Heart failure is a heart that pumps too weakly.
Heart failure does not mean the heart has stopped. It means the heart muscle is not pumping as well as the body needs. Blood and fluid back up behind it, into the lungs and the legs, causing breathlessness and swollen ankles. With the right medicines and daily care, many people live well with it for years.
In plain words.
The common causes are a past heart attack, years of high BP, damaged heart valves (in India often from rheumatic fever in childhood), diabetes, heavy alcohol use, and diseases of the heart muscle itself. Anaemia, thyroid problems, an irregular heartbeat or a chest infection can make it worse.
An echo measures how much blood the heart pumps out with each beat, the ejection fraction. In some people it is low (a weak pump); in others it is normal but the heart is stiff and does not fill well. Both can cause the same symptoms, and the treatment differs.
For a weak pump, several medicines taken together help the heart work better, keep people out of hospital and help them live longer. Water tablets (diuretics) clear the extra fluid and ease the breathing. They work best at the doses your doctor sets, taken every day.
Your weight each morning is the best early warning. Fluid builds up before you feel it: a quick rise on the scale often comes days before the breathlessness does.
A heart that pumps weakly
A healthy heart squeezes strongly with each beat and pushes blood out to the body. The lungs stay clear and the ankles stay slim.
The heart muscle is weak and often stretched. It squeezes feebly and pumps out less. Fluid backs up into the lungs, making you breathless, and into the legs, making the ankles swell.
Medicines help the heart pump better, and water tablets clear the extra fluid. The breathing eases and the swelling goes down; the daily medicines keep it that way.
Go to hospital now if
- Sudden or severe breathlessness, breathless at rest, or unable to lie flat: call 112.
- Coughing up pink, frothy phlegm: call 112.
- Chest pain or pressure lasting more than a few minutes: call 112.
- Fainting, or a very fast, pounding or irregular heartbeat with dizziness: call 112.
- New confusion, or lips turning blue or grey: call 112.
- An oxygen reading (pulse oximeter) below 92% at rest: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
Speak to your doctor the same day if
- Your weight goes up by more than 2 kg in three days
- Your ankles, legs or tummy swell more than usual
- You need more pillows to breathe at night, or are more breathless on your usual walk
- You pass much less urine, or feel dizzy or light-headed on standing
- You have vomiting or loose motions and cannot keep fluids down: ask whether to pause any tablets
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Echo (ultrasound of the heart) | The key test. Shows how well the heart pumps (the ejection fraction), its size, and the valves. |
| NT-proBNP or BNP blood test | A strained heart releases this hormone. A normal level makes heart failure unlikely. |
| ECG | Looks for a past heart attack, an irregular heartbeat, or a thickened heart wall. |
| Kidney function, sodium and potassium | Checked before and after starting heart failure medicines, which can change them. |
| Blood count, thyroid and HbA1c | Anaemia, thyroid problems and diabetes can cause or worsen heart failure. |
| Chest X-ray | Shows fluid in the lungs and an enlarged heart, and other causes of breathlessness. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Painkillers such as diclofenac, ibuprofen and naproxen can make heart failure worse and harm the kidneys: ask before taking any, and check with a doctor before starting any new medicine, including herbal or ayurvedic remedies. Salt substitutes (low-sodium salt) contain potassium and can be unsafe with some heart failure medicines.
A video call can
- Look for the cause, and arrange the right tests
- Adjust the medicines step by step, watching BP, kidney function and potassium
- Go through your weight record and fix the water-tablet dose with you
- Regular follow-up, alongside your cardiologist
Needs a visit in person
- Echo and ECG
- Oxygen and injected water tablets in hospital when fluid builds up badly
- Valve treatment or a special pacemaker with a cardiologist
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759