Understanding heart failure

Heart failure happens when your heart can’t pump blood or relax as well as it should. The good news is that there’s a lot you can do to manage heart failure. Find out what you can do to feel better and stay out of hospital.

The term heart failure can be frightening, but it doesn’t mean that your heart is going to stop working. It means that your heart muscle isn’t pumping blood around your body, or relaxing, as well as it should.

Although heart failure can’t usually be cured, there’s a lot you can do to manage it. By taking your medication, following a heart failure action plan and making some lifestyle changes, you can feel better, stay out of hospital and continue to lead an active, fulfilling life.

What is heart failure?

Heart failure is a long-term heart condition which occurs when your heart isn’t pumping or relaxing as well as it should.

When you have heart failure, the heart muscle becomes:

• weak and floppy or
• thickened and stiff.

This means the heart can’t pump or fill like normal, making it harder for the heart to pump blood around the body.

What causes heart failure?

Heart failure happens when the heart muscle has been damaged in some way. Common causes of this damage include:

• heart attack or angina
• high blood pressure
• heart rhythm problems such as atrial fibrillation
• cardiomyopathy (heart muscle disease)
• heart valve problems
• drinking too much alcohol
• virus
• thyroid disease.

Symptoms of heart failure

When your heart can’t pump or relax effectively, excess fluid may build up in your lungs, legs and other parts of your body.

This fluid build-up can lead to a range of symptoms including:

• swelling in the feet, ankles, legs and around your tummy or back
• shortness of breath when active or when lying down
• need for more pillows at night or to sleep upright
• coughing or wheezing
• extreme tiredness
• loss of appetite.

Heart failure tests

Your doctor may order some heart tests to confirm that you have heart failure and to help identify how well your heart is functioning. These tests may include:

• blood tests to indicate heart damage, find out how other organs are functioning and rule out any other health conditions with similar symptoms
• electrocardiogram (ECG) to check your heart’s electrical conduction system
• chest X-ray to show fluid build-up and rule out lung conditions with similar symptoms
• echocardiogram (echo) scan to show the heart's movement and how well it’s pumping.

What is ejection fraction?

Your doctor might discuss your ejection fraction with you.

An echocardiogram (echo) is the most common test used to measure ejection fraction. Other tests that can measure ejection fraction include cardiac catheterisation, MRI (magnetic resonance imaging), CT (computed tomography), and a nuclear medicine scan.

This video explains what ejection fraction is, how it’s measured, and what normal, borderline, and reduced levels mean. It also talks about the common symptoms for each level.

Heart failure treatment

In most cases heart failure can’t be cured, however, there’s a lot you can do to manage the condition and keep yourself well.

Medication will be an important part of your heart failure treatment. Some people may require a small device, such as a pacemaker implanted under the skin to help control their heart rate and rhythm and improve how well the heart functions.

Lifestyle and condition management are also very important for treating your heart failure.

Medication

Medication is a really important part of your heart failure treatment. Taking the right pills at the right time can:

• improve your symptoms and make you feel better
• improve your heart function
• keep you well and out of hospital
• help you to live longer.

Your medication plan will be personalised for you and specific pills will be introduced at different stages. Medications will be started at low doses and gradually increased until the right dose is reached.

It’s really important that you keep taking your medication even when you start to feel better. Heart medications aren’t one-off prescriptions and you need to stay on them in order to stay well and out of hospital.

You will probably be on one or more of the following types of medication:

ACE inhibitor or ARB

These medications help your blood vessels relax, lowering your blood pressure. This makes it easier for your heart to pump blood around your body.

Common ACE inhibitors (angiotensin-converting enzyme inhibitors) include:

• cilazapril
• enalapril
• quinapril
• lisinopril
• perindopril
• trandolapril
• captopril.

Common ARBs (angiotensin receptor blockers) include:

• candesartan
• losartan.

Read more about ACE inhibitors and ARBs and find the common brand names in our medication section.

Aldosterone antagonist

Aldosterone antagonists reduce fluid and sodium build-up in your blood. This helps to decrease the volume of blood that your heart needs to pump.

Common aldosterone antagonists include:

• spironolactone
• eplerenone (also called INSPRA).

ARNI

These medications combine two medicines that relax blood vessels and reduce the amount of water you have in the body. This reduces the strain on your heart. Currently, the only one available is Entresto.

Read more about ARNIs in our medication section.

Beta blocker

Beta blockers steady your heart rate and rhythm and help lower your blood pressure. Common beta blockers include:

• atenolol
• bisoprolol
• carvedilol
• celiprolol
• labetalol
• metoprolol
• sotalol.

Read more about beta blockers and their common brand names.

Diuretic

Diuretics, also commonly called water tablets, help your body to get rid of extra fluid. This decreases the amount of blood that your heart has to pump. Common diuretics include:

• frusemide
• bumetanide
• metolazone
• bendrofluazide.

Read more about diuretics and their common brand names in our medication section.

Digoxin

Digoxin helps to control your heart rate and rhythm, which helps to reduce the strain on your heart.

Read more about digoxin.

Device-based therapies

As well as heart failure medication, some people may need an implantable electronic device to keep their heart rate and rhythm beating steadily. These small, battery-operated devices are inserted under the skin on the chest or in your side. They include:

• pacemakers
• ICDs (implantable cardioverter defibrillators)
• CRTs (cardiac resynchronisation therapy).

Cardiac ablation

Cardiac ablation is a heart procedure that is sometimes recommended if you have problems with your heart rate and rhythm, which are contributing to your heart failure.

Read more about cardiac ablation.

Lifestyle and heart failure management

Your lifestyle also plays a key part in your heart failure treatment. This includes:

• taking your medications
• checking your heart failure symptoms daily
• eating a heart-healthy diet with plenty of whole grains, fruit and vegetables, and limiting salt intake
• staying active
• quitting smoking and cutting back on drinking if necessary
• going to your regular heart appointments, which will usually be every three to six months
• getting the rest that you need.

The Heart failure action plan and Daily checks record are free tools to help you manage your heart failure.

For information about lifestyle changes and top tips on managing your condition, visit our living well with heart failure page.

Download the Staying well with heart failure PDF