Heart failure When the heart isn’t keeping up with the body’s demands

What heart failure is

The name is misleading and frightening, and it’s worth clearing up first. Heart failure does not mean your heart is about to stop. It means your heart isn’t pumping or filling as efficiently as your body needs it to.

There are two broad types, and the distinction matters because treatment differs.

• Reduced ejection fraction

  The heart muscle has weakened and doesn’t squeeze strongly enough. Ejection fraction is the percentage of blood pushed out with each beat, normally above 50 percent. In this type it’s lower.

• Preserved ejection fraction

  The heart squeezes normally but has become stiff and doesn’t relax and fill properly between beats. Ejection fraction looks normal on the echo, but the heart still isn’t doing its job. This type is increasingly common, particularly with age, high blood pressure, and diabetes.

  Either way, blood backs up and fluid accumulates: in the lungs, producing breathlessness, and in the legs and abdomen, producing swelling.

Symptoms

The pattern that matters most is change over time. Being able to do less than you could six months ago, without another explanation, is worth investigating.

Causes

Heart failure is usually the end result of something else. Common causes include:

Identifying the underlying cause is a central part of the assessment, because treating it changes the outlook.

How it’s diagnosed

1. 01

   Echocardiogram

   The key test. This ultrasound of the heart measures ejection fraction, shows how the chambers are sized and how they move, checks valve function, and estimates pressures. It’s what determines which type of heart failure you have.

2. 02

   Blood tests

   BNP or NT-proBNP is released when the heart is under strain, and levels help confirm or rule out heart failure. Kidney function, electrolytes, blood count, thyroid, and iron studies are also checked.

   Iron deficiency is common in heart failure, and treating it improves symptoms.

3. 03

   ECG

   Records electrical activity and can show previous heart attack, rhythm problems, or thickening of the heart muscle.

4. 04

   Further testing when needed

   Depending on findings, this may include stress testing, coronary angiography, or cardiac MRI to identify the underlying cause.

How it’s treated

Treatment has improved dramatically over the past decade. Many people with heart failure live full, active lives, and for some the heart function recovers substantially.

• Medication

  For reduced ejection fraction there are four medication groups that together produce a large improvement in symptoms, hospitalizations, and survival: ACE inhibitors or ARNI, beta blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors. Getting all four in place at appropriate doses is a major focus of specialist care, and it’s typically done gradually over weeks to months. For preserved ejection fraction the evidence base is narrower, but SGLT2 inhibitors are now established, alongside treating blood pressure and other contributors.

• Diuretics

  Used to control fluid and relieve breathlessness and swelling. They make you feel better but don’t change the underlying disease, which is why they sit alongside the medications above rather than replacing them.

• Daily weights

  Weighing yourself at the same time each morning is one of the most useful things you can do. A gain of two to three pounds in a day, or five pounds in a week, usually means fluid is accumulating and needs attention before it becomes a hospital admission. Your team will give you a plan for what to do when that happens.

• Salt and fluid

  Reducing salt reduces fluid retention. Fluid restriction is sometimes advised but not for everyone. Follow the specific guidance you’re given rather than general advice.

• Exercise and cardiac rehabilitation

  Supervised exercise programs improve symptoms, capacity, and quality of life. Referral to cardiac rehab is a standard part of care.

• Devices and advanced therapies

  Some people benefit from an implanted defibrillator or a specialized pacemaker that resynchronizes the heart’s contraction. These are considered when medication alone isn’t sufficient and specific criteria are met.

• Treating the cause

  Opening blocked arteries, replacing a failing valve, controlling atrial fibrillation, or managing diabetes and blood pressure can substantially improve heart function.

What to expect at your appointment

Your first visit is a consultation with a cardiologist, lasting roughly an hour.

That practical detail is often more informative than any single test.

Testing may be arranged the same day or shortly afterward. A letter goes back to your referring doctor, usually within 1 to 7 days.