Overview
Heart failure means the heart cannot pump enough blood to meet the body's needs. It does not mean the heart has stopped or is about to stop beating.
In some people the heart muscle has become weak and squeezes poorly. In others it has grown stiff and does not fill properly between beats. Both cause the same problems: blood backs up, and fluid collects in the lungs, the legs and sometimes the tummy.
It is usually long term and cannot be cured, but treatment controls symptoms and helps people live longer.
Symptoms
Symptoms often build up slowly, and may include:
- Breathlessness during everyday activity, and later at rest
- Breathlessness on lying flat, or waking at night short of breath
- Swelling of the ankles, feet, legs or tummy
- Sudden weight gain over a few days as fluid collects
- Tiredness and weakness
- A cough that is worse at night
- Dizziness, a fast heartbeat, or loss of appetite
When to see a doctor
Contact a doctor within a few days for new or worsening breathlessness, weight gain of two kilograms or more over two or three days, swelling that is getting worse, needing extra pillows to sleep, or a new cough and unusual tiredness.
Causes
Heart failure is the end result of something that has damaged or overworked the heart: a heart attack or narrowed coronary arteries, years of high , valve disease, an irregular or very fast heartbeat, or disease of the heart muscle itself, called cardiomyopathy.
It can also follow diabetes, kidney disease, a viral infection of the heart, heavy alcohol use, some cancer treatments or an overactive thyroid. In some people no cause is found.
Risk factors
- A previous heart attack or known coronary artery disease
- High
- Diabetes
- Heart valve disease or a congenital heart problem
- and other rhythm disorders
- Age over 65
- Being overweight
- Smoking, heavy alcohol use and cocaine use
- Long-term kidney disease
Complications
- Fluid filling the lungs, which causes sudden severe breathlessness
- Irregular heart rhythms, including
- Kidney and liver problems caused by poor blood flow and congestion
- Blood clots
- Weight and muscle loss, and repeated hospital admissions
- Low mood and anxiety
Prevention
- Keeping within the target set by a doctor
- Treating coronary artery disease, diabetes and high
- Getting an irregular heartbeat checked and treated
- Not smoking, and keeping alcohol low
- Staying active and keeping to a healthy weight
- Using less salt
- Taking prescribed medicines regularly and keeping review appointments
Diagnosis
The doctor listens to the heart and lungs, looks for swelling and asks about breathlessness. Tests usually include:
- A blood test called BNP or NT-proBNP, which rises when the heart is under strain
- Blood tests for anaemia, kidney function, thyroid and blood sugar
- An and a chest X-ray
- An , an of the heart muscle and valves
The echocardiogram gives the ejection fraction, a measure of how much blood the main pumping chamber pushes out with each beat, which guides treatment.
Treatment
Most people take several medicines together. Water tablets, known as diuretics, remove extra fluid and relieve breathlessness and swelling. Other groups reduce the work of the heart, slow the heart rate and, over time, help the muscle recover some strength.
Whatever caused the heart failure is treated too: opening a blocked artery, repairing a valve, controlling or correcting a rhythm problem. Some people benefit from a special pacemaker or an implanted defibrillator, and a few from a transplant.
Day-to-day care matters as much: weighing daily, limiting salt and, if advised, fluid, staying as active as the doctor allows, having recommended vaccinations, and reporting weight gain early.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Heart failure means the heart is about to stop.”What is true?
Fact
The name is misleading. Heart failure means the heart is not pumping as strongly or filling as easily as it should, not that it has stopped or is about to. Many people live for years with it once treatment is started.
Myth“If I feel better, I can stop the tablets.”What is true?
Fact
Feeling better usually means the medicines are working. Several of them protect the heart and keep fluid from building up, and symptoms commonly return within days or weeks of stopping. Any change should be made by the doctor who prescribed them.
Myth“Someone with a weak heart should stay in bed and avoid all exertion.”What is true?
Fact
Complete rest weakens the muscles and makes breathlessness worse. Regular, gentle activity built up gradually is part of treatment for most people, and supervised cardiac rehabilitation is designed for this. The right level is set with the doctor.
Myth“Swelling in the legs just means weakness or too much walking, so it can wait.”What is true?
Fact
In someone with heart failure, swelling that increases, along with a quick rise in weight, usually means fluid is collecting because the heart is not keeping up. It is a signal to have the treatment reviewed rather than to wait.
Myth“Painkillers from the chemist are harmless if my heart is weak.”What is true?
Fact
Common anti-inflammatory painkillers, such as those often taken for joint or body aches, can make the body hold on to fluid and salt and can worsen heart failure and kidney function. Ask a doctor or pharmacist before taking any new medicine, including over the counter ones.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Does heart failure mean my heart will stop soon?
No. Heart failure describes a heart that is not pumping efficiently, not a heart that is stopping. It is a serious long-term condition, but modern treatment relieves symptoms and helps many people live active lives for years. The outlook depends on the cause, how early it is treated and how well the treatment is followed.
Why do I have to weigh myself every day?
A rise of about two kilograms over two or three days is usually fluid rather than body fat, and it is often the first sign that the heart failure is worsening. Catching it early lets the doctor adjust the water tablets before breathlessness becomes severe, which can prevent a hospital admission.
How much water and salt can I have?
Cutting down salt is advised for nearly everyone with heart failure, because salt makes the body hold fluid. A limit on how much you drink is not needed by everyone, and it depends on your symptoms, your kidney results and the medicines you take. Ask your doctor for the limit that applies to you.
Can heart failure get better?
Heart failure is usually long term, but it is not always fixed. When a treatable cause is corrected, for example a blocked artery, a faulty valve, an over-fast heart rhythm or heavy alcohol use, the pumping can improve a lot. Medicines taken steadily also help the heart recover some strength over months.
