Heart Failure

Heart failure is a condition where the heart fails to pump blood the blood around the body adequately for the bodies needs. Heart failure usually starts gradually but can be of sudden onset and be severe.

In heart failure the main pumping chamber of the heart  or 'ventricle' does not work as well as it can. This is usually because of a weakened muscle (systolic heart failure ) but can be due to a stiff heart muscle that does not relax (diastolic heart failure).


What causes heart failure?

Heart failure can result for many reasons. The common ones are listed here:

  • Coronary Artery Disease and heart attack - damaged muscle can lead to heart failure at the time of the heart attack
  • High blood pressure - causes the heart to work harder than usual. Other causes of heart failure include
  • Valvular heart disease - valves that  are narrowed or leak to a significant degree can put pressure on the heart and cause it to fail
  • Congenital heart defects
  • Cardiomyopathy - diseases of the heart muscle itself that may be genetic and inherited
  • Lung disease  - long standing lung disease can put pressure on the right side of te heart and cause right sided heart failure
  • Arrhythmia such as atrial fibrillation with uncontrolled heart rates
  • Alcohol - a high alcohol intake over a long period of time can damage the heart

What are the symptoms of heart failure?

Some people have no symptoms at all, but often the reduced blood supply to the body can cause:

  • Tiredness
  • Weight gain due to fluid retention and there may be swollen ankles (oedema)
  • Difficulty in lying flat in bed or waking up breathless at night due to fluid retention in lungs 

How can heart failure be diagnosed?

Sometimes it can be clear from the symptoms and from examination. In terms of investigations the following are commonly performed:

  • Chest x-ray - may show an enlarged heart or fluid on the lungs
  • Blood tests - looking for anaemia and kidney function. A Brain natriuetic peptide (BNP) test is a blood test that when normal excludes heart failure, and when raised means that heart failure is possible, and needs further investigation, usually with an echocardiogram.
  • Echocardiogram - an ultrasound of the heart that can look directly at the heart muscle and valves

What is the treatment of heart failure?

General lifestyle measures

  • Reduction of physical activity- to reduce demand on the heart
  • Dietary modifications- low salt diet
  • Losing weight if overweight
  • Stopping smoking
  • Alcohol restriction

Heart failure medications

  • Diuretics or 'water tablets' - increase salt and water excretion by the kidneys and so help with the symptoms of fluid retention
  • Beta-blockers - work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle.
  • ACE inhibitors - these medications open up blood vessels and take the pressure of the heart
  • Digoxin - increases the ability of the heart muscle to contract properly and slows the heart in atrial fibrillation.


Ordinary pacemakers do not generally help but in some cases specialised pacemakers with three leads instead of two (biventricular pacemakers) can be implanted to 'resynchronise' the right and left ventricles of the heart and improve overall function.


If the heart failure is caused by a faulty valve or sometimes when there is severe coronary disease a surgical operation will be considered, such as valve repair or replacement or coronary bypass surgery. Sometimes neither is possible and in some cases heart transplantation is considered.

Please note:

Every effort has been made to ensure that the information on this website is up-to-date and accurate. However, it is intended to serve as a guide only. Symptoms may vary and if you have any medical concerns you should always consult a healthcare professional.