About heart failure
Heart failure can happen if your heart structure or function isn’t as it should be. Around 900,000 people have the condition in the UK. You’re more likely to get heart failure as you get older. While about one in every 100 people under 65 has it, this increases to up to 20 in every 100 people over 85.
You’ll usually have heart failure for a long time, sometimes for the rest of your life. But with treatment, you can keep the symptoms of heart failure under good control for years.
Symptoms of heart failure
Your symptoms will depend on which part (or parts) of your heart are damaged, and how severely. Symptoms of heart failure include:
- trouble breathing – you may feel breathless when you’re doing some exercise or even when you’re resting, particularly when you’re lying flat
- swollen feet, ankles or abdomen (tummy)
- feeling extremely tired
- a cough (often at night) and wheezing
If you get to know the symptoms of heart failure, then you can contact your GP if you feel they’re getting worse.
Diagnosis of heart failure
Your GP will ask you about your symptoms and examine you. They’ll ask you about your medical history. Your GP may refer you to see a cardiologist – a doctor who specialises in conditions that affect the heart and blood vessels.
Tests for heart failure include those listed below.
- Blood and urine tests. These check your blood count and how well your kidneys are working, as well as other signs of heart failure.
- An electrocardiogram (ECG). This measures the electrical activity of your heart to see how well it’s working.
- An echocardiogram. This uses ultrasound to check the structure of your heart and to see how well it’s working.
- A chest X-ray. This can check if you have any congestion in your lungs and also rule out other conditions.
Self-help for heart failure
If you’re diagnosed with heart failure, your doctor may suggest some changes to your lifestyle that you can make to improve your symptoms. These may include:
- eating a healthy, balanced diet
- cutting down on salt
- stopping smoking
- doing some regular exercise
- not drinking too much (or not at all if alcohol has caused your heart failure)
- keeping to a healthy weight
- monitoring how many fluids you drink – ask your doctor how much you can drink each day
- managing stress
- having an annual flu vaccine
If you need help making these changes to your lifestyle, see our related information for advice. Or your GP may be able to arrange for you to attend a local rehabilitation programme and offer information and support too.
Medicines for heart failure
Below is a list of medicines that can relieve your symptoms of heart failure. Different medicines treat different symptoms, so you may need to take more than one. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.
Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors widen your blood vessels and make it easier for your heart to pump blood around your body. Side-effects may include a dry cough and low blood pressure, which can make you feel dizzy.
Angiotensin II receptor blockers
Angiotensin II receptor blockers (ARBs), also called angiotensin receptor antagonists, work in a similar way to ACE inhibitors. They lower your blood pressure and stop your symptoms from getting worse. Your doctor may prescribe this medicine if you can’t take ACE inhibitors because of the side-effects.
Beta-blockers slow down your heart rate, which helps to lower your blood pressure and the amount of work your heart does. They can also make your heart pump blood more forcefully. Your doctor will prescribe you a low dose of beta-blocker to begin with and might slowly increase this. It can take a few weeks or months for beta-blockers to work. You might think your symptoms are getting worse to begin with but try and stick with them. If you have asthma or other heart problems, you might not be able to take beta-blockers. Side-effects can include tiredness, cold hands and feet, trouble sleeping and impotence in men.
Diuretics can treat swollen feet and ankles, and prevent fluid build-up on your lungs, which will allow you to be more active and to breathe better. Diuretics cause your body to get rid of excess fluid by making you go to the toilet more often. Your heart won’t have to work as hard if there’s less fluid to pump around your body. Tell your doctor if you have gout, as diuretics can make it worse. They can also lower your blood pressure, which may make you feel dizzy.
Spironolactone or eplerenone are two types of aldosterone antagonists that are used to treat the symptoms of heart failure. They work in a similar way to diuretics by affecting the balance of water and salts going into your urine. These medicines can make you lose your hair and may affect how well your kidneys work. In men, they can cause painful breasts (gynaecomastia). Your GP may ask you to have regular blood tests to check how well your kidneys are working if you take this medicine.
