Heart failure

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Symptoms of heart failure

When your heart is not pumping blood as well as it should, it means you’re not getting enough oxygen. This affects how your body works, including your breathing and muscles. This causes some of the main symptoms of heart failure, like:

• fainting or feeling lightheaded
• feeling very tired (fatigued) or weak at rest which gets worse with movement
• shortness of breath when you’re active or resting
• swelling in your feet and ankles which can spread to your lower body.

You should see your GP as soon as you can if you experience any of these symptoms. If you are struggling to breathe or have chest pain, call 999 for immediate medical assistance.

Causes of heart failure

There are many reasons why you may develop heart failure. It can happen suddenly or it can progress slowly over months or years. The most common causes of heart failure are:

• A heart attack – this can cause long-term damage to your heart, affecting how well your heart can pump blood.
• Cardiomyopathy – a disease of the heart muscle which can be inherited or caused by infections or pregnancy.
• High blood pressure – this puts strain on the heart, which can lead to heart failure over time.

Other causes of heart failure include:

• Abnormal heart rhythms (arrhythmias) – where your heart beats too fast, too slow or irregularly.
• Amyloidosis – a build-up of abnormal proteins (building blocks that make up things like muscle and hair) in organs such as your heart and tissues. When it affects the heart it's called cardiac amyloidosis (or stiff heart syndrome) and can lead to heart failure.
• Anaemia – a lack of red blood cells carrying oxygen in your blood.
• Congenital heart conditions – different heart problems that you’re born with.
• Endocarditis – a viral infection affecting the heart muscle.
• Heart valve disease – where blood struggles to flow through the heart properly, putting extra strain on the heart.
• Pulmonary hypertension – raised blood pressure in the blood vessels that supply your lungs. This condition can damage the right side of your heart, leading to heart failure. Find out more about pulmonary hypertension on NHS Choices and PHA UK.
• Some cancer treatments, such as chemotherapy.
• An underactive or overactive thyroid gland.
• Too much alcohol – more than the recommended limit of 14 units a week.

If you feel like you’re struggling to manage your condition at home, contact your doctor or NHS 111.

Do not delay because you think hospitals are too busy – the NHS has systems in place to treat people who need urgent heart treatment. If you delay, you're more likely to suffer serious heart damage, intensive care and spend longer in hospital.

Diagnosing heart failure

Your doctor will ask about your medical history, symptoms and examine you. You may then be sent for tests such as:

• A 24-hour ECG – in some cases, you may need this test which records the rhythm, rate and electrical activity of your heart over a longer period.
• A chest X-ray – to check if there's fluid in your lungs or if a lung condition is causing the symptoms.
• An echocardiogram – an ultrasound of your heart to see how it’s working.
• Blood tests – to check your overall health and for signs of a problem with your heart. This may include testing your BNP levels, which is a protein. Higher levels of BNP in your blood can be a sign that your heart is not working as it should.
• Breathing tests – to see if a lung problem is causing your breathlessness.

Heart failure with preserved ejection fraction (HFpEF)

Your doctor may talk about the ‘ejection fraction’ of your heart. This is to do with the amount of blood squeezed out of the main chamber of the heart with every beat. It’s usually measured as a percentage – over 50% is considered normal. Your ejection fraction is measured from an echocardiogram.

Heart failure can be put into different groups depending on your ejection fraction. Depending on the percentage measured, and other tests, your heart failure may be classed as the following:

• heart failure with preserved ejection fraction (HFpEF) – 50% or more
• heart failure with mildly reduced ejection fraction (HFmrEF) – 40% to 49%
• heart failure with reduced ejection fraction (HFrEF) – 40% or less.

Watch our video about how HFpEF happens:

If you’re living with HFpEF you might start to notice symptoms or wonder how it will affect your life. Watch our video to find out more about what treatments are available and how you can manage your condition:

Stages of heart failure

There are 4 stages or classes of heart failure. These stages describe how serious your heart failure is. When you’re diagnosed, your doctor may tell you which stage you have based on your symptoms. The stages of heart failure are:

• Stage 1 – you do not have symptoms during everyday activity.
• Stage 2 – you feel normal when resting but physical activity causes symptoms.
• Stage 3 – you feel normal when resting but a little physical activity causes symptoms.
• Stage 4 – you cannot do any physical activity without symptoms and may feel uncomfortable while resting.

Treating heart failure

There is not a cure for heart failure but available treatments can help manage symptoms and improve your quality of life. Your doctor will discuss treatments with you depending on what stage they’ve diagnosed you with.

Treatments for heart failure include:

• A medical device such as a pacemaker or ICD – a pacemaker helps control your heart rate to reduce the demand on your heart. An ICD detects and treats dangerous, irregular heartbeats.
• Heart surgery – done to improve blood flow to your heart or to repair/replace a faulty valve that is putting strain on your heart.
• Medicine – to protect and improve your heart function, improve your symptoms and reduce fluid build-up.

Managing heart failure

It’s important to follow the guidance from your doctor and take the medicines you’re prescribed. Making changes to your lifestyle is another way to improve your health. Changes you could try are:

• Keeping active – which has been proven to boost energy and improve sleep and quality of life.
• Keeping to a healthy weight and diet – this will help your overall health and prevent extra strain on your heart.
• Limiting how much alcohol you drink (less than the recommended 14 units per week) – lowering your chance of getting abnormal heart rhythms, high blood pressure and diseases such as stroke, liver problems and some cancers.
• Stopping smoking and using other tobacco products – reducing your risk of developing heart and circulatory diseases.
• Watching the amount of fluid you have each day if recommended by your medical team.
• Weighing yourself regularly – sudden weight gain may mean too much fluid is building up in your body and will need treated.

Living a healthier lifestyle can be hard at first, but it’s important for your overall quality of life. Read our Eat better booklet to for tips on eating healthier.

Heart failure and my future

There is no cure for heart failure. This can be upsetting and raise concerns about your life expectancy. If this is something you’re worried about, talk to your GP or a specialist heart failure team. They will explain what to expect during your treatment and give you the information and support you need.

Conversations about life expectancy and death are difficult. You may need to discuss things like care, finances and Wills. Sorting these things out when you feel well enough to do so can help give you and your loved ones peace of mind.

Find resources and emotional support with end of life conversations.

Mood and heart failure

It is very difficult to live with the uncertainty of having heart failure. Learning about your condition and getting involved in making decisions about your treatment will help you feel more in control and may help to relieve anxiety. It’s also important to discuss your worries with your family and close friends and your heart failure team so they can support you.

Stress affects different people in different ways. People who do not manage their stress may turn to unhealthy habits such as smoking, drinking alcohol, or snacking on unhealthy foods.

Knowing what triggers the stress can help you to tackle the problem. Finding healthy ways of coping with stress and learning to relax can help you manage your heart failure.

Heart Helpline and other support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Sign up to our Heart Matters magazine for online information packed with health and lifestyle advice.
• Visit the Pumping Marvellous website, for heart failure patients.
• Get support if you are caring for someone with heart failure.