Heart Failure Explained: Causes, Symptoms, Diagnosis & Treatment Options
Heart failure is often misunderstood, despite the scary name, heart failure does not mean the heart has stopped. It means the heart isn’t pumping blood as well as it should. This usually happens because the heart muscle has become weaker or stiffer over time, and as a result the body may not get all the blood and oxygen it needs.
If you or a loved one has been diagnosed with heart failure, it’s natural to feel worried. But here’s the good news: with modern treatments and healthy lifestyle changes, people with heart failure can still lead active, fulfilling lives. We see this at The Keyhole Heart Clinic firsthand – patients often improve once they understand their condition and how to manage it. In this guide, we explain what heart failure is, its causes, symptoms to watch for, how doctors diagnose it, and the treatments available (from medications to pacemakers to self-care). Our goal is to give you clear information and reassurance that while heart failure is serious, it can be managed and improved with the right care.
🫀 What Is Heart Failure?
Heart failure is a chronic condition where the heart’s ability to pump blood is weaker than normal. In a healthy heart, each beat sends blood out efficiently. In heart failure, the heart might not fill up with enough blood, or it can’t pump out blood with enough force (sometimes both). Because of this, organs and muscles might not get all the oxygen-rich blood they need. Early on, the body may try to compensate – for instance, the heart might beat faster or the chambers may enlarge – but over time these measures aren’t enough.
It’s important to understand that heart failure doesn’t mean the heart stops – it means the heart is not keeping up with the body’s needs. It often develops gradually. Sometimes heart failure comes on suddenly (for example, after a large heart attack or a viral infection), but more often it gets worse slowly over months or years. There are also different types of heart failure: in some people the main issue is a weakened pumping ability (often called heart failure with reduced ejection fraction), while in others the heart’s pumping strength is preserved but it’s too stiff to fill properly (heart failure with preserved ejection fraction). Regardless of the type, the result is that the heart isn’t meeting the body’s needs, and the symptoms and treatments are largely similar. Heart failure is quite common (over a million people in the UK have it) and is usually seen in older adults, but it can affect younger people too.
Heart failure is typically a long-term condition that can range from mild to more severe. It tends to worsen over time if not addressed, but appropriate treatment can slow down its progression. Many people with heart failure, especially when it’s caught early, can live for years with good quality of life. The main aim of treatment is to help the heart work better and relieve symptoms, so you can feel better day to day.
⚠️ Causes of Heart Failure
Heart failure usually develops because of other health issues that damage or overwork the heart. Common causes include:
- Coronary artery disease and heart attacks: Blocked arteries can starve the heart muscle of blood. A heart attack (where part of the heart muscle is damaged) can weaken the heart’s pumping ability.
- High blood pressure: Uncontrolled high blood pressure forces the heart to pump harder. Over time, this strain can cause the heart muscle to thicken and weaken.
- Heart valve problems: If heart valves are narrowed or leaky, the heart has to compensate by working overtime. This can lead to the heart enlarging and weakening.
- Cardiomyopathy: Diseases of the heart muscle. Causes can include genetic conditions, long-term alcohol misuse, certain drugs, or viral infections that inflame the heart. These can all weaken the heart’s pumping action.
- Heart rhythm disorders (arrhythmias): Very fast or very irregular heart rhythms (like long-standing atrial fibrillation) can reduce the heart’s efficiency, and very slow rhythms can cause insufficient blood flow. Either can contribute to heart failure.
- Other factors: Diabetes, severe lung disease, thyroid gland disorders, obesity, and congenital heart defects (heart problems present from birth) can also contribute to heart failure. Often, several factors combine over the years to cause the condition.
Addressing underlying causes is a big part of preventing and treating heart failure. For example, controlling high blood pressure or repairing a faulty heart valve can stop heart failure from getting worse. At The Keyhole Heart Clinic, we’ve seen how fixing the root problem can dramatically improve a patient’s heart function. One patient with severe heart failure due to multiple blocked arteries underwent a minimally invasive bypass surgery with our team; within weeks, his breathing and energy levels improved significantly because blood flow to his heart was restored.
🔍 Symptoms of Heart Failure
Heart failure can cause a variety of symptoms. They often start mildly and may get worse over time. Here are key signs to be aware of:
- Shortness of breath: Feeling breathless during activities that used to be easy, or even when resting in advanced cases. It’s often worse when lying flat (you might need extra pillows) and can cause waking up at night gasping for air.
- Excessive fatigue and weakness: Feeling very tired and weak most of the time. You might find it hard to do daily tasks or exercise because you run out of energy quickly.
- Swelling in ankles, feet, or legs: This happens due to fluid build-up (oedema). Shoes may feel tighter, and you might notice indentations from socks. Some people also develop bloating in the abdomen. Sudden weight gain over a day or two can be a sign of fluid retention.
