What Is Heart Failure? Symptoms and Treatment of Heart Failure

Heart failure occurs when the heart muscle cannot pump blood as effectively as it should. As a result, blood often backs up, leading to fluid buildup in the lungs and causing shortness of breath.

What Is Heart Failure?

Heart failure means the heart cannot pump enough blood to meet the body’s needs. The heart does not stop completely, but because it struggles to pump efficiently, organs and tissues do not receive enough oxygen-rich blood.

Types of Heart Failure

Heart failure does not occur in just one form. The main types include:

• Systolic Heart Failure (HFrEF)
• Diastolic Heart Failure (HFpEF)
• Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)
• Left-Sided Heart Failure
• Right-Sided Heart Failure
• Biventricular Heart Failure
• Acute Heart Failure
• Chronic Heart Failure

Systolic Heart Failure (HFrEF)

Systolic heart failure occurs when the heart’s pumping (contraction) function is impaired. The left ventricle cannot contract strongly enough, reducing the amount of blood ejected with each beat. This condition is usually defined by an ejection fraction (EF) below 40%.

Ejection Fraction (EF) is measured by echocardiography (ECHO) and represents the percentage of blood pumped out of the left ventricle with each contraction.

Common causes include heart attack, hypertension, coronary artery disease, and cardiomyopathy.

Diastolic Heart Failure (HFpEF)

Diastolic heart failure happens when the heart cannot relax and fill properly during the diastolic phase, even though the pumping function (EF above 50%) remains normal. Because the heart doesn’t fill adequately, blood flow becomes impaired.

It often develops due to hypertension, diabetes, obesity, atrial fibrillation, or aging.

Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)

This type is characterized by an EF between 41% and 49%, representing a middle ground between systolic and diastolic heart failure — sometimes described as mild systolic dysfunction.

Left-Sided Heart Failure

Left-sided heart failure occurs when the left ventricle cannot pump enough oxygenated blood to the body. The left ventricle is the main pumping chamber responsible for systemic circulation.

It may result from a heart attack, hypertension, valve disease, or diabetes and can present as either systolic or diastolic dysfunction.

Right-Sided Heart Failure

Right-sided heart failure occurs when the right ventricle fails to pump sufficient blood into the lungs. It often develops secondary to left-sided heart failure, but may also result from COPD, congenital heart disease, or pulmonary hypertension.

Symptoms include swelling in the ankles and legs, abdominal fluid accumulation, liver enlargement, and neck vein distention.

Acute Heart Failure

Acute heart failure develops suddenly, either in someone with no prior history of heart disease or as a sudden worsening of chronic heart failure. It requires emergency treatment.

Symptoms of acute heart failure include:

• Sudden shortness of breath
• Pulmonary edema (fluid in the lungs)
• Palpitations, chills, and sweating
• Confusion
• Low blood pressure
• Leg swelling

Common causes include:

• Heart attack
• Hypertensive crisis
• Arrhythmia (such as atrial fibrillation)
• Inflammation of the heart muscle

Chronic Heart Failure

Chronic heart failure develops gradually as the heart weakens over time and cannot pump enough blood consistently.

Common causes:

• Long-term high blood pressure
• Previous heart attack
• Coronary artery disease
• Heart valve disease
• Cardiomyopathy
• Obesity
• Diabetes
• Thyroid disorders

Symptoms include:

• Fatigue and weakness
• Swelling in the legs
• Frequent nighttime urination
• Shortness of breath with exertion
• Waking up at night with breathlessness
• Exercise intolerance

Causes of Heart Failure

The most common underlying causes are heart attacks and chronic heart disease.

• Heart attack (Myocardial infarction): A blockage in blood flow causes part of the heart muscle to die.
• High blood pressure (Hypertension): Chronic high pressure thickens and weakens the heart muscle.
• Coronary artery disease: Narrowed or hardened arteries restrict blood flow.
• Valve diseases: Leakage or narrowing of heart valves causes overwork and fatigue of the heart.
• Arrhythmias: Abnormal heart rhythms like atrial fibrillation disrupt normal pumping.
• Cardiomyopathy: Diseases that damage or enlarge the heart muscle.
• Lung diseases: COPD, pulmonary embolism, and pulmonary hypertension strain the right heart.
• Metabolic disorders: Diabetes, obesity, and thyroid disease increase heart workload.

