Heart failure

Heart failure is when your heart doesn’t pump blood around your body as well as it should do. This means your body can’t get as much blood and oxygen as it needs. If you have heart failure, you may find it harder to breathe, especially after being active, and feel very tired.

About heart failure

Heart failure can happen if there’s a problem with the structure of your heart or how it works. This may be because you have a condition such as coronary heart disease, heart valve disease or high blood pressure. Many people with heart failure have had a heart attack in the past.

You’re more likely to get heart failure as you get older. Being told you have heart failure can be worrying because this is a serious medical condition. But getting the right treatment can help to ease your symptoms and make your heart stronger to give you a better quality of life.

Symptoms of a heart failure

Your symptoms will depend on which part (or parts) of your heart are damaged, and how badly they’re affected. Common symptoms include: 

• trouble breathing – you may feel breathless when you’re exercising or even when you’re resting, especially when you’re lying flat
• sudden breathlessness in the night
• swelling of your feet, ankles or tummy
• feeling extremely tired
• a cough (often at night) and wheezing
• feeling lightheaded or faint

If you get any of these symptoms or if you have heart failure and your symptoms are getting worse, contact your Doctor.

Causes of heart failure

Heart failure is when your heart can no longer pump blood as well as it needs to. This is usually because there is:

• damage to your heart muscle
• a problem with a heart valve
• an irregular heartbeat (arrhythmia)

Lots of things can cause heart failure. These include: 

• coronary heart disease – including after a heart attack
• heart valve disease
• atrial fibrillation
• high blood pressure (hypertension)
• heart muscle disease (cardiomyopathy) – this may be inherited or caused by other things such as an infection or pregnancy
• an overactive thyroid gland (hyperthyroidism)
• diabetes
• drinking too much alcohol or taking illegal drugs such as cocaine
• anaemia

Diagnosis of heart failure

Your doctor will ask you about your symptoms and medical history and examine you. They may refer you to a cardiologist – a doctor who specialises in conditions that affect the heart and blood vessels. Your doctor will probably arrange for you to have a blood test called the BNP blood test. This measures the amount of the hormone BNP in your blood and can help tell if you have heart failure. 

Your doctor may recommend various other tests to find out if you have heart failure and, if so, what’s causing it.

• Blood and urine tests. These check your blood cell count and how well your kidneys are working, as well as other signs of heart failure.
• An electrocardiogram (ECG). This measures your heart’s electrical activity. It can tell your doctor if you’ve had a heart attack, if your heart rhythm is normal and if part of your heart has thickened.
• An echocardiogram. This uses ultrasound to check your heart’s structure and how well it’s working. 
• A chest X-ray. This can check if you have any congestion in your lungs and whether your heart is bigger than it should be.
• Lung function tests. These check to see how well your lungs are working.

Stages of heart failure

At diagnosis, your doctor will usually be able to tell what stage of heart failure you have. There are four stages of heart failure which relate to how severe it is.

1. No symptoms doing normal physical activity.
2. Comfortable when not exercising but normal physical activity brings on some symptoms.
3. Comfortable when not exercising but slight physical activity brings on symptoms.
4. You may have symptoms when not exercising and you’re unable to do any physical activity without discomfort.

Self-help for heart failure

Some self-help measures may help to ease symptoms of heart failure.

• If you’re finding it hard to breathe and sleep on your back, keep yourself propped up with pillows.
• If you feel tired all the time, pace yourself and give yourself plenty of time to do everyday activities. Try breaking up big tasks into small parts and ask for help from your friends and family.
• If you have swollen feet and ankles, don’t sit or stand for a long time. Raise your feet on a stool or chair when you’re resting.

Aim to keep yourself as healthy as possible.

• Eat a healthy, balanced diet.
• Cut down on salt.
• Stop smoking.
• Do some regular low-intensity exercise (if you’re condition is stable).
• Don’t drink too much alcohol (or any alcohol if this has caused your heart failure).
• Keep to a healthy weight.
• Check how many fluids you’re drinking – ask your doctor how much you can drink each day.
• Manage your stress levels.
• Have an annual flu jab and the once-only pneumococcal jab.

A specialist heart failure nurse may give you advice on easing your symptoms and changing your lifestyle.

Treatments for heart failure

Medicines

If you have heart failure, your doctor is likely to prescribe some medicines. You may need to take one or more medicines for the rest of your life. These should ease your symptoms, keep you as well as possible and prolong your life. At first, your doctor may need to change the dose or the medicine a few times to get the best result. They’ll monitor how you’re doing and talk to you about any possible side-effects.

It’s important to take your medicines according to your doctor’s instructions. If you’re taking lots of different medicines, you may find it helpful to use a pill box organiser. Don’t stop taking your medicines or change how much or how often you take them without speaking to your doctor first.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice. 

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors make your blood vessels wider and so it’s easier for your heart to pump blood around your body. Possible side-effects include a dry cough and low blood pressure, which can make you feel dizzy.

