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Congestive heart failure

Heart failure is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.

Heart failure is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.

It usually occurs because the heart muscle has become too weak or stiff to work properly.

If you have heart failure it does not mean that your heart is about to stop working. It means that your heart needs some support to do its job, usually in the form of medicines.

Breathlessness, feeling very tired and ankle swelling are the main symptoms of heart failure. However, all of these symptoms can have other causes, only some of which are serious.

The symptoms of heart failure usually develop quickly (acute heart failure), but they can also develop gradually (chronic heart failure).

Read more about the symptoms of heart failure.

Types of heart failure

There are three main types of heart failure. They are:

  • heart failure due to left ventricular systolic dysfunction (LVSD) – due to the part of the heart that pumps blood around your body (the left ventricle) becoming weak 
  • heart failure with preserved ejection fraction (HFPEF) – usually due to the left ventricle become stiff, causing difficulty in filling with blood
  • heart failure due to valve disease

It is important that the type of heart failure you have is identified because it will affect the type of treatment you will be offered.

A number of tests can be used to help diagnose heart failure.

You should also have blood tests, an electrocardiogram (ECG) and/or an echocardiogram. These are used to investigate your heart and check how well it is functioning. If you have not had these tests, you should ask your doctor for an explanation.

Read more about how heart failure is diagnosed.

What causes heart failure?

Heart failure does not often have a single cause. A number of problems usually 'gang up' on the heart, causing it to fail.

There are a number of health conditions that increase your chances of developing heart failure including:

  • high blood pressure (hypertension) – can put extra strain on the heart which over time can lead to heart failure
  • coronary heart disease (CHD) – where the arteries that supply blood to the heart become clogged up by fatty substances (atherosclerosis); this may cause angina or a heart attack
  • heart muscle weakness (cardiomyopathy) – can cause heart failure; the reasons for this are often unclear but it may be genetic in origin, due to an infection (usually viral), alcohol misuse, or medication that is used to treat cancer
  • heart rhythm disturbance (atrial fibrillation)
  • heart valve disease, damage or problems with the heart's valves

Sometimes, anaemia, an overactive thyroid gland (hyperthyroidism), or high pressure in the lungs (pulmonary hypertension), can also lead to heart failure.

Read more about the causes of heart failure.

Treating heart failure

In most cases, heart failure is a lifelong condition that cannot be cured. Therefore, treatment aims to find a combination of measures, including lifestyle changes, medicines, devices, or surgery that will improve heart function or help the body get rid of excess water.

In cases where heart failure has a specific cause, a cure may be possible. For example, if your heart valves are damaged, it may be possible to replace them, which can cure heart failure.

As treatment will usually be lifelong, you and your doctor will need to find a balance of effective treatments that you can manage in the long-term so that you have the best symptom control and quality of life possible.

Effective treatment for heart failure can have the following benefits:

  • it helps make the heart stronger
  • it improves your symptoms
  • it reduces the risk of a flare-up
  • it allows people with the condition to live longer and fuller lives

Read more about how heart failure is treated.

Preventing heart failure

Many of the factors that increase your risk of developing heart failure can be managed either by making lifestyle changes or by taking medicines.

For example, in terms of lifestyle factors, you should:

Read more about preventing heart failure.

Living with heart failure

Being diagnosed with heart failure may come as a shock. While the outlook is related to age, the severity of the heart condition, and any other health problems that may exist, such as lung or kidney diseaseanaemia and diabetes, it also depends on what you do to reduce your risk.

Self care means taking responsibility for your own health and wellbeing, with support from the people who are involved in your care.

It is very important that you take any prescribed medication, even after you feel better. Some medicines are designed to protect or heal your heart. If you do not take them, they cannot help and the underlying problem will get worse. The medicines can prevent or delay your heart problem and symptoms from getting worse.

Speak to your healthcare team if you have any questions or concerns about the medication you are taking or any side effects.

As heart failure is a long-term condition, you will have regular contact with your healthcare team. Developing a good relationship with the members of your team will enable you to discuss your symptoms and any concerns that you have. The more the team knows about you, the more they can help you.

Read more about living with heart failure.

