Conditions and diseases
Symptoms and causes
What is it?
The heart normally pumps the exact amount of blood that your body needs. With heart failure, the pump function is not working properly and the heart does not pump enough blood. Insufficient blood in circulation results in the following problems:
- Minor blood circulation (heart and lungs): blood and fluid accumulate in the body. You can have leg and ankle swelling.
- Major blood circulation (heart and body): there is insufficient blood pumped to the body. Blood and fluid accumulate in the lungs. You experience shortness of breath and a tickling cough.
There is a difference between systolic and diastolic heart failure.
Systolic heart failure
With systolic heart failure, the heart muscle no longer contracts with enough strength to pump blood through the minor circulation. Systolic heart failure tends to be the most common cause of heart failure.
Diastolic heart failure
With diastolic heart failure, the heart muscle relaxes less effectively during the resting phase, resulting in it filling with less blood.
Every case of heart failure is different.
There are many different underlying causes:
Acute heart attack
When there is a heart attack, a part of the heart muscle dies. This portion becomes stiff and can no longer pump. This can lead to heart failure. The severity of the heart attack determines the risk of subsequently developing heart failure.
Hypertension (high blood pressure)
When there is high blood pressure, the heart must pump at a high pressure. This thickens the heart muscle. Over time, the thick heart muscle becomes stiffer and less supple, which decreases its pumping force. This can lead to heart failure.
When heart valves do not close well or are narrowed, the heart has to work harder. This places additional stress on the heart and can lead to heart failure
Heart rhythm disturbances
With heart rhythm disturbances, the heart beats too fast, too slowly or irregularly. This causes the heart to lose its pumping force.
Heart muscle disease
The heart muscle is thickened or enlarged. The cells have an abnormal shape or are replaced by fat or connective tissue. This reduces the pumping force.
When there is heart failure, the amount of good blood circulating throughout the body is reduced. This means that organs receive less oxygen and nutrients. The most important symptoms of heart failure are:
- shortness of breath (especially with exertion)
- leg and ankle swelling
- restless sleep and having to urinate frequently at night
Other symptoms include:
- cold hands and feet
- heart rhythm disturbances
- feeling bloated and difficult bowel movements
- gaining weight even though you have a reduced appetite
- a tickling cough (especially when lying on your back)
- forgetfulness and lack of concentration
These symptoms may also be present when there are other conditions. If you recognise these symptoms, it does not necessary mean that you have heart failure!
In certain cases, the symptoms may be severe and require urgent medical attention. A heart rhythm disturbance that causes a heart attack can be life-threatening. Dial your GP or 112 immediately if you feel a persistent, heavy and painful pressure in the middle of your chest, accompanied by sweats, nausea and vomiting.
There can be rapid fluid accumulation in the lungs, which is an acute medical situation. Call your GP or dial 112 if you feel quite out of breath, this often occurs in conjunction with wheezing or a tickling cough.
Diagnosis and treatment
How is the diagnosis made?
Diagnosing heart failure is not simple. Using a stethoscope, the cardiologist listens for signs of valve abnormalities or fluid in the lungs. He or she will also check to see if fluid has accumulated in the legs or if the liver is swollen.
Additional tests can be used to diagnose heart failure:
- Blood test
- Chest X-ray
- Echocardiography through the chest (trans-thoracic echocardiography)
- Diagnostic cardiac catheterisation
- Echocardiography through the oesophagus (trans-oesophageal echocardiography)
- Stress test (cycling test)
- Isotope examination of the heart (MIBI scan)
The treatment of heart failure focuses on reducing symptoms. It is not always possible to take away the cause.
- Unblocking or widening the cardiac valve
- Surgical treatment of the cardiac valve
- Unblocking or widening the coronary arteries
- Bypass operation (Coronary artery bypass surgery)
- Cardiac medication
- Pacemaker (PM) implantation
- Internal defibrillator (ICD) implantation
- Cardiac rehabilitation
- Heart transplant
Treatment centres and specialisations
Latest publication date: 01/07/2021
Supervising author: Dr Provenier Frank