- Persistent cough or wheezing: A lasting cough, especially when lying down, or a wheeze can occur if fluid accumulates in the lungs. Some people cough up frothy or slightly pink sputum.
- Heart palpitations and dizziness: You might feel your heart pounding or racing (palpitations), or notice an irregular heartbeat. Reduced blood flow can also cause dizziness or light-headedness, and in severe cases, fainting.
If you experience several of these symptoms, especially if they’re getting worse, it’s important to see a doctor. These signs could be due to heart failure or another condition, but either way you should get medical advice. Early diagnosis and treatment of heart failure can improve symptoms and help you live longer. Many patients begin to notice improvement in their symptoms within a few weeks of starting the right medications and lifestyle changes, although full benefits often develop over several months.
🧪 How Is Heart Failure Diagnosed?
To diagnose heart failure, doctors will evaluate your symptoms and perform a few tests. Often, your GP (general practitioner) will start this assessment and then refer you to a heart specialist (cardiologist) for further testing:
- Medical history and exam: Your doctor will ask about symptoms like breathlessness, fatigue, and swelling. They will check your blood pressure, listen to your heart and lungs, and look for signs of fluid build-up (such as swollen ankles or crackling sounds in the lungs).
- Blood tests: These can detect signs of strain on the heart (for example, a hormone called BNP is often elevated in heart failure) and check for other issues that might cause symptoms (like thyroid function or anaemia).
- Chest X-ray: An X-ray can show if your heart is enlarged and whether there is fluid in your lungs.
- Electrocardiogram (ECG): This simple test records your heart’s electrical activity. It can identify irregular rhythms or evidence of a prior heart attack that might indicate weakened heart muscle.
- Echocardiogram: An ultrasound scan of the heart. This is a key test for diagnosing heart failure. It shows how well your heart is pumping and can identify if parts of the heart are weak or if valves are not working properly. The echocardiogram also measures the ejection fraction (the percentage of blood the heart pumps out with each beat).
In some cases, additional tests like a cardiac MRI or an angiogram (to look at the heart’s blood vessels) may be done to find the exact cause of heart failure, but the tests above are the main tools. At The Keyhole Heart Clinic, we make sure anyone suspected of heart failure gets a thorough evaluation, so we can tailor treatment to their specific situation.
💊 Treatment Options for Heart Failure
Heart failure can be managed with a combination of medical therapies and lifestyle adjustments. While it usually cannot be “cured” (unless a reversible cause can be fixed), the right treatment plan can significantly improve symptoms and help you live longer. Here are the main components of heart failure treatment:
Medications
Medications are fundamental in treating heart failure. Different drugs help the heart in various ways:
- ACE inhibitors or ARBs: These relax blood vessels and reduce the strain on the heart, making it easier for the heart to pump blood forward.
- Beta-blockers: They slow the heart rate and lower blood pressure, giving the heart a chance to fill more fully and reducing its workload. Over time, beta-blockers can improve heart function.
- Diuretics: Often called “water pills,” diuretics help the body get rid of excess fluid and salt. This relieves swelling and congestion, helping you breathe easier.
- Other medicines: For example, mineralocorticoid receptor antagonists (like spironolactone) further help the heart and prevent fluid build-up, and there are newer medications (including some originally for diabetes) that have been shown to benefit heart failure patients.
Your doctor will decide the best combination for you. It’s common to take several medications in heart failure, each with a specific role. Taking them regularly as prescribed is crucial – these medicines can relieve symptoms and also help prevent your condition from worsening. In fact, these medications have been shown to not only improve how patients feel but also help many people with heart failure live longer.
Device Therapy (Pacemakers & ICDs)
In some cases, medical devices can improve heart function or protect against serious heart rhythm problems:
- Pacemaker (Cardiac Resynchronization Therapy): If the chambers of your heart aren’t beating in sync, a special pacemaker can be implanted to coordinate them. This helps the heart pump more efficiently and can reduce symptoms in certain heart failure patients.
- Implantable Cardioverter Defibrillator (ICD): If your heart is weak, there’s a risk of dangerous arrhythmias (abnormal rhythms). An ICD is a device that constantly monitors your heartbeat and can deliver a shock to correct a life-threatening rhythm, effectively preventing sudden cardiac arrest.
These devices are implanted under the skin (below the collarbone) during a minor surgery. Not every heart failure patient needs a pacemaker or ICD, but for those at risk, these devices provide an added safety net and can improve survival. At The Keyhole Heart Clinic, our experienced team often uses minimally invasive techniques to implant such devices. And indeed, many patients who receive a CRT pacemaker notice they can be more active and less breathless than before – a tangible improvement in quality of life.
(In very advanced heart failure that doesn’t respond to usual treatments, options like mechanical heart pumps or even a heart transplant might be considered. These are last-resort treatments and are handled in specialist centres.)
