Heart failure

When To See Doctor

See a healthcare professional if you develop: New or increasing breathlessness Swelling of the feet or ankles Unexplained rapid weight gain Persistent tiredness Reduced ability to walk or exercise Recurrent nighttime breathlessness Persistent cough or wheezing Fast or irregular heartbeat Symptoms that are gradually becoming worse If you already have heart failure, contact your treating doctor when you notice a new or significant change from your usual symptoms.

Nutrition

There is no single diet that is appropriate for every person with heart failure. Nutritional advice should be individualised, particularly when kidney disease or other conditions are also present. Reduce Excess Salt Too much sodium can contribute to fluid retention in some people with heart failure. Avoid regularly consuming large amounts of: Pickles Papad Packaged snacks Instant foods Processed meats Very salty sauces Highly processed foods Choose Heart-Healthy Foods A balanced diet can include: Vegetables Fruits in appropriate portions Whole grains Pulses and legumes Appropriate protein sources Nuts and seeds in suitable portions Be Careful With Fluids Some patients with advanced heart failure may be advised to restrict fluid intake, while others do not require strict fluid restriction. Do not impose a severe fluid restriction on yourself unless your healthcare professional recommends it. Maintain a Healthy Weight Both excess weight and severe unintentional weight loss can be concerns in heart failure and should be discussed with a healthcare professional.

Types

• Explanation: In this type, the heart's main pumping chamber—the left ventricle—does not contract strongly enough to pump blood effectively. The ejection fraction is reduced. | Name: Heart Failure With Reduced Ejection Fraction (HFrEF)
• Explanation: In HFpEF, the heart's pumping percentage may remain relatively preserved, but the heart muscle can become stiff and may not relax and fill with blood properly. The heart can therefore still have difficulty delivering enough blood to meet the body's needs. | Name: Heart Failure With Preserved Ejection Fraction (HFpEF)
• Explanation: Some patients have an ejection fraction that falls between the traditionally reduced and preserved ranges. This group is commonly described as heart failure with mildly reduced ejection fraction. | Name: Heart Failure With Mildly Reduced Ejection Fraction (HFmrEF)
• Name: Left-Sided Heart Failure | Explanation: Left-sided heart failure occurs when the left side of the heart has difficulty pumping blood effectively to the body. It may lead to increased pressure and fluid accumulation in the lungs, contributing to breathlessness.
• Explanation: Right-sided heart failure affects the heart's ability to pump blood toward the lungs. It can contribute to fluid accumulation in the legs, ankles, abdomen and other tissues. Right-sided heart failure can occur independently but often develops alongside left-sided heart failure. | Name: Right-Sided Heart Failure
• Name: Acute and Chronic Heart Failure | Explanation: Chronic heart failure develops and persists over time. Acute heart failure refers to a sudden worsening or new onset of heart failure symptoms and may require urgent medical treatment.

Causes

• Name: Coronary Artery Disease | Explanation: Narrowing or blockage of the arteries supplying blood to the heart can reduce the heart muscle's ability to function properly.
• Explanation: A heart attack can permanently damage part of the heart muscle and reduce its pumping ability. | Name: Previous Heart Attack
• Explanation: Long-standing uncontrolled high blood pressure makes the heart work harder. Over time, this can cause the heart muscle to become thick or stiff and eventually contribute to heart failure. | Name: High Blood Pressure
• Name: Heart Valve Disease | Explanation: Damaged or abnormal heart valves can make it harder for the heart to pump blood efficiently.
• Explanation: Diseases affecting the heart muscle can weaken or alter the structure and function of the heart. | Name: Cardiomyopathy
• Name: Abnormal Heart Rhythms | Explanation: Certain persistent or severe arrhythmias can affect the heart's ability to pump efficiently.
• Name: Congenital Heart Conditions | Explanation: Some people are born with structural abnormalities of the heart that can contribute to heart failure.
• Name: Other Conditions | Explanation: Diabetes, kidney disease, certain infections, thyroid disorders and some medicines or treatments can also contribute to heart failure in particular circumstances.

