Heart failure
Heart failure is the state in which the heart stops pumping as much blood as the body needs.
On this page
Medicines commonly prescribed for Heart failure
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 40 mgActive substance: furosemideManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: TABLET, 2.5 mgActive substance: ramiprilManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 40 mg furosemideActive substance: furosemideManufacturer: Sandoz Farmaceutica S.A.Prescription required
Heart failure is the state in which the heart stops pumping as much blood as the body needs. The name frightens people more than it should: it does not mean the heart is about to stop. It means the pump is labouring — either the muscle has weakened and ejects too little blood, or it has stiffened and fills poorly between beats. The upshot is similar either way: blood backs up on the approach to the heart, fluid seeps into the lungs and the legs, and the muscles and the brain go short. Clearing the condition away entirely is rarely possible, but with modern drug combinations many people live for years and decades while keeping up their ordinary lives.
Signs that are easily blamed on age
The treacherous part of heart failure is that its earliest signs look like the ordinary tiredness of someone getting older. The most typical:
- breathlessness — at first climbing stairs, later walking on the flat and, in severe cases, at rest as well;
- an inability to lie flat: a second pillow appears, and at night the person wakes short of air and has to sit up to catch their breath;
- swelling of the ankles and lower legs by evening, with a sock leaving a deep mark; in someone confined to bed the fluid settles in the lower back and abdomen;
- tiredness that rest does not fix, and the sense that even a light effort drains you;
- rapid weight gain — a kilogram or two over a couple of days, which is retained fluid, not fat;
- a dry nagging cough, worse lying down, sometimes with wheeze;
- a bloated abdomen, heaviness under the right ribs, appetite gone;
- a fast or irregular heartbeat;
- dizziness and, in older people, confusion and slowed thinking.
The picture builds up in different ways: over weeks and months in the chronic form, and within hours in the acute one, when the lungs fill with fluid quickly.
When an ambulance is needed
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 applies) if:
- breathing has suddenly become hard at rest, the person is gasping, cannot speak in full sentences and has to stay sitting upright;
- the breathing sounds bubbling, or there is frothy, sometimes pink-tinged sputum;
- the lips, face or fingers have turned blue;
- there is pressure or burning in the chest, pain spreading to the arm, neck or jaw, with cold sweat and nausea;
- the person has lost consciousness;
- the heartbeat has become very fast or very slow and comes with weakness and vision greying out.
It is worth seeing a doctor the same day, though without an ambulance, if the weight has climbed by two kilograms or more over two or three days, if the swelling has risen above the ankles, if breathlessness has clearly worsened, or if a night had to be spent sleeping upright. These are warnings that the condition is slipping out of control, and adjusting treatment in time is usually enough to avoid a hospital admission.
What leads to heart failure
Most often several causes have accumulated in one person and have been working together for years:
- coronary artery disease and a previous heart attack — part of the muscle is replaced by scar and stops contracting;
- long-standing high blood pressure — the heart pumps against resistance for years, the wall thickens and loses its give;
- valve disease;
- rhythm disorders, above all atrial fibrillation;
- cardiomyopathies, including inherited ones and those linked to alcohol;
- diabetes and obesity;
- congenital heart defects.
Some causes particularly matter because they have treatment of their own: thyroid disease, severe anaemia, cardiac amyloidosis, myocarditis, pulmonary hypertension, muscle damage from certain chemotherapy drugs, and cardiomyopathy arising around childbirth. When heart failure turns up in a young person or develops quickly, these possibilities are worked through first.
How the diagnosis is reached
It starts with the history and the examination: the doctor listens to the lungs and the heart, looks at the neck veins and the swelling, and weighs the patient. Then comes a blood test for natriuretic peptides, the substance the heart releases when overloaded. A normal result makes the diagnosis unlikely, which is valuable in itself — it frees everyone to look for another cause of the breathlessness.
The key test is the echocardiogram. It shows how forcefully the left ventricle contracts and what state the valves and walls are in. This is where the ejection fraction is measured, the share of blood the ventricle pushes out with each contraction, and it steers the choice of treatment: a reduced fraction responds to one set of drugs, a preserved one to another.