Digoxin helps if you have a rapid or irregular heartbeat as it slows down your heart rate. Side-effects can include feeling sick and diarrhoea.
Anticoagulants and antiplatelets
These affect how well your blood can clot and prevent harmful blood clots from forming. You’re more likely to get blood clots with heart failure and this risk is even higher if you have atrial fibrillation. Blood clots can cause a stroke if they block narrow blood vessels and stop blood getting to your brain.
Pacemakers and ICDs for heart failure
Cardiac re-synchronisation therapy
Cardiac re-synchronisation therapy can improve how well your heart is able to pump blood around your body. A pacemaker is fitted under your skin at the top of your chest. This sends electrical currents to leads that are connected to the different parts of your heart so they contract in synchronisation with each other.
Implantable cardioverter defibrillator
An implantable cardioverter defibrillator (ICD) is a device that’s usually implanted under your skin below your collarbone. An ICD can monitor your heart rhythm. If it detects a serious problem with this, it will deliver an electric shock to return your heartbeat and rhythm back to normal.
Surgery for heart failure
If you have very severe heart failure, you might be able to have a heart transplant. Heart transplants can be very successful but they aren’t suitable for everybody because of the risks of surgery. There’s also a limited number of donor hearts available. Ask your doctor if a heart transplant is an option for you.
If one or more of the valves in your heart aren’t working properly, it can cause heart failure. You might be able to have an operation to replace them, which should improve your symptoms. For more information about what the operation involves, see Related information.
Coronary artery bypass graft
If your heart failure is caused by coronary heart disease, you may be offered a coronary artery bypass graft. This aims to bypass your blocked arteries to increase the blood flow to your heart. For more information about this procedure, see Related information.
Causes of heart failure
Heart failure can be caused by:
- damage to your heart muscle
- a problem with a valve in your heart
- an irregular heartbeat, which is called an arrhythmia
Lots of things can cause these problems, which include:
- coronary heart disease – this causes heart failure in seven out of 10 patients
- a heart attack
- high blood pressure (hypertension)
- an overactive thyroid gland (hyperthyroidism) or an underactive thyroid (hypothyroidism)
- heart muscle disease (cardiomyopathy) – this may be inherited or caused by other things such as an infection or pregnancy
- drinking too much alcohol or taking illegal drugs such as cocaine
Complications of heart failure
If you have heart failure, it can affect your quality of life because it’s harder to carry out everyday activities. You might have problems with other areas of your life too, such as with sex. This might be because you get tired and feel weak, or because of side-effects from the medicines you’re taking.
It can be difficult to live with heart failure. Up to a third of people with heart failure also have depression – if you feel you need support, talk to your GP. There are also support groups that give you the opportunity to get in touch with other people with heart failure. This might be a good source of advice and tips on how to cope with heart failure.
Other complications of heart failure include:
- losing weight and muscle loss, which is called cachexia
- an irregular heartbeat (arrhythmia)
- sudden cardiac death – but the number of people dying from heart failure is getting lower
Prevention of heart failure
You’re less likely to get heart failure if you have a healthy lifestyle. This includes:
- not smoking
- losing weight (if you’re overweight, of course)
- doing regular physical activity
- eating a healthy, balanced diet without too much salt
- not drinking too much – see our Related information for a guide on the limits
If you have a health condition that might cause heart failure in the future, such as high blood pressure, it’s important to get treatment. You might be able to prevent heart failure developing.
FAQ: Can I drive my car or travel with heart failure?
You may be able to carry on driving but this will depend on how serious your heart failure is. You might need to let the Driver and Vehicle Licensing Agency (DVLA) know about your condition. If your heart failure is under control, you can probably still fly.
