Heart Failure
Heart failure is a clinical syndrome in which the heart is unable to pump blood efficiently enough to meet the body's demands, or can only do so at the cost of abnormally elevated filling pressures. It is a serious and progressive condition, but with appropriate treatment, many people are able to live well with it for years. It affects people of all ages but becomes considerably more common with advancing age.
Types and causes
Heart failure is broadly classified into two types: heart failure with reduced ejection fraction (HFrEF), where the heart muscle is weakened and pumps less blood than it should, and heart failure with preserved ejection fraction (HFpEF), where the heart muscle is stiff and does not relax properly between beats. The most common causes include coronary artery disease and previous heart attacks (which damage the heart muscle), long-standing uncontrolled hypertension, heart valve disease, cardiomyopathy (disease of the heart muscle itself), and certain arrhythmias. Less commonly, conditions such as anaemia, thyroid disease, viral infections of the heart (myocarditis), and alcohol excess can also lead to heart failure.
Symptoms
The cardinal symptoms are breathlessness — particularly on exertion or when lying flat — ankle and leg swelling (oedema) due to fluid accumulation, fatigue, and reduced exercise tolerance. Some people also experience a persistent dry cough, particularly if they are taking certain medications. Symptoms can vary considerably in severity and may fluctuate over time.
Diagnosis
Key investigations include a blood test for a marker called BNP or NT-proBNP, which is elevated in heart failure, an echocardiogram (ultrasound of the heart), an ECG, and a chest X-ray. These together help confirm the diagnosis, identify the type and severity, and guide treatment.
Treatment
Treatment aims to relieve symptoms, slow disease progression, reduce hospitalisations, and improve survival. A combination of medications — including ACE inhibitors or angiotensin receptor blockers, beta-blockers, and diuretics — forms the backbone of therapy for most patients. More recently, a class of drugs called SGLT2 inhibitors has been shown to significantly reduce the risk of hospitalisation and death in heart failure. Some patients benefit from devices such as implantable defibrillators or cardiac resynchronisation therapy. Lifestyle measures — monitoring weight daily, restricting fluid and salt intake, and regular gentle exercise — are also important.
Choosing where to be treated
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