Understanding Heart Failure

💡 What is Heart Failure?

Heart failure doesn't mean your heart has stopped working — it means your heart isn't pumping blood as well as it should. This can happen gradually over time or more suddenly after a heart attack.

When your heart can't pump efficiently, blood can back up and fluid can build up in your lungs, legs, and other parts of your body. This causes the main symptoms of heart failure.

The good news: with the right treatment and lifestyle changes, many people with heart failure live active lives and their symptoms can be well controlled.

What causes heart failure?

• Coronary heart disease — damaged or blocked arteries
• Previous heart attack — damaged heart muscle
• High blood pressure — heart works harder over time
• Heart valve problems — valves not opening or closing properly
• Cardiomyopathy — disease of the heart muscle
• Atrial fibrillation — irregular heartbeat

🩺 Recognising the Symptoms

Heart failure symptoms can range from mild to severe and may include:

• Breathlessness — especially when active or lying flat
• Fatigue — feeling tired even after rest
• Swollen ankles and legs — fluid retention (oedema)
• Persistent cough — especially at night
• Weight gain — from fluid build-up (rapid gain is a warning sign)
• Reduced appetite — feeling full or nauseous
• Needing to wee at night — more than usual

📊 Understanding Severity (NYHA Classes)

Doctors use the NYHA (New York Heart Association) classification to describe how much heart failure affects your daily life:

Class	What it means
Class I	No symptoms with normal activity — heart failure doesn't limit what you do
Class II	Mild symptoms — comfortable at rest, but normal activity causes some breathlessness or fatigue
Class III	Moderate symptoms — comfortable at rest, but less than normal activity causes symptoms
Class IV	Severe symptoms — symptoms even at rest, unable to carry out most activities

Your class can change over time with treatment — many people move to a better class with the right care.

💊 How Is Heart Failure Treated?

Lifestyle changes (essential)

• Reduce salt — helps prevent fluid build-up
• Limit fluids — your doctor may advise a daily limit
• Weigh yourself daily — rapid weight gain (1-2kg over 2-3 days) can mean fluid retention
• Stay active — gentle exercise as advised by your healthcare team
• Stop smoking — vital for heart health
• Limit alcohol — can weaken the heart muscle
• Get vaccinated — flu and pneumonia jabs reduce complications

Medications

Most people with heart failure take a combination of medications. Key treatments include:

• ACE inhibitors or ARBs (e.g., ramipril, candesartan) — reduce strain on the heart
• Beta-blockers (e.g., bisoprolol, carvedilol) — slow and strengthen heartbeat
• Diuretics (e.g., furosemide, bumetanide) — reduce fluid build-up
• MRAs (e.g., spironolactone, eplerenone) — help the heart work better
• SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) — newer medicines that help the heart even without diabetes

Your GP or heart failure nurse will explain which medicines are right for you and may adjust doses over time.

Devices and procedures

Some people may benefit from:

• Pacemaker — helps coordinate the heart's pumping (CRT)
• ICD — defibrillator that treats dangerous rhythms
• Heart valve surgery — if a valve problem is causing heart failure

❓ Questions to Ask Your GP or Heart Failure Nurse