Heart failure (HF) — also known as cardiac insufficiency — is a chronic condition in which the heart is unable to pump enough blood to meet the body's needs.
It does not mean that the heart stops working, but rather that it is weaker or stiffer than normal.

Heart failure can involve:

• The left ventricle (more common)

• The right ventricle

• Both sides of the heart

It may appear suddenly (acute) or develop gradually over months or years (chronic).

 

Types of Heart Failure

There are two main functional types:

✅ Heart Failure with Reduced Ejection Fraction (HFrEF)

The heart contracts poorly and cannot pump blood effectively.

• The ejection fraction (EF) is < 40%

✅ Heart Failure with Preserved Ejection Fraction (HFpEF)

The heart contracts normally, but becomes rigid and cannot fill properly.

• The ejection fraction is normal or ≥ 50%

Your cardiologist may determine the type through an echocardiogram.

 

Main Symptoms

Typical signs and symptoms include:

• Shortness of breath (initially on exertion, later even at rest)

• Fatigue and reduced exercise tolerance

• Swelling of legs, ankles, or abdomen (fluid retention)

• Rapid weight gain over a few days

• Need to sleep with multiple pillows (orthopnea)

• Persistent cough, especially at night

• Palpitations or irregular heartbeat

If these symptoms occur suddenly or worsen rapidly, seek urgent medical care.

 

Why Does Heart Failure Occur? – Main Causes

Heart failure can result from many conditions, including:

• Hypertension (high blood pressure)

• Coronary artery disease and previous heart attack (myocardial infarction)

• Valvular heart disease (stenosis or regurgitation)

• Atrial fibrillation and other arrhythmias

• Cardiomyopathies

• Diabetes

• Excessive alcohol consumption

Lifestyle factors (sedentary lifestyle, overweight, smoking) increase risk.

 

How is Heart Failure Diagnosed?

The diagnostic process includes:

• Physical examination

• Echocardiogram (key exam to assess ejection fraction)

• ECG (electrocardiogram)

• Blood tests (including BNP or NT-proBNP)

• Chest X-ray

• Holter monitor or cardiac MRI if needed

Your cardiologist will determine the most appropriate tests.

 

Treatments for Heart Failure

Treatment depends on the cause and type of heart failure.
Common goals are to improve symptoms, reduce hospitalizations, and increase life expectancy.

🩺 Medication

May include:

• Diuretics (reduce fluid retention)

• ACE inhibitors / ARBs / ARNI

• Beta-blockers

• Mineralocorticoid receptor antagonists

• SGLT2 inhibitors (important new drug class)

Medication must be personalized and taken regularly.

🫀 Devices and Procedures

In selected patients:

• Cardiac resynchronization therapy (CRT)

• Implantable defibrillator (ICD)

• Valve repair/replacement

• Coronary angioplasty if coronary artery disease is present

In advanced cases, heart transplantation or ventricular assist devices may be considered.

Lifestyle: What You Can Do

Your role is essential.

✔ Reduce salt intake (≤ 2 g/day)
✔ Maintain a healthy body weight
✔ Monitor daily body weight (sudden gain = fluid retention)
✔ Avoid smoking and excess alcohol
✔ Regular physical activity, guided by your cardiologist
✔ Follow medication schedule precisely

A multidisciplinary program and regular follow-up visits dramatically improve outcomes.

 

When to Contact Your Cardiologist Immediately

Seek medical attention if you notice:

• Sudden swelling of legs or abdomen

• Fast weight gain (> 2 kg in 2 days)

• Increasing shortness of breath

• Chest pain or fainting

Early intervention prevents hospitalizations.

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Heart failure is a chronic but manageable condition.
With the right treatment plan and lifestyle adjustments, many patients lead fulfilling, active lives.