Heart Failure

What is heart failure?

From: MedlinePlus, National Library of Medicine

Heart failure means that your heart can't pump enough oxygen-rich blood to meet your body's needs. Heart failure doesn't mean that your heart has stopped or is about to stop beating. But without enough blood flow, your organs may not work well, which can cause serious problems.

Heart failure can affect one or both sides of your heart:

• With right-sided heart failure, your heart is too weak to pump enough blood to your lungs to get oxygen.
• With left-sided heart failure, your heart can't pump enough oxygen-rich blood out to your body. This happens when the left side of your heart becomes either: Too weak to pump enough blood. Too thick or stiff to relax and fill with enough blood.

Left-sided heart failure is more common than right-sided heart failure.

What causes heart failure?

From: MedlinePlus, National Library of Medicine

Heart failure can start suddenly after a medical condition or injury damages your heart muscle. But in most cases, heart failure develops slowly from long-term medical conditions.

Conditions that can cause heart failure include:

• Arrhythmia (a problem with the rate or rhythm of your heartbeat)
• Cardiomyopathy
• Congenital heart defects or other types of heart diseases that you are born with
• Coronary artery disease
• Endocarditis
• Heart attack
• Heart valve diseases
• High blood pressure
• A blood clot in your lung
• Diabetes
• Certain severe lung diseases, such as COPD (chronic obstructive pulmonary disease)
• Obesity

Over time, left-sided heart failure can lead to right-sided heart failure.

Who is more likely to develop heart failure?

From: MedlinePlus, National Library of Medicine

Heart failure can happen at any age. It happens to both men and women, but men often develop it at a younger age than women. Your chance of developing heart failure increases if:

• You're 65 years old or older. Aging can weaken and stiffen your heart muscle.
• Your family health history includes relatives who have or have had heart failure.
• You have changes in your genes that affect your heart tissue.
• You have habits that can harm your heart, including: Smoking Eating foods high in fat, cholesterol, and sodium (salt) Having an inactive lifestyle Alcohol use disorder (AUD) Illegal drug use
• You have other medical conditions that can affect your heart, including: Any heart or blood vessel conditions, including high blood pressure Serious lung diseases Infection, such as HIV or COVID-19 Obesity Diabetes Sleep apnea Chronic kidney disease Anemia Thyroid disease Iron overload disease Cancer treatments that can harm your heart, such as radiation and chemotherapy
• You are African American. African Americans are more likely to develop heart failure and have more serious cases at younger ages than people of other races. Factors such as stigma, discrimination, income, education, and geographic region can also affect their risk of heart failure.

What are the symptoms of heart failure?

From: MedlinePlus, National Library of Medicine

The symptoms of heart failure depend on which side of your heart is affected and how serious your condition has become. Most symptoms are caused by reduced blood flow to your organs and fluid buildup in your body.

Fluid buildup happens because the flow of blood through your heart is too slow. As a result, blood backs up in the vessels that return the blood to your heart. Fluid may leak from the blood vessels and collect in the tissues of your body, causing swelling (edema) and other problems.

Symptoms of heart failure may include:

• Feeling short of breath (like you can't get enough air) when you do things like climbing stairs. This may be one of the first symptoms you notice.
• Fatigue or weakness even after rest.
• Coughing.
• Swelling and weight gain from fluid in your ankles, lower legs, or abdomen (belly).
• Difficulty sleeping when lying flat.
• Nausea and loss of appetite.
• Swelling in the veins of your neck.
• Needing to urinate (pee) often.

At first you may have no symptoms or mild symptoms. As the disease gets worse, your symptoms will usually bother you more.

What other problems does heart failure cause?

From: MedlinePlus, National Library of Medicine

Fluid buildup and reduced blood flow to your organs can lead to serious problems, including:

• Breathing problems from fluid in and around your lungs (also called congestive heart failure)
• Kidney or liver damage, including cirrhosis
• Malnutrition if fluid buildup makes eating uncomfortable or if your stomach doesn't get enough blood flow to digest food properly
• Other heart conditions, such as irregular heartbeat and sudden cardiac arrest
• Pulmonary hypertension

How is heart failure diagnosed?

From: MedlinePlus, National Library of Medicine

To find out if you have heart failure, your health care provider will

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart failure
• Do a physical exam
• Likely run heart tests and blood tests, including a brain natriuretic peptide (BNP) test

What are the treatments for heart failure?

From: MedlinePlus, National Library of Medicine

Your treatment will depend on the type of heart failure you have and how serious it is. There's no cure for heart failure. But treatment can help you live longer with fewer symptoms.

Even with treatment, heart failure usually gets worse over time, so you'll likely need treatment for the rest of your life.

Most treatment plans include:

You may need heart surgery if:

As part of your treatment, you'll need to pay close attention to your symptoms, because heart failure can worsen suddenly. Your provider may suggest a cardiac rehabilitation program to help you learn how to manage your condition.

• Taking medicine
• Eating less sodium and drinking less liquid to control fluid buildup
• Making other changes, such as quitting smoking, managing stress, and getting as much physical activity as your provider recommends
• Treating any conditions that may make heart failure worse
• You have a congenital heart defect or damage to your heart that can be fixed.
• The left side of your heart is getting weaker and putting a device in your chest could help. Devices include: An implantable cardioverter defibrillator. A biventricular pacemaker (cardiac resynchronization therapy). A mechanical heart pump (a ventricular assist device (VAD) or a total artificial heart).
• Your heart doctor recommends a heart transplant because your heart failure is life-threatening and nothing else is helping.

Can heart failure be prevented?

From: MedlinePlus, National Library of Medicine

You may be able to prevent or delay heart failure if you:

• Work with your provider to manage any health conditions that increase your risk of developing heart failure
• Make healthy changes in your eating, exercise, and other daily habits to help prevent heart disease

Which doctor should you see?

The suggested department for discussing Heart Failure is Cardiology, with a cardiologist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Is the main concern heart structure, rhythm, circulation or another cause?
• Which symptoms should change the timing of follow-up?
• How would a proposed investigation change the care plan?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.