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Congestive heart failure

The symptoms of heart failure can vary from one person to the next. The main symptoms are breathlessness, extreme tiredness and ankle swelling, which may extend up the legs.

The symptoms of heart failure can vary from person to person. The main symptoms are breathlessness, extreme tiredness, and ankle swelling, which may extend up the legs.

These symptoms may be caused by conditions other than heart failure, and sometimes there may be more than one cause for them.

For example, it is possible for someone to have both emphysema and heart failure, and for both to cause breathlessness. Tiredness and ankle swelling are not usually caused by serious problems.

If you have symptoms such as tiredness and breathlessness, your GP may suggest that you have some tests to see whether you have heart failure, or to rule it out as a cause of your symptoms.

If you have heart failure, you may also get breathless if you lie flat, or you may wake up in the middle of the night with such severe breathlessness that you have to sit or stand up to catch your breath. If you have severe heart failure, you may need to sleep propped up by several pillows.

Ankle swelling related to heart failure is usually better in the morning and gets worse later in the day, although this is the case for most causes of ankle swelling.

If you have ankle swelling in the morning, it may be useful to raise the foot end of your mattress by 15-30cm (about 6-12 inches) because this will help gravity to drain the fluid back into your body.

Other symptoms that are sometimes associated with heart failure include: 

  • a persistent cough
  • lack of appetite
  • weight loss
  • tachycardia (rapid heart rate)

Some people diagnosed with heart failure may find the diagnosis difficult to cope with and develop depression and anxiety.

Monitoring your health

If you have been diagnosed with heart failure, you should monitor your symptoms closely. Weigh yourself daily (after getting up in the morning, before getting dressed) using a reliable set of scales.

If your weight increases by more than 2kg (4-5lb) over a few days, it may be a sign of fluid retention. This could be an indication that you need to watch the amount of salt in your diet, or check with your care team about whether you need to take some more diuretics (water pills).

You should also inform your GP or care team if you develop any new symptoms, or if an existing symptom suddenly gets worse.


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Congestive heart failure

In most cases, heart failure does not have a single cause. There are a number of other conditions that increase your chances of developing heart failure.

In most cases, heart failure does not have a single cause.

There are a number of other conditions that increase your chances of developing heart failure. These include:

There are also a number of other conditions that can increase your risk of developing heart failure. Some of these are discussed below.

Heart rhythm abnormalities (arrhythmias)

If your heart beats too fast, it may not have enough time to fill and empty properly. This will cause the heart muscle to weaken.

A very slow heartbeat (less than 40 beats a minute) may reduce the output of your heart, leading to the symptoms of heart failure. However, some people who are very fit can have a pulse of less than 40 beats a minute.

An irregular heart rhythm (atrial fibrillation is the most common irregularity) increases your risk of developing a blood clot (thrombosis), which may cause a stroke. In some people, it may also cause heart failure, particularly if the heart rate is too fast.

Damaged heart valves

The heart contains four one-way valves that ensure the blood flows in the right direction. A leaking valve means that your heart has to work harder and will stretch to deal with the extra volume of blood.

A narrowed valve can obstruct blood flow and reduce the amount of blood that your heart can pump and increase the stress on the heart muscle.

Some children are born with faulty valves (congenital heart disease). Heart valves can also be damaged during a heart attack, or sometimes they can just wear out. The average heart beats about 75 times a minute, which is 4,500 beats an hour or more than 100,000 heart beats a day.

Some damaged heart valves can be repaired but others have to be replaced. This usually requires an open heart operation, although less invasive alternatives are now becoming available and can be used in certain situations.


Myocarditis is inflammation of the heart muscle. It is usually caused by a viral infection and can sometimes lead to heart failure. However, myocarditis is rarely recognised as a cause of heart failure in the UK.

Other congenital heart conditions

Some babies are born with a 'hole in the heart', which is an abnormal connection between the left and right sides of the heart. This allows blood to flow from one side of the heart to the other (usually left to right), putting a strain on the right side and sometimes causing heart failure.

In some cases, a hole in the heart may not be detected until adult life. Holes can often be plugged using devices that are mounted on a heart catheter, though sometimes an operation is required.

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Congestive heart failure

If you have symptoms of heart failure, your GP will ask you to describe them in detail, and you will also have a physical examination.

