Heart failure is a condition where your heart isn’t pumping blood around your body as well as it should.

If your heart muscle is damaged or not pumping properly, it may be enlarged, weak or stiff.

There are two types of heart failure:

• heart failure with reduced ejection fraction (HFrEF)
  

• heart failure with preserved ejection fraction (HFpEF).

Health professionals refer to heart failure in many ways. Sometimes they may discuss the condition that caused it – you might hear terms such as coronary heart disease or myocarditis (when your heart muscle is inflamed).

Work with your professional healthcare provider to understand why you have developed heart failure and how you can manage your symptoms and continue doing the things you enjoy.

For more information visit the Heart Foundation’s website https://www.heartfoundation.org.au/conditions/heart-failure

Your health professional might think that you have heart failure because of symptoms you have described. Heart failure causes these symptoms because of the reduced supply of oxygen and nutrients to your muscles and organs, and the build-up of fluid in your body.

You might have told your health professional about some or all of these symptoms:

• Bloating because there is a build-up of fluid collecting around the middle of your body.
• Chest pain (angina) because your heart is not getting enough oxygen-rich blood.
• A cough because there is a build-up of fluid in your lungs that your body wants to get rid of. This can be a wet or dry cough, or a wheeze.
• Difficulty with breathing or shortness of breath (dyspnoea), especially when doing physical activity, because of the fluid build-up and because your body is not getting enough oxygen. You may also feel short of breath after bending down.
• Discomfort when lying flat or waking in the night due to difficulty breathing as a result of fluid in your lungs.
• Dizziness because less blood is reaching your brain.
• Heart pounding or racing (also called palpitations) because your heart is trying to beat faster to meet the demands of your body.
• Feeling uncomfortable in the stomach, or no longer feeling hungry because of fluid build-up around your middle or because you are not going to the toilet as frequently as you should (constipation).
• Swollen ankles or legs (oedema) because fluid is building up in those areas of the body. You may find that your shoes no longer fit your feet.
• Tiredness because your heart is working hard but not pumping enough blood to meet the demands of your body.
• Weakness because your body is distributing blood to the areas that need it most, which means that your arms and legs may not be getting enough blood flow.

Reproduced with permission from Living well with Heart Failure © 2016. National Heart Foundation of Australia.

Your health professional may also believe that you have heart failure because you have risk factors that make you more likely to develop the condition. These include:

• coronary heart disease and history of heart attack
• high blood pressure (hypertension)
• old age
• chronic conditions, such as diabetes, HIV and thyroid conditions
• valvular heart disease damage to the heart muscle (cardiomyopathy) – causes can include infection, alcohol abuse and certain medications
• heart rhythm problems (arrhythmias)
• inflammation of the heart muscle (myocarditis)
• heart conditions you were born with (congenital heart disease)
• pregnancy, which forces your heart to work harder than usual.

To diagnose heart failure, your doctor will need to ask you questions about your health and you will need a physical examination. Write down the symptoms that you are experiencing and think about your medical history and that of your family.

Your doctor may recommend you have some tests, including:

• a blood test, which can provide information about your heart health and whether your heart might be under strain
• an echocardiogram (ECHO), which uses soundwaves to look at the size and shape of your heart and to learn about the way that it moves. An ECHO is used to measure the amount of blood entering and leaving your heart every time it beats, which is called the ejection fraction. The ejection fraction is expressed as a percentage. A healthy heart will have an ejection fraction that is between 50% and 70%.
  The results of the ECHO are very important because they show if you have heart failure, and help classify the type of heart failure. This will guide the treatment you need to feel better, stay out of hospital and live a longer and healthier life.
• an electrocardiogram (ECG), which measures the electrical activity generated by the heart as it contracts. It can detect abnormalities which may be a sign of heart disease. An ECG is performed with an ECG machine. Wire leads from this machine are stuck to your chest, arms and legs with small sticky dots, which allow it to measure the electrical activity generated by your heart The ECG machine records the electrical impulses and prints them out on paper. It usually takes about 10 minutes.
  
• a chest X-ray, which can be used to see the size and shape of your heart, and whether you have fluid in your lungs, which is another way to help diagnose heart failure.

If you are unsure about why you need a particular test, always ask your doctor. You can find a guide to the type of questions you can ask on the Choosing Wisely website.

Yes, there are. The medicine you need to take will depend on the type of heart failure you have.

There are two types of heart failure.

• In heart failure with reduced ejection fraction (HFrEF or systolic heart failure), your heart muscle is weakened and is not pumping enough blood to meet the needs of your body. You will be diagnosed with HFrEF if the results of your ECHO show that more than half the volume of blood remains in your heart chamber after each heartbeat.
  
  It might help to think of your body as a lawn and your heart as a garden hose – if you have HFrEF, supplying blood to your body is a bit like watering the lawn with a low-pressure hose.
• In heart failure with preserved ejection fraction (HFpEF or diastolic heart failure), your heart muscle can pump blood to the rest of your body, but it does not stretch well. This can raise the pressure inside your heart and can lead to fluid build-up around your lungs and other areas of your body, causing shortness of breath and swelling.

Heart failure occurs mostly on the left side of the heart but can sometimes be found on the right, or on both sides of the heart. Right-side heart failure is sometimes called right ventricular heart failure.

If you are not sure about the type of heart failure you have (or someone you care for has), ask your trusted health professional. Talk to them about your heart failure and what it means for your treatment and management.

Find out more about medicines to treat heart failure

Heart failure is a long-term condition. Often it cannot be cured and needs lifelong management. However, treatment can help you feel better, stay out of hospital and live a longer and healthier life.

• If you were told you have heart failure while you were in hospital, see your GP within 1–2 weeks of going home.
• Recognise the signs that will let you know when you need help managing your heart failure and when to see your health care team. Ask your health professional about how to recognise your own symptoms and make sure you know what to do if you feel worse.
  Learn more about heart attacks by downloading the Heart Foundation’s Heart Attack Warning Signs action plan.

• It’s useful to have an up-to-date list of the medicines you need to take in one place that is easy to access for you and the people who care for you.
  If you do not have a medicines list, you can download and print a medicines list from the NPS MedicineWise website. If you are a smart phone user, you can use the medicines list on the free MedicineWise app, available on Google Play or the App Store.

• Taking an active role in managing your heart failure by making changes to your lifestyle will help you feel better and live longer. These changes may include eating food with less salt, being physically active and reducing the amount of alcohol you drink. Talk to your GP about the best way to achieve these goals. You can download and print our action plan, Heart failure: more than just the heart, and fill it out with your GP at your next appointment.

Find out more about taking an active role in managing heart failure

• Know your heart consumer resources from NPS MedicineWise
• Useful terms for people with heart failure from NPS MedicineWise
• What is Heart Failure? from the Heart Foundation and the accompanying videos
• Download the ‘Living Well with Heart Failure’ booklet from the Heart Foundation
• Information about heart failure for Aboriginal and Torres Strait Islander peoples from St Vincent’s Heart Health and the National Heart Foundation
• Taking steps to live well with heart failure from Veterans’ Mates

For more information visit the Heart Foundation’s website: https://www.heartfoundation.org.au/conditions/heart-failure

Read more about living well with heart failure