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What is heart failure?

The term ‘heart failure’ is used to describe the signs and symptoms which can arise when the heart muscle is unable to pump as efficiently as normal. A common consequence is a build up of fluid in the body.

Heart failure is very common and although it is not a curable condition there are very effective treatments available to improve symptoms, improve quality of life and help people live longer.

What causes heart failure?

There are many causes of heart failure. Some of these causes are:

  • previous history of heart attacks
  • poor blood supply to the heart (coronary heart, or artery, disease)
  • high blood pressure
  • narrow or leaking heart valves
  • a very fast or slow heart rate
  • infection or disease of the heart muscle
  • excessive alcohol intake

What are the main signs and symptoms of heart failure?

If you have heart failure you may have some, none or all of these symptoms.

  • Shortness of breath

    This is more common when you are taking physical exercise such as climbing the stairs or walking up a slope. Some people are breathless when lying flat in bed. Some people wake in the middle of the night feeling breathless. You may find that sleeping propped up by extra pillows will help.
  • Swollen feet, ankles, legs or abdomen

    This is called oedema and is due to a build up of fluid. You may find that sitting with your feet up when possible will help reduce ankle swelling.
  • Severe tiredness, weakness and fatigue; feeling less mentally alert. The tiredness and lack of alertness is surprisingly variable and you may have good days and bad days.
  • Frequent dry ‘hacking’ cough, particularly when lying down.

    Some of these symptoms may appear very quickly or may develop over a period of weeks or months.

How is heart failure diagnosed?

You will have some tests to diagnose your heart failure. These may include an electrocardiogram (ECG), a chest X-ray and a scan of your heart called an echocardiogram.

  • An ECG is a test which looks at the electrical activity in your heart. It can detect changes in the rate and rhythm of your heart as well as detecting heart attacks (old and new) and signs that your heart may be enlarged. It may be necessary to take a repeat ECG in the future.
  • A chest X-ray will look at the size of your heart and also show if there is any fluid in your lungs.
  • An echocardiogram is an ultrasound scan of your heart which will show how well your heart is pumping and whether the valves in your heart are opening and closing effectively.

What is the treatment for heart failure?

There has been lots of research into which medications will help heart failure patients stay well and help to keep symptoms under control. The National Institute of Clinical Excellence (NICE) guidelines in England and Wales, and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines in Scotland, recommend that heart failure patients should be considered for the following medications.

In general, you will be asked to start all the drugs at low doses to start with, but with the aim of gradually increasing the doses of medication over a period of months. The aim is to reach the 'target dose' of the medications shown to be beneficial in clinical trials. You will need frequent blood tests to make sure that there are no harmful side-effects whilst starting medications or changing the doses.

ACE Inhibitor (Angiotensin Converting Enzyme Inhibitor)

These tablets help to relax your blood vessels, making it easier for your heart to pump blood around the body. ACE inhibitors may slow down the disease progression.

Occasional side effects may include a troublesome cough or dizziness. You should report any of these symptoms to your Heart Failure Nurse or GP.

Diuretics (water tablets)

Diuretics increase the amount of water and salt passed from the kidneys into the urine and therefore can help to get rid of any build-up of fluid. They are very effective in reducing your heart failure symptoms.

Diuretics are best taken in the morning on an empty stomach. If you take an afternoon diuretic try to take it no later than 4pm to avoid having to get up often in the night to pass urine.

Beta blockers

These tablets work by slowing down your heart beat and reducing the work that your heart has to do. Some relax your blood vessels, making it easier to pump blood through them.

You may feel tired or a bit more short of breath in the early days, as your body adjusts to taking these tablets.

Research has shown that people with heart failure benefit from taking these tablets. People who have asthma may not be able to take a beta blocker.

Mineralocorticoid Receptor Antagonists (MRAs)

If you still have symptoms despite taking ACE inhibitors, beta blockers and diuretics, or if your heart failure is graded as moderate-severe, you may be asked to take MRAs as well.

The MRAs (spironolactone and eplerenone) work by blocking another hormone called aldosterone. Aldosterone causes salt and water retention and so blocking its action is beneficial. MRAs are increasingly used in people with all grades of heart failure as research studies have shown that they help with symptom control and increase life expectancy.


Ivabradine works by slowing down the heart rate. It is usually prescribed if your heart rate is still too fast despite your taking a betablocker. It may be offered to you if you cannot tolerate a beta blocker.

The only side-effect of note is that it can cause bright lights in your field of vision.

Research has shown that it reduces the risk of being admitted to hospital with heart failure.


You may be asked to take Digoxin if you have a rapid or irregular heart beat or if you still have symptoms once you are on all of the other medication.

Digoxin slows, steadies and strengthens your heart beat and helps the heart to pump more efficiently.