Heart Failure: Symptoms, Causes, Tests and Treatment Options

The name heart failure can sound frightening, but it does not mean your heart has stopped or is about to stop. This article explains what it does mean, based on the NHS and the US CDC, and what care may involve.

What is heart failure?

The NHS says heart failure means the heart cannot pump blood around the body as effectively as it should. The CDC explains that the heart cannot pump enough blood and oxygen to support the body's other organs, but that it has not stopped beating. The NHS says there is no cure, but treatment and lifestyle changes can help.

Symptoms

The NHS lists these symptoms:

• Breathlessness during everyday activity or when lying down
• Feeling more breathless than expected when exercising
• Weakness, light-headedness, dizziness or unusual tiredness, especially after activity
• Swelling in the feet, ankles, legs or tummy, or feeling bloated
• Sudden weight gain
• Coughing at night, or coughing up frothy pink phlegm

The CDC lists similar signs, including shortness of breath in daily activities, trouble breathing when lying down, weight gain with swelling and feeling tired or weak.

Causes and risk factors

The NHS says heart failure can come on suddenly, for example after a heart attack or an infection, or gradually from long-term strain on the heart such as high blood pressure or coronary heart disease. Other causes include heart valve disease, cardiomyopathy, heart rhythm problems, chronic kidney disease, anaemia, too much iron in the blood and thyroid problems.

Groups at higher risk, according to the NHS, include people aged 65 or over, people who are overweight or obese, smokers, people who drink heavily and cocaine users. The CDC adds diabetes and coronary artery disease, and says smoking, a diet high in fat, cholesterol and salt, inactivity and too much alcohol raise risk further.

How is it diagnosed?

The NHS says a doctor checks how well the heart and lungs are working using blood and urine tests, an ECG, imaging such as a chest X-ray, echocardiogram or MRI, and lung function tests. A referral to a heart specialist (cardiologist) is typical. The doctor explains the type of heart failure, meaning why the heart is not pumping well, and the stage, meaning how severe symptoms are.

Treatment options

Treatment aims to ease symptoms and slow progression. The doctor decides what is suitable for each person. The NHS describes:

• Medicines: such as diuretics to reduce fluid build-up, medicines that widen blood vessels, and beta blockers to slow the heart.
• Surgery or devices: to improve blood flow, repair or replace heart valves, or fit a pacemaker or implantable cardioverter defibrillator. For severe cases, a heart pump or a heart transplant may be offered.
• Cardiac rehabilitation: offered to everyone diagnosed, covering safe exercise, lifestyle advice and peer support.

The CDC lists lowering salt in the diet, limiting fluids when advised, daily physical activity and tracking symptoms each day to share with your care team. It says early diagnosis and treatment can improve quality and length of life.

When to see a doctor

The NHS says to see a GP or doctor about any symptoms of heart failure. Get an urgent appointment or call a health helpline if you feel breathless lying down or during everyday activity, cough up frothy pink phlegm, or gain weight suddenly.

Emergency signs, according to the NHS, are severe breathing difficulty such as gasping, choking or being unable to speak fully, pale, blue or grey lips or skin (on brown or black skin, check the palms, soles or gums), or someone who has passed out and is not responding normally. Do not drive yourself to hospital.

In an emergency, call your local emergency number (112 in India, 911 in the United States).