The picture is filled in by an electrocardiogram, a chest radiograph and blood tests covering kidney function, electrolytes, iron and thyroid function. Breathing tests help separate cardiac breathlessness from lung disease, and where things remain unclear a cardiac magnetic resonance scan or coronary angiography follows.
Four classes: how far a person can go
Severity is described in functional classes, which say nothing about how the heart looks on a scan and everything about what the person can actually do:
- class one — ordinary activity is tolerated without limitation;
- class two — comfortable at rest, but usual exertion brings on breathlessness or fatigue;
- class three — symptoms appear with slight effort, such as dressing or walking across the flat;
- class four — discomfort even at rest, and any movement worsens the breathlessness.
The class is neither a verdict nor a fixed figure: with treatment it often improves. Doctors use it to judge how intensive the therapy should be and when to raise the question of devices or surgery.
How it is treated
The aim is to ease symptoms, slow the deterioration of the muscle and cut the number of hospital admissions. The backbone is a set of drug families prescribed together, with doses raised gradually: agents that widen the vessels and unload the heart (angiotensin converting enzyme inhibitors or angiotensin receptor blockers, plus the combined preparation with a neprilysin inhibitor), beta blockers, mineralocorticoid receptor antagonists, and the sodium-glucose cotransporter inhibitors, which arrived from diabetes care and turned out to help the heart regardless of blood sugar. Diuretics are prescribed alongside: they do nothing for the muscle itself, but they clear the congestion and give breathing back.
Getting the combination right takes weeks: doses go up in steps, with blood tests between steps, because these drugs act on blood pressure, potassium and kidney function. Side effects — a dry cough, dizziness, weakness — are usually settled by switching to another drug within the same family. Stopping treatment because you feel better is a mistake: feeling better is what the treatment is doing.
For some forms, devices help: a pacemaker when the rhythm is too slow, a resynchronisation device that makes the ventricular walls contract together, and an implantable defibrillator against life-threatening arrhythmias. Where the cause can be corrected, surgery is discussed: repairing or replacing a valve, restoring coronary flow with a stent or a bypass. In severe cases, once medication has been exhausted, the conversation turns to mechanical circulatory support and heart transplantation.
What is in the patient's own hands
The patient's part counts for more here than in almost any other heart condition, and a handful of habits genuinely change the course:
- weigh yourself every morning, before breakfast and after the toilet, and write it down: weight is the most sensitive detector of fluid building up;
- cut down on salt and, if your doctor advises it, on the volume of fluid over the day;
- stop smoking outright rather than "gradually", and take help if going it alone does not work;
- keep alcohol low, and give it up entirely if the heart failure is related to it;
- keep moving regularly and within your limits: supervised cardiac rehabilitation programmes improve both wellbeing and exercise tolerance;
- have the influenza and pneumococcal vaccinations offered under your national schedule — a chest infection is a classic trigger for a flare;
- run any new medicine past your doctor, over-the-counter ones included: anti-inflammatory painkillers hold on to fluid and work against the treatment.
The diagnosis often lands hard on the mood. Fear, anxiety and low spirits are an ordinary reaction, not a weakness. It is worth raising with the doctor, because low mood also worsens the illness itself: people stop taking their tablets and stop moving. Support groups and talking to others with the same diagnosis both help.
Online consultation
In an online consultation an Oladoctor doctor helps you get your bearings: listens to your symptoms, reviews the echocardiogram reports and blood results you send, explains what your ejection fraction and functional class mean, goes through your medication schedule and points out which signs call for prompt attention.
The format suits the questions that can be planned: how to keep a weight diary, what to do about swollen legs, whether flying is safe, how to combine this treatment with other conditions, what to ask the cardiologist at the face-to-face appointment. For sudden severe breathlessness, chest pain, blue lips or loss of consciousness an online appointment is the wrong route — that calls for an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Heart failure
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Heart failure
Discuss your symptoms and possible next steps for Heart failure with a doctor online.
