition effectively, maintain their quality of life, and continue leading active and fulfilling lives.