Angiotensin II receptor blockers

Angiotensin II receptor blockers (ARBs), also called angiotensin receptor antagonists, work in a similar way to ACE inhibitors. They lower your blood pressure and stop your symptoms getting worse. Your doctor may prescribe these if ACE inhibitors give you troublesome side-effects.

Beta-blockers

Beta-blockers slow down your heart rate, which helps to lower your blood pressure and reduce how much work your heart does. It can take a few weeks or months for beta-blockers to work. You may think your symptoms are getting worse at first, but try and stick with them. Possible side-effects include tiredness, cold hands and feet and trouble sleeping.

Diuretics

Diuretics make you pee more. They can treat swollen feet and ankles and stop fluid building up on your lungs. This means you can be more active and breathe more easily. They can lower your blood pressure, which may make you feel dizzy. 

Aldosterone antagonists

Aldosterone antagonists, such as spironolactone and eplerenone, are also called potassium-sparing diuretics. They work in a similar way to diuretics and are often given together with other medicines. They may affect how well your kidneys work. In men, they can cause swelling and discomfort of the breasts.

Digoxin

Digoxin strengthens your heartbeat and slows down your heart rate. It’s used if you have atrial fibrillation (an abnormal heartbeat that can be caused by heart failure). It may be added to other medicines to treat heart failure or used if other medicines haven’t worked well enough. Side-effects include feeling sick and diarrhoea.

Anticoagulants and antiplatelets

If you have heart failure, you’re more likely to get blood clots, especially if you have atrial fibrillation. So, your doctor may recommend you take anticoagulant and antiplatelet medicines, which help to prevent clots forming. Blood clots can cause a stroke if they block narrow blood vessels and stop blood getting to your brain.

Implanted devices for heart failure

Cardiac re-synchronisation therapy

If there’s a problem with how electrical signals pass through your heart, this may affect how well your heart pumps blood. Cardiac re-synchronisation therapy involves fitting a pacemaker device under your skin at the top of your chest or in your tummy. This sends electrical currents to leads connected to the different parts of your heart so they contract together in the correct way.

Implantable cardioverter defibrillator

Sometimes heart failure can cause a sudden, unexpected change in your heart rhythm. This is very serious and may be fatal. If your doctor thinks you’re at risk, they may offer you an implantable cardioverter defibrillator (ICD) to monitor your heart rhythm. This device is usually implanted under your skin below your collarbone. If it detects a serious problem, it’ll deliver an electric shock to return your heartbeat and rhythm back to normal.

Surgery for heart failure

Transplant

If your heart failure is very severe, you may be able to have a heart transplant. Heart transplants can be very successful but they aren’t suitable for everyone. There’s also a limited number of donor hearts available.

Valve replacement

If one or more of your heart valves aren’t working properly (heart valve disease), this can cause heart failure. You may be able to have heart valve surgery to replace them.

Coronary artery bypass graft

If your heart failure is caused by coronary heart disease, you may be offered a coronary artery bypass graft. This bypasses your blocked arteries to boost the blood flow to your heart muscle. 

Living with heart failure

If you have heart failure, it’s natural to worry about how it’s going to affect your day-to-day life and your future. Heart failure affects everyone differently. You may cope better if you find out lots about the condition and learn what you can do to help yourself. This can make you feel more in control and reduce any anxiety or stress. You may have to make some changes to your life – see our section on self-help for heart failure.

Work

Most people with heart failure can keep working. But you may need to make some changes, such as reducing your working hours because of your symptoms. If you have a very physical job, this may be more difficult. If your work involves driving, see our FAQ: Can I still drive if I have heart failure?  

Mental health

It’s normal to feel low or sad from time to time, but if this feeling doesn’t go away you may be developing depression. If you think you may be becoming depressed, contact your Doctor.

Sex

Having heart failure doesn’t mean you can’t have sex, as long as it doesn’t make your symptoms worse. But it can affect your desire or ability to enjoy sex. This may be because of the disease itself, the medicines you’re taking or because you’re tired, anxious or depressed.

Complications of heart failure

Heart failure can cause some complications including: 

• losing weight
• muscle loss
• kidney disease
• an irregular heartbeat (arrhythmia) 
• sudden death caused by a problem with your heart – but the number of people dying from heart failure is falling

Every person is different – your doctor can discuss with you how likely these complications are in your particular circumstances.

Prevention of a heart failure

You’re less likely to get heart failure if you lead a healthy lifestyle. This includes: 

• not smoking
• losing any excess weight
• doing regular physical activity
• eating a healthy, balanced diet without too much salt
• not drinking too much

Some health conditions (for example, high blood pressure) can cause heart failure. If you have such a condition, it’s important to get treatment. If you’ve been prescribed medicines for these conditions, it’s important to keep taking them as recommended. You may be able to prevent heart failure developing in the future.