Symptoms of Heart Failure

The most common symptom is shortness of breath.

• Persistent cough
• Swelling in the ankles and legs
• Abdominal bloating
• Fatigue and weakness
• Irregular heartbeat
• Loss of appetite or nausea (in advanced stages)
• Exercise intolerance

When to See a Doctor

Heart failure symptoms may start mild and easily be overlooked. You should consult a cardiologist if you experience:

• Noticeable shortness of breath during exertion or at night
• Persistent fatigue
• Swelling in legs or ankles
• Chest pain or tightness, especially with exercise
• Breathlessness even at rest

Diagnosis of Heart Failure

Diagnosis begins with a clinical examination followed by several tests:

• Echocardiography (ECHO): Evaluates heart pumping strength and EF.
• Electrocardiography (ECG): Detects arrhythmias and prior heart attacks.
• Exercise Stress Test: Measures heart performance under exertion.
• Chest X-ray: Checks for heart enlargement or lung fluid.
• Blood tests: BNP or NT-proBNP help confirm diagnosis.
• Coronary angiography: Detects artery blockages.

Treatment of Heart Failure

Treatment depends on the cause, type, and severity of failure.

• Lifestyle changes: Limit salt, exercise regularly, avoid alcohol and smoking.
• Medications: ACE inhibitors, beta-blockers, and other supportive drugs.
• Advanced therapies: Pacemaker, ICD, CRT, LVAD, or heart transplantation.
• Stent placement or valve surgery may be required.

Risk Factors for Heart Failure

• Coronary artery disease
• High blood pressure
• History of heart attack
• Diabetes
• Obesity
• Sleep apnea
• Alcohol or drug abuse
• Smoking
• Genetic predisposition
• Valve disease
• Arrhythmias

Prevention of Heart Failure

• Control blood pressure
• Keep cholesterol and blood sugar under control
• Reduce salt intake
• Manage stress
• Maintain a healthy weight
• Exercise regularly
• Eat a balanced diet
• Get regular check-ups
• Avoid smoking and alcohol

Diet for Heart Failure Patients

• Reduce salt intake
• Avoid processed and packaged foods
• Eat plenty of fruits and vegetables
• Include fiber and whole grains
• Monitor potassium levels
• Stay hydrated but avoid excess fluid
• Limit saturated fats and red meat
• Use healthy oils such as olive oil

Complications of Heart Failure

• Arrhythmias
• Pulmonary hypertension
• Blood clots
• Kidney failure
• Liver failure
• Cognitive decline

Frequently Asked Questions

What is the first symptom of heart failure?

Shortness of breath—especially during exertion or climbing stairs—is often the first sign.

What happens in heart failure?

You may experience shortness of breath, swelling in legs or ankles, cough, chest tightness, and fatigue during activity.

How long can you live with heart failure?

It depends on the type, cause, severity, and adherence to treatment.

Which organs are affected?

The lungs, kidneys, liver, and brain may all be affected.

Can heart failure be cured completely?

It cannot be fully cured, but symptoms can be managed with proper treatment and follow-up.

How many stages are there?

There are four stages: A, B, C, and D — ranging from risk with no symptoms to advanced heart failure.

When is a pacemaker used?

When EF falls below 35% or when medications fail to improve symptoms.

How strong should the heart pump normally?

A normal EF is 50–70%. Below 50% suggests possible heart failure.

Does heart failure affect the lungs?

Yes. Fluid buildup causes shortness of breath and lung congestion.

Does it improve after a heart attack?

Sometimes. Early treatment and cardiac rehabilitation can reduce damage.

Can angioplasty (stenting) help?

If caused by blocked arteries, angioplasty or bypass surgery can relieve symptoms but cannot reverse existing heart muscle damage.

Main sign of right-sided heart failure?

Swelling in the legs and ankles (peripheral edema), abdominal fluid buildup, liver enlargement, and distended neck veins.