What is heart failure?

Heart failure is when your heart can't pump enough blood to the rest of your body.

This may be because your:

• heart muscle has become too weak to pump blood
• heart becomes too stiff to fill up with blood properly

Heart failure is usually an ongoing (chronic) condition — unlike heart attacks, which occur suddenly and need immediate treatment. But in some cases, symptoms of heart failure can start suddenly.

Heart failure is common in Australia, and usually affects older people.

Watch this video about heart failure from the Heart Foundation. It's also available in other languages, including Arabic, Greek, Italian and Mandarin.

What are the different types of heart failure?

The ejection fraction (EF) is a way to measure how well your heart is pumping. It measures how much blood your left ventricle (LV — a chamber in your heart) pumps out with every heartbeat. A healthy heart will have an LVEF of 55% to 70%.

People with heart failure can be diagnosed with:

• heart failure with reduced EF (HFrEF) — where the LVEF is 40% or less (previously known as 'systolic heart failure')
• heart failure with mildly reduced EF — where the LVEF is 41% to 49%
• heart failure with preserved EF (HFpEF) — where the LVEF is 50% or more (previously known as 'diastolic heart failure')

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.

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, because that position can make it difficult to breathe normally.

Other common signs of heart failure include:

• weakness or fatigue
• heart palpitations
• swelling in your legs, ankles and feet (fluid retention or oedema)
• swelling or bloating in your abdomen (tummy)
• coughing at night
• dizziness and fainting

These symptoms can occur due to the lack of oxygen and nutrients reaching your muscles and organs and the build-up of fluid in your body.

What causes heart failure?

There are many causes of heart failure. Some of the main causes are:

• hypertension (high blood pressure)
• coronary heart disease, including heart attacks
• heart arrhythmias, such as atrial fibrillation
• excessive alcohol use or use of some stimulant drugs
• cardiomyopathy (a condition that affects your heart muscle)
• heart valve disease
• chronic lung disease or pulmonary embolism

Thyroid problems and diabetes are also related to heart failure.

There are also things that can make heart failure symptoms suddenly get worse. These can include:

• not taking your heart failure medicine
• not following your diet and fluid advice (such as having too much fluid, salt or alcohol)
• heart arrhythmias
• angina or a heart attack
• some medicines
• an infection
• anaemia

When should I see my doctor?

See your doctor as soon as possible if you have symptoms of heart failure.

When should I call an ambulance?

Symptoms that need urgent treatment are:

• difficulty breathing
• chest pain that's severe or worsening, or has lasted longer than 10 minutes
• chest pain that feels heavy, crushing or tight
• pain in your jaw or down your left arm

If you have any of the symptoms above, call triple zero (000) immediately and ask for an ambulance.

How is heart failure diagnosed?

Your doctor will ask about your symptoms and perform a physical examination. Your doctor will want to know about:

• your general health
• your lifestyle
• your family history
• any medicines you take

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

• an echocardiogram ('echo') — where high-frequency sound waves are used to examine your heart and how well it is working
• an electrocardiogram (ECG) — where electrical leads are placed on your chest, arms and legs to record the electrical signals travelling through your heart
• blood tests
• a chest x-ray

Your doctor may refer you to a specialist or other healthcare professional for further tests and treatment. This may be a:

• cardiologist (heart specialist)
• dietitian
• physiotherapist
• exercise physiologist
• specialist heart failure nurse

How is heart failure treated?

Treatment will depend on the cause, type and severity of your heart failure.

It's important to treat any condition that is making your heart failure worse. People with acute and severe heart failure usually need treatment in hospital.

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 live with heart failure. This includes:

• managing your fluid balance — monitoring how much fluid you drink, according to your doctor's advice
• quitting smoking and vaping
• limiting your salt intake
• limiting your alcohol intake
• eating a healthy diet
• getting enough physical activity
• maintaining a healthy weight

Your doctor may enrol you in a heart failure management program. This might include specialised support from nurses, dietitians and exercise specialists.

Medicines

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

Several medicines can be given together, including:

• ACE inhibitors, angiotensin II receptor blockers (ARBs) or an angiotensin-receptor neprilysin inhibitor (ARNI)
• beta-blockers
• aldosterone antagonists
• sodium-glucose co-transporter 2 (SGLT2) inhibitors

Diuretics can also be used to help reduce fluid build-up. Other medicines may also sometimes be recommended.

If you think your medicine is not working, causing you problems or if 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. These can include:

• an implantable cardioverter defibrillator (ICD) — a small box that detects and corrects dangerous heart rhythms
• coronary bypass surgery to improve blood flow to your heart
• heart valve repair or replacement
• cardiac resynchronisation therapy (CRT) with a special pacemaker — a small device that helps your heart pump in a better and more organised way

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.

Living with heart failure

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.

Go to the Heart Foundation website for real-life 'heart stories'.

What are the complications of heart failure?

There are several complications of heart failure, including:

• anaemia
• kidney problems
• high potassium levels
• fluid in and around the lungs

People with heart failure are also at a higher risk of having depression.

Can heart failure be prevented?

Not all causes of heart failure can be prevented. But early treatment of some potential causes can delay or prevent heart failure. This includes treatment for:

• high blood pressure
• diabetes
• coronary heart disease
• high cholesterol levels

There are also lifestyle measures that can help prevent heart failure. These include:

• not smoking
• limiting how much alcohol you drink
• maintaining a healthy weight
• staying physically active
• eating a healthy diet

Resources and support

The Heart Foundation has information on heart failure. You can also watch the Heart Foundation's video series on living well with heart failure.

Do you prefer to read languages other than English? The Heart Foundation has fact sheets on heart health translated into more than 25 languages.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.