🏃♂️ Lifestyle Changes
Lifestyle adjustments are a vital part of managing heart failure. What you do day-to-day can greatly affect how you feel. Important changes include:
- Eat a heart-healthy, low-salt diet: Too much salt causes the body to retain water, which can worsen swelling and blood pressure. Try to avoid adding extra salt to meals and limit salty foods like processed snacks and fast food. Your doctor might also advise limiting fluids in some cases – if so, follow their guidance.
- Stay active with gentle exercise: Regular light exercise (such as walking or tailored exercises from a cardiac rehab programme) helps strengthen your heart and improve circulation. Even if you get tired easily, a little activity on most days can improve stamina. Always check with your doctor about what level of exercise is safe for you.
- Quit smoking and limit alcohol: Smoking damages your heart and blood vessels, so quitting is essential. If you need help quitting, ask for support – there are programmes and medications that can assist. Alcohol should be limited because heavy drinking weakens the heart; your doctor can tell you if it’s safe to drink at all in your case (many people with heart failure are advised to avoid alcohol or only drink sparingly).
- Monitor your weight and symptoms: Weigh yourself daily at the same time. A sudden increase (for example, more than 2 kg in 2 days) might mean you’re retaining fluid and your doctor may need to adjust your treatment. Also pay attention to your symptoms day by day – if you notice swelling or shortness of breath worsening quickly, contact your healthcare provider.
- Manage stress and get support: Stress and anxiety can affect your heart. Use relaxation techniques (deep breathing, meditation, gentle yoga) to help manage stress levels. Make sure you get enough sleep. It also helps to talk about your condition – whether with family, friends, or in a support group. Emotional support is important in managing a chronic condition. Consider talking to a counsellor or therapist if you feel overwhelmed – mental health support can make coping with heart failure easier.
- Follow your care plan: Take your medications as directed and keep your medical appointments and get recommended vaccinations (like the annual flu jab and pneumonia vaccine), even if you’re feeling better. Heart failure is an ongoing condition, and regular check-ups allow your doctor to adjust treatments as needed.
Making these lifestyle changes can make a big difference. Many patients find that after adopting a low-salt diet or starting gentle exercise, they feel improvements in their energy and breathing. It might take some effort to change habits, but you’re not alone – your healthcare team can offer advice, and the improvements in how you feel will be worth it. Small changes can yield big benefits – for example, one of our patients who adopted a low-salt diet and daily walks found that her ankle swelling reduced and she had more energy within a couple of months.
🌟 Living with Heart Failure: Outlook and Hope
Heart failure is a serious diagnosis, but it’s not a hopeless one. Many people with heart failure continue to enjoy life, work, and spend quality time with their families. Thanks to better treatments, people with heart failure are living longer and with a better quality of life than in decades past. Heart failure is a chronic condition that requires ongoing care, but with early and effective treatment even people with moderate heart failure can live for many years. In other words, a heart failure diagnosis is not an immediate sentence – especially if you take action to look after your heart. With the right combination of treatments and lifestyle changes, symptoms can be controlled – and in some cases even improve significantly. In fact, some patients find that their heart strength increases over time with treatment, moving them from a more severe stage of heart failure to a milder one.
It’s important to remember that you’re not alone. Heart failure is common, especially in older adults, which means there are resources and support networks out there. Cardiologists, nurses, and other specialists (like dietitians or physiotherapists) will work with you on managing the condition. In many areas, specialist heart failure nurses provide regular follow-up and advice, helping to adjust medications and offer guidance between doctor visits. Don’t hesitate to ask questions and discuss any worries with your healthcare providers – understanding your condition better will help you manage it more confidently. You will also have regular follow-up appointments – your doctors may check blood tests and occasionally repeat an echocardiogram to monitor your heart’s function and adjust your treatment as needed. Support groups (in person or online) can also provide encouragement and practical tips from others who are going through the same thing.
At The Keyhole Heart Clinic, we believe in treating the whole person, not just the heart condition. That means we’re here to provide medical treatment and also to support you in making lifestyle changes and coping with the emotional aspects of heart failure. We’ve seen patients go from feeling scared about their diagnosis to feeling empowered – by sticking to their treatment plans, they often see real improvements in how they feel. In fact, we’ve had patients who could barely walk across a room initially and later were able to enjoy holidays and long walks once their heart failure was well managed.
In summary: Heart failure means your heart needs some help to do its job, but with proper care, many people with this condition can live full and enjoyable lives. By taking your medications, looking after your diet and exercise, and working closely with your healthcare team, you give yourself the best chance to feel better and stay well. Medical advances are continually giving us new tools to fight heart failure, so there is more hope now than ever. Stay positive and proactive – with the right support, heart failure is a condition you can manage, not a sentence that defines you.
