What is heart failure?

Medicines for heart failure

What to do when you feel sick

Mental and emotional health

How does heart failure make you feel

Things to do to make you feel better

Heart failure and physical activity

Heart failure is a condition where your heart isn’t pumping blood to the rest of your body as well as it should. If your heart is damaged or not pumping properly, it can become enlarged, weak or stiff.

If you suffer from heart failure, your muscles and organs receive less oxygen and nutrients. This can make you feel dizzy and tired. Extra fluid can build up in your body, which can make you feel short of breath and cause swelling in your legs or abdomen.

What are the different types of heart failure?

Heart failure can occur in the left, right or both sides of the heart. Heart failure can also be grouped by an important measure known as the ejection fraction – which measures how well your heart is pumping blood, and it is used to guide treatment of heart failure.

The ejection fraction measures the amount of blood your heart pushes in and out with each heartbeat. In a healthy heart, the ejection fraction is 50% or higher – meaning that the heart is pumping out at least half the volume of blood that fills the chambers with each beat.

In heart failure, you can either have a reduced rejection fraction, or a preserved ejection fraction.

Heart failure with reduced ejection fraction (HFrEF, or systolic heart failure)

In heart failure with reduced ejection fraction, your heart muscle is weakened and does not pump enough blood to meet the needs of your body. When your heart muscle struggles to properly pump blood to your body, fluid begins to build up in your body’s blood vessels.

As more fluid builds up, it can leak into the space around your lungs and other areas of your body, causing shortness of breath and swelling. When your heart doesn’t pump well, your muscles and organs receive less oxygen and nutrients, which can make you feel dizzy and tired.

Heart failure with preserved ejection fraction (HFpEF, or diastolic heart failure)

In heart failure with preserved ejection fraction, your heart muscle can pump blood to the rest of your body, but the heart muscle does not stretch well. When your heart muscle does not stretch, the pressure inside your heart can build up. This can cause fluid to leak into the space around your lungs and other areas of your body, causing shortness of breath and swelling.

There are other types of heart failure that cause similar symptoms, such hypertrophic obstructive cardiomyopathy and right ventricular failure. Talk to your doctor about your heart failure and what it means for your treatment and management.

What are the causes of heart failure?

The most common causes of heart failure are heart attack and coronary heart disease, but there are numerous other causes. Many people who have heart failure live with other long-term conditions, such as lung disease or diabetes.

Heart failure can develop as the result of other conditions which have damaged, weakened or stiffened your heart, such as: 

Old age
Chronic conditions – such as diabetes, HIV and thyroid conditions
Coronary heart disease and heart attack 
Damage to the heart muscle (cardiomyopathy) – causes can include infection, alcohol abuse and certain medications
Faulty heart valves (heart valve disease)
Heart rhythm problems (arrhythmias)
Heart conditions you're born with (e.g. congenital heart disease)
High blood pressure (hypertension)
Inflammation of the heart muscle (myocarditis)
Pregnancy – which forces your heart to work harder than it should

Work with your professional healthcare provider to understand why you have developed heart failure and how you can manage your symptoms and live a quality life.

What are the signs and symptoms of heart failure?

Heart failure causes symptoms because of the reduced supply of oxygen and nutrients to your muscles and organs, and the build-up of fluid in your body (i.e. congestion). You may feel one or many of these common heart failure symptoms:

Bloated stomach 
Chest pain
Coughing 
Difficulty with breathing or shortness of breath, especially when doing physical activity
Discomfort when lying flat, due to difficulty with breathing
Dizziness 
Heart pounding or racing (i.e. palpitations) 
Loss of appetite or nausea
Swollen ankles or legs (i.e. oedema)
Tiredness
Waking overnight due to difficulty with breathing
Weakness

What should you do if your symptoms get worse?

If your symptoms of heart failure get worse, you need to see your health care team quickly. If you see your doctor early, you may stop your heart failure symptoms from becoming worse and this could help you avoid the need for a long hospital stay.

How can you prevent heart failure?

The best way to prevent heart failure is to prevent coronary heart disease and heart attack. If you have had a heart attack it’s important to manage your risk factors and follow your treatment plan, including regular check-ups with your health care team.

However, sometimes heart failure is not preventable, and you may develop symptoms because of another condition, genes or an unknown cause. Work with your health team to understand why you have developed heart failure and how you can manage your symptoms and live a quality life.

How is heart failure diagnosed?

To diagnose heart failure, your doctor will review your symptoms, ask about a family history of heart disease and conduct a physical examination. Your doctor may recommend you have some tests including:

Blood tests
Echocardiogram (ECHO) 
Electrocardiogram (ECG)
Chest X-ray

How is heart failure treated?

Heart failure is a long-term condition. Often it cannot be cured and needs lifelong management. However, treatment can help you feel better, stay out of hospital and live a longer and healthier life.

Your doctor will treat your heart failure with medicines, which will make it easier for your heart to pump blood, improve symptoms and help to keep you out of hospital. Medicines to treat heart failure can help you live longer and stay out of hospital. Heart failure medicines belong to the following groups.

Angiotensin Converting Enzyme inhibitors (ACE inhibitors)

ACE inhibitors is a medication that dilates your blood vessels and reduces strain on your heart, making it easier for your heart to pump blood.

Angiotensin receptor blockers (ARB)

ARBs work in the same way as ACE inhibitors

ARBs are sometimes used instead of ACE inhibitors if you get side effects (e.g. a persistent cough) from taking ACE inhibitors.

Beta blockers

Beta blockers help your heart pump better by pumping slower and stronger.

Mineralocorticoid Receptor Antagonists (MRAs or aldosterone blockers)

MRAs block the effects of the hormone aldosterone, helping to control your blood pressure and reduce the changes that occur to your heart muscle as a result of damage.

Diuretics

Diuretics help get rid of extra fluid from your body, including your lungs, feet, legs and around your middle.

Diuretics help you to feel better by reducing swelling and making it easier to breath.

Angiotensin receptor-neprilysin inhibitor (ARNIs)

ARNIs are used instead of ACE inhibitors or ARBS if your doctor feels your heart failure medicines aren’t working well enough

It is very important to take all your medicines every day, as your doctor instructs. Heart failure medicines are usually long-term therapies and your doctor may increase the dose of your medicines even if you feel well. Do not stop taking your heart failure medicines without discussing with your doctor or pharmacist.

Your doctor may recommend you have a procedure to insert an automated implantable cardioverter defibrillator (ICD).

Implantable cardioverter defibrillator (ICD)

An ICD is a small box that is inserted under the skin which continuously monitors your heart and can correct dangerous abnormal heart rhythms if needed.

Pacemakers are also sometimes used in heart failure to help reduce symptoms when the left and the right side of the heart do not beat together.

Pacemakers

A pacemaker is a small implantable device that electrically stimulates the heart to maintain a regular heart rhythm.

Living well with heart failure

Heart failure is a serious chronic condition that needs lifelong management. The good news is that treatment can help you feel better, stay out of hospital and live a longer and healthier life.

Treatment for heart failure is rarely a cure, so it’s important to speak to your loved ones and health care team about your end of life wishes. Letting your support network know what is important to you and which treatments you’re OK with is important in managing your health and quality of life. You can write down these wishes with your health care team in an advanced care directive or plan.

Download our Living well with heart failure booklet