Heart failure
Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs. It does not mean that the heart has stopped, but that it has weakened or cannot fill and empty properly, so that blood and fluid build up in the lungs or other parts of the body. The result is symptoms such as shortness of breath, fatigue, weakness, swollen legs or reduced exercise tolerance.
Heart failure has many causes. The most common are long-standing high blood pressure, coronary artery disease (including a previous heart attack), heart valve disease, other cardiomyopathies, arrhythmias such as atrial fibrillation, and some thyroid or kidney diseases. In older people, a common form is one in which the heart muscle is stiff and fills with difficulty, even though the strength of its contraction is preserved – this is called heart failure with preserved ejection fraction (HFpEF).
Symptoms usually develop gradually. They most often include shortness of breath on exertion or when lying down, tiring quickly, a feeling of heaviness in the legs due to fluid retention, waking at night short of breath, or sudden weight gain due to oedema. Some patients notice reduced stamina even in everyday activities that they used to manage without difficulty.
The diagnosis is based on the medical history, a clinical examination and a heart ultrasound, together with laboratory tests such as NT-proBNP, which indicates strain on the heart muscle.
Treatment is tailored to the individual and involves a combination of medicines that strengthen the heart's function, reduce its workload and prevent fluid build-up. Treating the underlying cause is equally important – controlling blood pressure, controlling arrhythmias, treating ischaemic heart disease, correcting valve problems or managing hormonal disorders.
Alongside medication, lifestyle changes also play a major role: reducing salt intake, regular physical activity within your capabilities, monitoring your body weight, stopping smoking and a balanced diet. In more severe forms, devices such as a cardiac resynchronisation therapy (CRT) device or an implantable cardioverter-defibrillator (ICD) are sometimes needed.
Although heart failure is a chronic condition, with timely diagnosis, tailored treatment and regular check-ups many patients can lead a good-quality, active life. The key to success is recognising the symptoms in time and receiving timely, appropriate treatment.