You can drive as long as you don’t have any symptoms that could distract you. If you drive lorries or buses, you may need to have regular exercise tests to make sure you’re well enough to continue. If your symptoms are more serious, you might need to stop driving. If you feel unwell, dizzy or your symptoms get worse, don’t drive.
Most people with heart failure can fly but tell the airline that you’re travelling with beforehand. During the flight, your legs and ankles may swell and you might find it more difficult to breathe if you have severe heart failure. Try to do some stretches and walk around the cabin regularly. Places at high altitude and places that are hot or humid may make your symptoms worse.
It’s important to take your medicines as you usually would when you travel. If you’re flying, check with your airline about taking medicines on your flight. Make sure your travel insurance covers you too.
FAQ: Do I have to stop exercising if I have heart failure?
Most people with heart failure can still exercise. In fact, exercise can improve your symptoms. But it’s a good idea to talk to your GP before you start anything new.
How much you can exercise will depend on how serious your heart failure is and what treatment you’re having. If you have heart failure, keeping active may improve your quality of life because it enables you to do everyday activities more easily.
It’s a good idea to exercise as part of a rehabilitation programme. This involves going to a number of sessions that are designed to be specific to your needs. They usually involve group-based education and exercise sessions. The education sessions will give you advice and support in many lifestyle areas including managing your weight, giving up smoking, and relaxation techniques.
Speak to your GP if you’d like more information about cardiac rehabilitation programmes.
FAQ: What can I do to help ease my symptoms of heart failure?
Medicines can help but there are lots of things you can do yourself to try to manage your symptoms.
The most common symptoms people get with heart failure are breathlessness, tiredness, and swollen feet and ankles. Here are some practical tips on how to cope with these.
- If you have difficulty breathing and sleeping while lying on your back, keep yourself propped up with pillows. This should help you to breathe more easily and stop breathlessness disturbing your sleep. If you’re wheezing and coughing, cut back on salt in your diet. Too much salt makes your body hold on to more fluid than usual, which can cause congestion in your lungs and make you short of breath.
- If you feel tired all the time, pace yourself and give yourself plenty of time to do everyday activities. Try breaking up big tasks into small parts and ask for help from your friends and family.
- If you have swollen feet and ankles, don’t sit or stand for a long time. And raise your feet when you rest – use a stool or chair to rest your feet on. Wear comfortable shoes and socks that aren’t too tight. It’s also important to keep active by walking and regularly moving your legs.
FAQ: Will I need to take medicines for the rest of my life for my heart failure?
Yes, you’ll probably need to take one or more medicines for the rest of your life. They’ll help to ease the symptoms of heart failure but won’t cure your condition. Most medicines can cause side-effects and your doctor will monitor you closely. Don’t stop taking your medicines or change how much or how often you take them without speaking to your doctor first.
- Acute heart failure: diagnosis and management in adults. National Institute for Health and Care Excellence (NICE), 3 December 2015. www.nice.org.uk
- Chronic heart failure in adults. National Institute for Health and Care Excellence (NICE), 29 June 2011. www.nice.org.uk
- Chronic heart failure in adults: management. National Institute for Health and Care Excellence (NICE), 25 August 2010. www.nice.org.uk
- Heart failure – chronic. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published May 2015
- An everyday guide to living with heart failure. British Heart Foundation. www.bhf.org.uk, published 2012
- Heart failure diagnosis and investigation. PatientPlus. www.patient.info/patientplus, reviewed 19 July 2012
- Heart failure management. PatientPlus. www.patient.info/patientplus, reviewed 19 July 2012
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 15 February 2016
- Heart failure. Medscape. www.emedicine.medscape.com, published 11 January 2016
- Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. National Institute for Health and Care Excellence (NICE), 25 June 2014. www.nice.org.uk
- Cardiac rehabilitation. PatientPlus. www.patient.info/patientplus, reviewed 18 February 2011
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, Bupa Heath Content Team, March 2016.
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