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 body fat, insulin resistance and type 2 diabetes 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 in trials weight loss and exercise let people with the stiff type do more.
What you can do
- Food. Reducing sugar and ultra-processed food helps most people. Build meals with plenty of protein and non-starchy vegetables, with starchy carbohydrate reduced or personalised. 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. See the Metabolic Health 28 Day Plan at healthshelf.org/28-day-plan.
- 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 snore loudly or wake unrefreshed, ask about sleep apnoea, as it can be treated.
- Weight, alcohol and smoking. Reaching a healthier weight, cutting down alcohol and not smoking all help.
Medicines
Four types of medicine improve survival and ease symptoms when the heart muscle is weak. They are usually started together, then built up at a pace that suits you. Two of them also help when the heart is stiff, and one, the SGLT2 inhibitor, works whether or not you have diabetes. Weight-loss injections may be considered if you have the stiff type and obesity. 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.