What it is
Heart failure is a condition where the heart cannot pump blood around the body, or fill with blood, as well as it should. It does not mean the heart has stopped, but that it is struggling to keep up. Fluid can then build up in the lungs and the legs. In some people the heart muscle has become weak. In others it pumps well but has become stiff.
Symptoms to look out for
- Breathlessness, at first when active, later when lying flat or at night
- Tiredness, and being able to do less than before
- Swelling of the ankles, legs or tummy
- Putting on weight quickly, caused by fluid
Heart failure is confirmed with a blood test and an ultrasound scan of the heart.
What causes it
Heart failure usually follows something that has damaged or overloaded the heart over many years. Common causes are narrowed arteries supplying the heart, a heart attack, long-standing high blood pressure, heart valve problems, and an irregular heartbeat. The stiff type is closely linked to carrying extra weight, type 2 diabetes and high blood pressure. Age and previous heart disease also add to the risk.
Improving metabolic health eases the load on the heart
Extra fat inside the tummy, insulin resistance and type 2 diabetes all make the heart stiffer and inflamed, and make it work harder. Insulin resistance is where the body's cells respond less well to insulin. Some specialists describe the stiff type of heart failure as partly a metabolic disease of the heart. These causes can be improved, and doing so can ease symptoms.
What you can do
- Food. Build meals around a good portion of protein, plenty of non-starchy vegetables and natural fats, and personalise and possibly reduce starchy foods. Talk to your heart team before making a big change, as salt and fluid need separate thought. Avoid low-sodium salt substitutes, as they contain potassium.
- Movement. Ask about cardiac rehabilitation, a supervised exercise programme built around what you can manage. It improves symptoms and how you feel day to day.
- Sleep and stress. Aim for 7 to 9 hours of sleep. If you stop breathing during sleep, ask for this to be treated.
- Weight, alcohol and smoking. Reaching a healthier weight, cutting down alcohol and not smoking all help.
Medicines
Four types of medicine improve symptoms and survival when the heart muscle is weak. They are usually started together at low doses, then built up slowly. One of them, called an SGLT2 inhibitor, also helps when the heart is stiff, and works whether or not you have diabetes. Water tablets clear excess fluid and ease breathlessness. Blood tests check your kidneys.
When to get help
- Go to your regular reviews, usually at least every 6 months, and talk to your doctor before changing your diet, salt or fluid.
- Tell your doctor promptly if you put on weight quickly, your swelling increases, or your breathlessness gets worse.
- Sudden, severe breathlessness needs emergency help.