Cardiac failure

What is heart failure?

Heart failure (also known as ‘congestive heart failure’ or CHF) occurs when your heart muscle has become too weak to pump blood effectively through your body. It can also happen if your heart becomes too stiff to fill up with blood properly, so not enough blood is pumped around your body. As a result, your muscles and organs don’t get enough oxygen and nutrients. This may cause fluid to build up in your body and make you feel breathless or tired.

Heart failure is usually an ongoing (chronic) condition — unlike heart attacks, which occur suddenly and require immediate treatment (acute).

However, the conditions can be related: a heart attack can cause ongoing muscle weakness and stiffness that leads to long-term heart failure. In some cases, symptoms of heart failure can also start suddenly.

Heart failure is common, with around 110,000 people in Australia living with heart failure. Around 2 in 3 people with heart failure in Australia are male.

What are the symptoms of heart failure?

A key symptom of heart failure is difficulty breathing, or shortness of breath. You may notice it in the following ways:

• You may find physical activity difficult.
• You may wake up during the night with shortness of breath.
• You may find it uncomfortable to lie flat, as that can make it difficult to breathe normally.

Other common signs of heart failure include:

• weakness or fatigue
• swelling in your legs, ankles and feet (oedema)
• swelling or bloating in your stomach
• coughing
• chest pain (angina), if you have previously had a heart attack
• dizziness

When should I call an ambulance?

These symptoms can be the sign of a serious problem that needs urgent treatment:

• difficulty breathing
• chest pain that’s severe or worsening, or has lasted longer than 10 minutes
• chest pain that feels heavy, crushing or tight
• other symptoms, such as breathlessness, nausea, dizziness, or a cold sweat
• pain in your jaw or down your left arm

What are the different types of heart failure?

A healthy heart will pump out at least half the volume of blood that fills its chambers every time the heart ‘beats’. The percentage of blood that your heart pumps out with every heartbeat is called the ‘ejection fraction’. A healthy heart will pump out at least half the volume of blood that fills its chambers every time the heart pumps or ‘beats’.

If you have heart failure, your heart may have one of these problems:

• Your heart muscle has become weak and can’t pump blood effectively. This causes fluid to back up and pool around your lungs and other parts of your body. This type of heart failure is known as systolic heart failure or heart failure with reduced ejection fraction (HFrEF).
• Your heart muscle is too stiff and can’t stretch to allow your heart to fill up with enough blood to meet your body’s needs. This also causes fluid to back up around your lungs. This is known as diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF).

There are other ways your doctor may describe the type of heart failure you have, for example, whether the right or left side of your heart is primarily affected.

Your doctor will refer you for tests to know which type of heart failure you have. It’s important to find this out, as the treatments can be different.

What causes heart failure?

Damage, weakness and stiffness to your heart commonly develop after a heart attack or coronary heart disease.

Other causes may include:

• long-term conditions such as diabetes, obesity, hypertension (high blood pressure). high cholesterol and HIV
• damage to the heart muscle (cardiomyopathy) caused by infection, excessive alcohol use and certain medicines
• faulty heart valves
• certain conditions you were born with, such as congenital heart disease or thyroid disorders
• pregnancy, which causes your heart to work harder than normal

Your doctor will investigate why you developed your heart failure. Understanding what caused it can help you and your doctor decide on the best way to treat it.

For information on how COVID-19 affects the heart, visit the Victor Chang Cardiac Research Institute website.

How is heart failure diagnosed?

Your doctor will ask about your symptoms and your family medical history, and perform a physical examination.

There are several tests that help to confirm a diagnosis of heart failure, and identify which type it is:

• echocardiogram (‘echo’): high-frequency sound waves are used to examine the shape and function of your heart
• electrocardiogram (ECG): electrical leads are placed on your chest, arms and legs to record the electrical signals travelling through your heart muscle
• blood tests
• chest x-ray
• angiogram (or coronary catheterisation): fluid is inserted through a small tube (catheter) to show whether your coronary arteries are narrowed or blocked

How can I prevent heart failure?

Not all causes of heart failure can be prevented.

The best way to prevent heart failure is by preventing coronary heart disease and heart attack.

To improve your health and reduce your risk of heart disease, you can:

• quit smoking
• follow a healthy diet
• see your doctor to help manage your cholesterol and blood pressure
• stay physically active
• maintain a healthy weight
• drink alcohol in moderation
• reduce stress and look after your mental wellbeing

If you have had a heart attack, it’s even more important to manage your risk factors and follow your treatment plan. Make sure you check in frequently with your healthcare team.

Some risk factors — such as your age, whether you have other health conditions, or your genes — are outside your control. Speak with your doctor if you have concerns about developing heart failure, and how you can manage it.

How is heart failure treated?

While there is no treatment to reverse or cure heart failure, there are things you can do to help you live longer and enjoy a better quality of life.

Lifestyle changes

Maintaining a healthy lifestyle is very important to help you manage heart failure. This includes:

• Managing fluid balance: monitor how much fluid you drink and take diuretic medicines if prescribed by your doctor. Don’t have more than 2 drinks containing caffeine in a day.
• Limiting salt intake: salt makes your body retain fluid, so eat foods low in salt and avoid adding salt to your food.
• Becoming smoke-free: cigarette smoke damages your artery walls and reduces the amount of oxygen in your blood.
• Limiting alcohol intake: alcohol can damage your heart. Limit your drinking to 1 to 2 standard drinks a day, or stop drinking altogether if your heart failure was caused by alcohol.
• Joining a support program: ask your doctor to recommend a program for people living with chronic heart failure. This might include specialised support from health professionals such as nurses, dietitians and exercise specialists.

Medicines

Heart failure is also treated with medicines. These can help you live longer and stay out of hospital. These may include:

• medicines to lower blood pressure and reduce strain on your heart, such as ACE inhibitors and angiotensin II receptor blockers (ARBs)
• beta-blockers to help your heart pump slower and stronger
• aldosterone antagonists to help control your blood pressure
• diuretics to help reduce fluid build-up that leads to swelling in your body

You might also need medicine to treat angina, if you have it. If you think your medicine is not working, is causing you problems or you have any questions, talk to your doctor. Do not stop taking your medicines without talking to your doctor first.

Other treatments

In some cases, you may need a surgical or medical device to help maintain regular heart function, such as:

• an implantable cardioverter defibrillator (ICD): a small box that detects and corrects abnormal heart rhythms
• a pacemaker: a small device that electrically stimulates the heart to keep a regular rhythm
• bypass surgery (coronary bypass surgery): which improves blood flow to your heart
• heart valve repair or replacement

For some people with severe heart failure, the only option may be a heart transplant. After a heart transplant, you will need to be on lifelong anti-rejection medicines and maintain a healthy lifestyle.

How do I live with heart failure?

In addition to your treatment, there are things you can do to feel better:

• Maintain a healthy weight — do some physical activity each day and eat fresh, healthy food.
• Talk to your doctor about keeping your vaccinations up to date, such as the flu vaccine and others.
• Talk to your family or support person about what’s important to you, and what steps you want to take to reduce the impact of heart failure on your life.

Living with heart failure can be emotionally and physically challenging. Hearing stories from others who have experienced heart conditions may be reassuring and can help you know what to ask your doctor or specialist.