Lifestyle

Lifestyle management is an important part of living with heart failure. Take Medicines Regularly Take medicines exactly as prescribed and maintain regular follow-up appointments. Monitor Your Weight Some patients are advised to check their weight regularly. A rapid increase may indicate fluid retention and should be discussed with the treating doctor. Stay Physically Active Appropriate physical activity can be beneficial for many people with stable heart failure. However, the exercise plan should match your condition and doctor's advice. Stop Smoking Smoking increases cardiovascular risk and can worsen overall heart health. Limit Alcohol If you drink alcohol, discuss an appropriate limit with your doctor. Some people with specific forms of cardiomyopathy may need to avoid alcohol completely. Monitor Symptoms Pay attention to changes such as: Increasing breathlessness New or worsening swelling Rapid weight gain Increasing fatigue Reduced ability to perform usual activities Early reporting can sometimes prevent a more serious deterioration.

Risk Factors

• Explanation: Several factors can increase the likelihood of developing heart failure. These include: High blood pressure Coronary artery disease Previous heart attack Diabetes Obesity or excess body weight High cholesterol Smoking or tobacco use Excessive alcohol consumption Certain heart valve diseases Abnormal heart rhythms Cardiomyopathy Family history of certain heart conditions Increasing age Chronic kidney disease Certain congenital heart conditions Having a risk factor does not mean that a person will definitely develop heart failure. | Name: Risk Factors

Faqs

Diagnosis

Diagnosing heart failure usually involves combining the patient's: Symptoms Medical history Physical examination Blood tests ECG findings Imaging studies Heart function measurements A doctor may listen to the heart and lungs, check for swelling and assess blood pressure, pulse and oxygen levels. The diagnosis is not made from one symptom or one test alone.

Overview

Heart failure is a long-term condition in which the heart cannot pump blood around the body as effectively as it should. This does not mean that the heart has stopped working. Instead, the heart may be too weak to pump enough blood, too stiff to fill properly, or both. Because the heart cannot meet the body's needs efficiently, fluid can build up in the lungs, legs, ankles and other parts of the body. This can lead to symptoms such as breathlessness, tiredness and swelling of the legs. Heart failure can develop gradually or sometimes appear suddenly. It can affect people of different ages, although it is more common in older adults. Heart failure is usually a long-term condition, but appropriate treatment, regular medical follow-up and lifestyle changes can help control symptoms, improve quality of life and reduce the risk of hospitalisation.

Symptoms

• Explanation: You may feel short of breath while walking, exercising or doing everyday activities. In more advanced cases, breathlessness may also occur while resting. | Name: Breathlessness
• Explanation: Some people find it difficult to breathe comfortably when lying flat and may need to sleep with their upper body raised. Persistent Tiredness Reduced blood flow to the body's tissues can contribute to tiredness, weakness and reduced ability to perform normal activities. | Name: Breathlessness When Lying Down
• Name: Swelling of the Legs or Ankles | Explanation: Fluid may accumulate in the lower legs and ankles, causing swelling.
• Name: Rapid Weight Gain | Explanation: A sudden increase in body weight over a short period can sometimes be caused by fluid retention rather than increased body fat.
• Explanation: Fluid accumulation in or around the lungs can cause coughing or wheezing. | Name: Persistent Cough or Wheezing
• Explanation: Some people may experience a racing, pounding or irregular heartbeat. | Name: Fast or Irregular Heartbeat
• Name: Reduced Exercise Tolerance | Explanation: Activities that were previously comfortable may become difficult because of breathlessness or fatigue.
• Name: Loss of Appetite or Feeling Full Quickly | Explanation: Fluid accumulation and changes in circulation can sometimes reduce appetite or cause a feeling of fullness.
• Name: Difficulty Concentrating | Explanation: Some people with heart failure may experience confusion or difficulty concentrating, particularly when the condition becomes more severe. Important: These symptoms can occur in many other conditions as well. They do not automatically mean that someone has heart failure.

Red Flags

• Explanation: Seek urgent medical attention if there is: Severe or rapidly worsening breathlessness Difficulty breathing while resting Severe chest pain or pressure Fainting or near-fainting New severe confusion Bluish or grey lips or skin Coughing up pink or frothy sputum Very rapid or severely irregular heartbeat with symptoms Sudden severe weakness If someone has severe chest pain, difficulty breathing, collapses or becomes unconscious, seek emergency medical help immediately. | Name: Heart failure can sometimes suddenly become worse and may require emergency treatment.

