Published: 14/05/2025
Edited by: Jessica Wise on 20/05/2025

Heart failure is a serious condition where the heart's ability to pump blood effectively is impaired, leading to a variety of symptoms and, if left untreated, causing significant health complications. It can be fatal. In this article, consultant cardiologist Dr Alex Simms explains what heart failure is, its symptoms, how it develops, and the approaches to managing and treating it.

What is heart failure?

Heart failure occurs when the heart is unable to pump blood efficiently to meet the body’s needs, eventually leading to organ shutdown. This can happen due to the heart muscle becoming weak or stiff, which hinders its ability to contract and relax properly. The condition does not mean the heart has stopped working, but rather that its function is impaired.

Symptoms of heart failure can vary but commonly include:

Shortness of breath, especially with exertion or when lying down,
Fatigue and dizziness
Swollen ankles or legs
Rapid or irregular heartbeat
Coughing

Patients may also experience fluid retention, which can lead to weight gain.

In some cases, heart failure can worsen suddenly, requiring emergency treatment. Symptoms such as severe breathlessness, chest pain, fainting, or confusion may indicate an urgent situation. Emergency services can administer oxygen and medications to stabilise the condition, and hospitalisation may be required to manage fluid levels and monitor the heart’s function.

It is crucial to avoid delaying treatment for a potential heart failure emergency, as this can lead to further complications, including organ damage or even death.

How does heart failure occur?

Heart failure usually develops as a result of damage to the heart, which can happen for several reasons. Common causes include coronary artery disease, where the arteries supplying blood to the heart become narrowed or blocked, high blood pressure (hypertension), which forces the heart to work harder, and arrhythmias, which strain the heart muscles and cause the different areas of the heart to fall out of sync. Over time, this extra workload can weaken the heart muscle. Other factors, such as heart valve problems, diabetes, heart attacks, genetic and congenital heart defects, can also increase the risk of developing heart failure.

Certain lifestyle factors and conditions can increase the likelihood of heart failure. For example, smoking, excessive alcohol consumption, a poor diet, and lack of physical activity are all risk factors. Additionally, conditions like diabetes, sleep apnoea, and obesity are linked to a higher risk of heart failure. Men, older individuals, and those with a family history of heart disease are also at greater risk.

Diagnosis of heart failure

The diagnosis of heart failure begins with a detailed medical history and physical examination. The doctor will ask about symptoms and assess risk factors such as blood pressure levels, lifestyle habits, and any history of heart disease. To confirm the diagnosis, the doctor may order several tests, including:

Blood tests: These can help determine if there is an underlying condition, such as kidney disease, contributing to heart failure.
B-type natriuretic peptide (BNP) blood test: Elevated levels of this hormone can indicate heart failure.
Electrocardiogram (ECG): An ECG records the heart’s electrical activity and can identify irregular heart rhythms.
Echocardiogram: An ultrasound of the heart which provides detailed images of the heart’s size, shape, and pumping ability, and helps assess how well the heart valves are functioning.
Chest X-ray: This can show whether the heart is enlarged or if there is fluid in the lungs.

Treatment for heart failure

Heart failure cannot be definitely ‘cured’, but with the right treatment, it is possible to manage the condition and improve quality of life. Treatment options depend on the severity of the condition, and in most cases, treating the underlying issue can significantly lower the risks of heart failure. Common treatments include:

Medications: These may include diuretics to reduce fluid buildup, ACE inhibitors/Angiotensin Receptor Neprilysin inhibitors, beta-blockers and/or mineralocorticoid receptor antagonists to help the heart pump more effectively, and blood thinners to reduce the risk of blood clots.
Lifestyle changes: A heart-healthy diet, regular exercise, and weight management are all important aspects of managing heart failure.
Surgery or devices: In some cases, surgery to repair damaged heart valves or the use of devices such as pacemakers or implantable cardioverter defibrillators (ICDs) may be necessary.

The prognosis for heart failure varies. With early diagnosis and proper treatment, many people with heart failure can lead relatively normal lives. However, heart failure can be a progressive condition, and regular follow-up with a healthcare provider is essential for managing the disease effectively.

How to avoid heart failure

Medications: These may include diuretics to reduce fluid buildup, ACE inhibitors/Angiotensin Receptor Neprilysin inhibitors, beta-blockers and/or mineralocorticoid receptor antagonists to help the heart pump more effectively, and blood thinners to reduce the risk of blood clots.
Lifestyle changes: A heart-healthy diet, regular exercise, and weight management are all important aspects of managing heart failure.
Surgery or devices: In some cases, surgery to repair damaged heart valves or the use of devices such as pacemakers or implantable cardioverter defibrillators (ICDs) may be necessary.

Cardiology in Leeds