If you have symptoms of heart failure, your GP will ask you to describe them in detail, and you will also have a physical examination.

If heart failure is suspected, a number of tests may be recommended to find out more. Some of the tests that you may have include:

  • blood tests – to check whether there is anything in your blood that might indicate heart failure or some other illness
  • breathing test – you may be asked to blow into a tube to check whether a lung problem is contributing to breathlessness 
  • an electrocardiogram – which records the electrical activity of your heart 
  • an echocardiogram – where ultrasound waves are used to examine your heart and check how well it is pumping and whether there are valve problems (the procedure is similar to the one used to look inside the womb during pregnancy)

You should ask your doctor whether you should have these tests if you are not offered them but you are receiving treatment for heart failure.

Blood tests

Blood tests can help identify whether another condition is causing your symptoms, such as anaemia, diabetes, thyroid problems, kidney disease, or liver disease. A high blood cholesterol level is often associated with coronary heart disease, which may lead to heart failure.

Natriuretic peptide test

Your blood will be tested for a substance called natriuretic peptide (also called BNP or NTproBNP). If your heart is under high levels of stress, it will secrete BNP into your blood. The test is able to detect these increased levels.

A natriuretic peptide test can also indicate the severity of your heart failure. Higher levels of BNP/NTproBNP in your blood may indicate that you have more severe heart disease, while lower levels may indicate a milder form.

You can read more about the BNP test on the Lab Tests Online UK website. 

Echocardiogram (echo)

An echocardiogram, or echo, is a procedure that can be used to look at the structure of your heart in detail.

A pulse of harmless, high-frequency sound waves is passed through the chest wall and produces a picture by ‘bouncing back’ from the heart's structures (it is similar to an ultrasound scan used during pregnancy).

During the test, you will be asked to lie on your left side with your left arm behind your head. A gel will be put on your chest and an ultrasound probe (recorder) will be placed at various points on your chest between your ribs.

The probe will pick up echoes from your heart and show them on a screen as a detailed image of the structures of your heart. The image is known as an echocardiogram.

An echocardiogram provides a lot of useful information about the heart, including:

  • how well your heart valves are working and whether any are damaged
  • how well your heart is working as a pump (when your heart contracts it forces blood to circulate around your body; this is known as the systolic function)
  • how well your heart relaxes after pumping (when the heart relaxes after each contraction it fills with blood; this is known as the diastolic function)
  • whether there are holes in the walls between the chambers of your heart that allow blood to flow from one side to the other (intracardiac shunts)

The most important finding from an echocardiogram is usually a measurement of how well one of the heart's chambers – the left ventricle – is pumping. The left ventricle pumps the blood around the body.

A measurement called the left ventricular ejection fraction (LVEF) is an estimate of how much of the blood that enters the left ventricle is pumped out when the heart muscle contracts.

In a healthy heart, about 60% of the blood entering the left ventricle is pumped out when the heart muscle contracts. A value of less than 40% indicates that your heart is definitely not pumping normally.

Sometimes, different types of echocardiogram are carried out. These are outlined below.

Stress echocardiogram

A stress echocardiogram is carried out to see how well your heart functions when it has to work hard. During the test, your heart rate will be increased, either by exercising on a treadmill or exercise bike, or by using injected medication.

Trans-oesophageal echocardiography

Ultrasound does not travel well through lungs, which can make imaging the heart through the chest wall difficult.

However, the heart lies right in front of the oesophagus (the tube connecting your mouth to your stomach). This makes it possible for a thin, flexible tube with a small ultrasound probe at the end to be inserted into your oesophagus to examine the structures of your heart in much greater detail. There is no lung in the way and the probe can get very close to your heart.

Before the procedure, you may be given a mild sedative to help you relax, and an anaesthetic will be sprayed onto the back of your throat.

You can read more about echocardiograms on the British Heart Foundation website.

Chest X-ray

A chest X-ray may sometimes be used to check whether your heart is bigger than it should be and whether there is fluid in your lungs, which might indicate heart failure. It can also pick up lung conditions that may be causing breathlessness.

Read more about tests for heart conditions on the British Heart Foundation website.

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