Heart Failure
Heart failure is a chronic, progressive condition in which the heart muscle becomes weakened or stiff, losing its ability to pump blood efficiently throughout the body. This means that oxygen and nutrients cannot reach organs and tissues in adequate amounts. The consequences of heart failure can range from mild fatigue and reduced exercise tolerance to life-threatening complications and hospitalisation. It is a major global health concern and one of the leading causes of morbidity and mortality worldwide.
Although often referred to as “congestive heart failure,” the term encompasses more than just fluid buildup. Heart failure can occur with reduced ejection fraction (HFrEF), where the heart’s pumping ability is diminished, or with preserved ejection fraction (HFpEF), where the heart pumps normally but is too stiff to fill properly. Both forms impair the circulation of blood and place strain on various organs, leading to a cascade of physiological effects.
The condition typically develops over time as the heart becomes damaged by other underlying diseases. These may include coronary artery disease, long-standing hypertension, previous heart attacks, diabetes, valvular disorders, and certain infections or genetic conditions. As the heart struggles to compensate for its declining function. It undergoes structural changes such as enlargement (dilation), thickening (hypertrophy), and scarring, which further impair its performance.
Heart Failure
One of the hallmark features of heart failure is fluid retention. Because the heart is not pumping effectively, blood can back up into the lungs, abdomen, or legs. This causes symptoms like breathlessness, swelling (oedema), and weight gain. Patients often feel fatigued or weak, and may notice they need to sleep with extra pillows. Additionally, wake at night gasping for air due to fluid accumulation in the lungs (orthopnoea and paroxysmal nocturnal dyspnoea).
Heart failure is often classified according to the New York Heart Association (NYHA) functional classification system:
- Class I: No limitation of physical activity.
- Class II: Mild symptoms with ordinary activity.
- Class III: Marked limitations with less-than-ordinary activity.
- Class IV: Symptoms present at rest.
This system helps guide treatment and assess prognosis, although the condition can vary day-to-day depending on factors such as salt intake, medication adherence, and concurrent illnesses.
Diagnosing heart failure typically involves a combination of patient history, physical examination, blood tests (e.g., BNP or NT-proBNP levels), ECG, echocardiogram, and sometimes imaging such as cardiac MRI or stress testing. Identifying the underlying cause is crucial, as treatment will often be tailored to address the root problem—whether it’s ischaemic, hypertensive, valvular, or idiopathic in origin.
Management of heart failure requires a multidisciplinary approach. It includes lifestyle modifications (e.g., sodium restriction, fluid management, weight control), pharmacological therapy (including ACE inhibitors, beta-blockers, diuretics, and newer agents like SGLT2 inhibitors), and in some cases, device therapy (e.g., implantable defibrillators or biventricular pacemakers). In advanced cases, mechanical circulatory support or heart transplantation may be necessary.
Heart Failure
While it is a serious diagnosis, heart failure is not a death sentence. With the right care and monitoring, many individuals lead active and fulfilling lives. Patient education and engagement are essential, particularly when it comes to recognising symptom flare-ups and adhering to daily weight monitoring or medication schedules.
Preventing heart failure involves controlling the underlying risk factors that damage the heart in the first place. Managing high blood pressure, avoiding smoking, staying physically active, treating diabetes, and adopting a heart-healthy diet can significantly lower the risk of developing the condition. For those already living with heart failure, close follow-up with a cardiologist, regular bloodwork, and participation in cardiac rehabilitation programmes improve both longevity and quality of life.
As the global population ages and chronic diseases become more prevalent, the number of people living with heart failure is expected to rise dramatically. This highlights the importance of not only treating the condition but also investing in public health strategies to prevent it through early intervention and education.