Prevention

Not every case of heart failure can be prevented, but controlling cardiovascular risk factors can significantly reduce the risk. Control Blood Pressure Regularly check your blood pressure and take prescribed medicines consistently. Manage Diabetes Good diabetes management can reduce cardiovascular and kidney complications. Control Cholesterol High cholesterol contributes to coronary artery disease, one of the important causes of heart failure. Avoid Tobacco Stopping smoking is one of the most important steps for cardiovascular health. Stay Active Regular physical activity supports cardiovascular fitness and overall health. Maintain a Healthy Weight Maintaining a healthy body weight can reduce cardiovascular risk. Treat Heart Problems Early Coronary artery disease, valve disease and abnormal heart rhythms should be appropriately evaluated and treated. Attend Regular Health Check-ups Early detection of high blood pressure, diabetes, cholesterol problems and cardiovascular disease can help prevent or delay heart damage.

Treatment

Heart failure treatment depends on its cause, type, severity, symptoms and other medical conditions. Treatment may include a combination of medicines, lifestyle changes, treatment of underlying diseases and, in selected patients, procedures or devices. Medicines Doctors may prescribe medicines that help: Reduce fluid overload Lower blood pressure and pressure on the heart Improve heart function Reduce the risk of hospitalisation Reduce cardiovascular complications Common medication groups used in appropriate patients include: ACE inhibitors ARBs ARNI Beta-blockers Mineralocorticoid receptor antagonists SGLT2 inhibitors Diuretics The choice depends on the patient's individual condition. Do not start, stop or change heart-failure medicines without medical advice. Treatment of the Underlying Cause If heart failure is related to coronary artery disease, valve disease, uncontrolled blood pressure, abnormal heart rhythm or another condition, treating that underlying problem may be an important part of management. Devices and Procedures Some patients may benefit from treatments such as: Pacemakers Implantable cardioverter-defibrillators (ICDs) Cardiac resynchronisation therapy Coronary procedures Heart valve procedures Advanced heart failure may require specialised treatment at an experienced cardiac centre.

Doctor Note

Heart failure does not mean that the heart has stopped working. It means that the heart is not functioning efficiently enough to meet the body's needs. Many people can live meaningful and active lives with heart failure when the condition is diagnosed early and managed appropriately. Treatment is not limited to one medicine. Effective management may involve medicines, control of blood pressure and diabetes, appropriate diet and physical activity, monitoring of symptoms and regular medical follow-up. One of the most important things patients can do is recognise a change in their usual condition. Increasing breathlessness, swelling or sudden weight gain can sometimes indicate worsening fluid retention and should not simply be ignored. Do not stop your heart medicines because you feel better, and do not change your dose without speaking with your doctor. With the right treatment and consistent follow-up, many patients with heart failure can improve their symptoms, reduce complications and maintain a better quality of life.

Investigations

• Explanation: An ECG records the electrical activity of the heart and can identify certain abnormal rhythms, previous heart damage and other cardiac abnormalities. Echocardiogram An echocardiogram (2D Echo) uses ultrasound to examine the heart's structure and function. It can assess: Heart chamber size Heart muscle movement Heart valves Pumping function Ejection fraction | Name: ECG / Electrocardiogram
• Explanation: Blood tests may help identify conditions contributing to symptoms and assess organs such as the kidneys and liver. Doctors may also use BNP or NT-proBNP blood tests when appropriate to support the evaluation of suspected heart failure. | Name: Blood Tests
• Name: Chest X-Ray | Explanation: A chest X-ray can provide information about the heart size and whether there are signs of fluid accumulation in the lungs.
• Explanation: These are particularly important because kidney function and electrolyte levels can be affected by both heart failure and its treatment. | Name: Kidney Function and Electrolytes
• Explanation: If coronary artery disease is suspected, additional testing may be required to assess blood flow to the heart. | Name: Coronary Evaluation
• Explanation: Depending on the suspected cause, a doctor may recommend cardiac MRI, stress testing, Holter monitoring, CT imaging or other specialised investigations. | Name: Other Tests