Heart failure: symptoms, causes, treatment and living with it

The NHS lists the symptoms of heart failure as feeling out of breath when doing everyday activities or lying down, being more out of breath than you would expect during physical activity, feeling weak, light-headed or very tired (particularly after moving), swelling in your feet, ankles, legs or tummy or feeling bloated, sudden weight gain, coughing at night, and coughing up frothy pink phlegm.

The BHF explains that when the heart is not pumping blood as well as it should, you are not getting enough oxygen, and this affects how your body works, including your breathing and muscles. It lists fainting or feeling light-headed, tiredness or weakness that is worse with movement, breathlessness when active or resting, and swelling in the feet and ankles that can spread to the lower body. If you think you have symptoms of heart failure, the NHS says it is important to get them checked and to see a GP.

Heart failure is a condition where the heart cannot pump blood around the body as well as it should, according to the BHF and the NHS. The name sounds alarming, but the NHS is clear that it does not mean your heart has stopped working or is about to stop working.

The NHS says there are different types and stages. The type relates to why the heart is not pumping as well as it should, and the stage explains how severe your symptoms are. Heart failure can happen suddenly, for example after a heart attack or infection, or develop from long-term strain on the heart from high blood pressure or coronary heart disease.

The NHS says there are lots of possible causes. The BHF names a heart attack, cardiomyopathy (a disease of the heart muscle) and high blood pressure as the most common. The NHS adds heart valve disease, heart rhythm problems, chronic kidney disease, anaemia, haemochromatosis and thyroid problems.

The BHF also lists amyloidosis, congenital heart conditions, pulmonary hypertension, some cancer treatments such as chemotherapy, and drinking more than the recommended limit of 14 units a week. The NHS says anyone can get heart failure, but you may be more at risk if you are 65 or older, living with overweight or obesity, pregnant, smoke, drink a lot of alcohol or use cocaine.

The NHS says a doctor who thinks you may have heart failure will do tests to see how well your heart and lungs are working and refer you to a heart specialist (cardiologist). Tests may include blood and urine samples, an electrocardiogram (ECG), scans such as a chest X-ray, echocardiogram and MRI, and lung tests such as a peak flow test and spirometry.

The BHF says blood tests may include BNP, a protein that is higher when the heart is not working as it should, and that an echocardiogram (ultrasound of the heart) is used to measure ejection fraction. A 24-hour ECG may be used in some cases.

The NHS says there is currently no cure, but treatment aims to ease symptoms and help prevent your condition from getting worse. Your treatment depends on the type and stage of heart failure and your overall health.

Medicines the NHS describes include diuretics such as furosemide to make you pee more and reduce fluid build-up, drugs such as candesartan or enalapril that widen your blood vessels so the heart does not have to work as hard, and beta blockers that slow your heart so it needs less oxygen.

You may need surgery to improve blood flow from blocked or damaged arteries, repair or replace damaged heart valves, or fit a pacemaker or implantable cardioverter defibrillator (ICD). If heart failure is severe, the NHS says you may be offered a left ventricular assist device or a heart transplant if treatments are not helping.

The NHS says everyone diagnosed with heart failure should be offered cardiac rehabilitation, which may include an assessment and advice on how to exercise safely, exercise classes or a personal exercise programme, guidance on lifestyle changes such as healthy eating, and support groups.

The BHF describes 4 stages or classes of heart failure, which show how serious it is. When you are diagnosed, your doctor may tell you which stage you have based on your symptoms.

The NHS says heart failure affects everyone differently and symptoms can vary from day to day and week to week. Treatment and lifestyle changes can help manage symptoms and keep heart failure stable for many years.

• Take your medicine as your doctor has prescribed.

• Weigh yourself regularly, because a build-up of fluid can cause sudden weight gain and may need treatment.

• Have any vaccinations you are offered, such as the flu vaccine, because illness and infections can be more serious with heart failure.

• Stay active, and ask about a cardiac rehabilitation assessment.

• Eat a balanced diet, maintain a healthy weight, try to quit smoking and cut down on alcohol if you drink.

• If you drive, tell the DVLA about your condition and check with your insurance company, as the NHS advises.

• Follow any advice from your medical team about watching how much fluid you have each day, the BHF adds.

The NHS and the BHF both say there is no cure. The BHF acknowledges that this can be upsetting and raise concerns about life expectancy, and advises talking to your GP or specialist heart failure team, who can explain what to expect during treatment.

The NHS says that as part of your treatment you should be referred to a team of doctors and nurses for palliative care, which focuses on improving quality of life for anyone with a lifelong illness that cannot be cured. Palliative care covers managing symptoms, helping you feel more comfortable, thinking about practical needs and supporting your family.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you feel breathless when lying down or from everyday activity, you are coughing up frothy pink phlegm, or you have suddenly gained weight.

Call 999 if you have severe difficulty breathing (gasping, choking or not able to get words out), your lips or skin are pale, blue or grey, or someone has passed out and is not responding normally. Do not drive yourself to A&E.

On the NHS, a GP arranges first tests and refers you to a cardiologist, and ongoing care is usually with a heart failure team that includes specialist nurses. Cardiac rehabilitation should be offered to everyone with heart failure, in hospital, clinics or the community, face to face or online, depending on where you live.

Private cardiology can offer quicker echocardiograms and specialist review. Ask how results and medicine changes will be shared with your GP and heart failure team, because heart failure medicines are usually adjusted over time and need regular monitoring.