Heart Failure
The heart cannot pump efficiently enough to meet the body's needs.
Overview
Heart failure is a chronic condition where the heart's pumping or filling function is impaired. It causes breathlessness, fatigue and fluid retention. Modern treatment significantly improves symptoms and survival.
Symptoms
- • Breathlessness on exertion or lying flat
- • Waking at night short of breath
- • Ankle and leg swelling
- • Persistent fatigue
- • Rapid weight gain (fluid)
Risk factors
- • Coronary artery disease, previous heart attack
- • Long-standing hypertension
- • Diabetes
- • Valvular heart disease
- • Excess alcohol, certain chemotherapies
Causes
- • Reduced ejection fraction (HFrEF) — weakened pumping muscle
- • Preserved ejection fraction (HFpEF) — stiff heart muscle
- • Valve disease, arrhythmia, cardiomyopathy
🚨 Red flags — seek urgent care
- • Severe breathlessness at rest
- • Chest pain with breathlessness
- • Confusion, cold clammy skin, very low BP
- • Coughing pink frothy sputum
When to seek care
- • New or worsening breathlessness
- • Weight gain >2 kg in 3 days
- • Increasing swelling
Diagnosis
- • Clinical assessment (breathlessness, fatigue, oedema) plus NT-proBNP — values >2,000 ng/L urgent (within 2 weeks)
- • Transthoracic echocardiogram to classify LVEF: reduced (≤40%), mildly reduced (41–49%), preserved (≥50%)
- • ECG, chest X-ray, U&E, FBC, TFTs, ferritin, HbA1c, lipids
- • Consider ischaemia work-up (angiography or functional imaging) where appropriate
Treatment
- • HFrEF four pillars: ARNI (or ACEi/ARB), beta-blocker, MRA, SGLT2 inhibitor
- • Loop diuretic (furosemide) for congestion — titrate to dry weight
- • Devices: CRT if QRS ≥130 ms and LVEF ≤35%; ICD for primary prevention in selected patients
- • HFpEF: SGLT2 inhibitor, diuretics for congestion, aggressive comorbidity control
- • Cardiac rehab, fluid/salt advice, vaccination (influenza, pneumococcus, COVID-19)
Prevention
- • Control blood pressure, diabetes and cholesterol
- • Treat coronary disease promptly
- • Avoid excessive alcohol and cardiotoxic chemotherapy where possible
- • Manage atrial fibrillation rate and rhythm
Complications
- • Acute decompensation and hospitalisation
- • Arrhythmias (atrial fibrillation, ventricular tachycardia)
- • Renal impairment (cardiorenal syndrome)
- • Thromboembolism
- • Cachexia and progressive functional decline
Education & self-care
Daily weights, low salt diet, fluid awareness, and strict medication adherence are the backbone of self-management. Cardiac rehabilitation improves both symptoms and mortality.
Frequently asked questions
Can heart failure be reversed?
Some causes are reversible (valve repair, rhythm control). Most patients need lifelong therapy to slow progression and prevent admissions.
Why daily weights?
A sudden gain often signals fluid retention before symptoms worsen — early action prevents hospitalization.
What is the difference between HFrEF and HFpEF?
Heart failure with reduced ejection fraction (HFrEF) means the pumping function is weakened. Preserved ejection fraction (HFpEF) means pumping is normal but the heart is stiff and does not fill well.
Why so many tablets?
Four cornerstones — ACE inhibitor/ARNI, beta-blocker, MRA and SGLT2 inhibitor — each independently reduce death and admissions in HFrEF. Used together, they roughly halve the risk of cardiac death.
Should I weigh myself daily?
Yes. A gain of more than 1.5 kg in 2 days, or 2 kg in a week, often signals fluid retention and is a cue to follow your action plan or contact your heart failure nurse.