Content discussed in this post
What heart failure is
Symptoms and warning signs
Most common causes and factors that worsen the condition
How the diagnosis is made
Useful classifications: ejection fraction and symptom severity
Treatment: medications, devices, lifestyle, and rehabilitation
Exacerbations and decompensations: what to do
Living well with heart failure
Quick FAQ
Important notice (health disclaimer)
References and recommended reading
What heart failure is
Heart failure (HF) is a clinical syndrome in which the heart cannot pump enough blood for the body’s needs, or does so only at the cost of high filling pressures that lead to congestion. The result is shortness of breath, swelling, fatigue, and activity limitation. HF can develop chronically and progressively, or acutely worsen due to an intercurrent event such as infection, myocardial infarction, or uncontrolled blood pressure.
Symptoms and warning signs
Symptoms vary in intensity and may gradually worsen. Seek evaluation if you notice:
Shortness of breath with exertion, when lying flat, or sudden nighttime breathlessness
Swelling in legs and ankles, rapid weight gain from fluid retention
Fatigue, weakness, and reduced exercise tolerance
Cough or wheezing, especially at night
Dry mouth, poor appetite, a feeling of abdominal fullness
Fast or irregular heartbeat
In advanced cases, bluish lips or fingers, dizziness, or fainting
Red flags for urgent care: shortness of breath at rest, chest pain, confusion, sudden marked swelling, low blood pressure with severe dizziness.
Most common causes and factors that worsen the condition
HF has many origins. Frequent causes include:
Coronary artery disease and prior myocardial infarction
Long-standing hypertension
Valvular disease, for example aortic or mitral
Familial or idiopathic cardiomyopathies
Chagas disease in endemic regions
Arrhythmias such as persistent atrial fibrillation
Toxins: excessive alcohol, some chemotherapies
Metabolic and endocrine disorders such as diabetes and thyroid disease
The condition worsens with high salt intake, use of common nonsteroidal anti-inflammatory drugs, respiratory infections, anemia, sleep apnea, blood pressure out of target, and stopping medications.
How the diagnosis is made
Diagnosis combines history, physical exam, and complementary tests that confirm congestion and cardiac dysfunction.
Echocardiogram: core test. Reports left ventricular ejection fraction (LVEF), chamber sizes, valve function, and estimated pressures.
BNP or NT-proBNP: biomarkers of cardiac wall stress that help distinguish HF from other causes of dyspnea.
ECG and chest X-ray: assess rhythm, hypertrophy, and pulmonary congestion.
Laboratory tests: kidney function, potassium, sodium, iron and ferritin (iron deficiency is common), TSH, glucose, and lipid profile.
Selected cases: cardiac MRI, exercise or cardiopulmonary testing, coronary angiography, sleep testing for apnea.
Useful classifications: ejection fraction and symptom severity
Two frameworks guide daily management.
By ejection fraction (LVEF)
HFrEF: reduced LVEF, less than 40%
HFmrEF: mildly reduced LVEF, roughly 41 to 49%
HFpEF: preserved LVEF, 50% or more, with congestion signs and diastolic dysfunction
By symptom limitation (NYHA)
I: no limitation with usual activities
II: symptoms with moderate exertion
III: symptoms with light exertion
IV: symptoms at rest or with any activity
These are not fixed stages. With adequate treatment, a person may improve in class.
Treatment: medications, devices, lifestyle, and rehabilitation
Treatment is individualized. In HFrEF, care usually combines four foundational medication pillars, plus general measures for all patients.
Foundational medications
Renin–angiotensin system inhibition
ACE inhibitors (ACEi) or ARBs reduce mortality and hospitalizations.
Sacubitril–valsartan (ARNI) often replaces ACEi or ARB for additional benefit.
Beta-blockers
Common options: carvedilol, bisoprolol, metoprolol succinate. They protect the heart, reduce arrhythmias, and improve survival.
Mineralocorticoid receptor antagonists
Spironolactone or eplerenone lower hospitalizations and mortality. Monitor potassium and kidney function.
SGLT2 inhibitors
Dapagliflozin or empagliflozin improve symptoms and reduce admissions. There is benefit in HFpEF as well.
Other medications according to profile
Loop diuretics such as furosemide for relief of congestion
Ivabradine if sinus rhythm remains fast despite beta-blocker
Hydralazine plus nitrates in selected cases, useful when ACEi or ARNI are contraindicated
Intravenous iron when iron deficiency is present with symptoms
Anticoagulation when there is a specific indication, such as atrial fibrillation
Devices and procedures
ICD (implantable cardioverter-defibrillator) to prevent sudden death in HF with very low LVEF and defined criteria
CRT (cardiac resynchronization therapy) when bundle branch block and dyssynchrony are present, improving symptoms and survival
Valve repair or replacement by catheter or surgery when indicated
Advanced circulatory support and transplantation for refractory HF
Lifestyle and rehabilitation
Education and self-care: daily weights, symptom tracking, simple green–yellow–red action plans
Diet: less salt, attention to ultra-processed foods, hydration guided by the care team
Physical activity: supervised cardiac rehabilitation improves functional capacity and quality of life
Vaccines: influenza and pneumococcal vaccines reduce infections that decompensate HF
Sleep: screen and treat sleep apnea
Avoid common NSAIDs, excess alcohol, and drugs that impair cardiac function
Exacerbations and decompensations: what to do
Warning signs include a 2 to 3 kg weight gain over a few days, worse than usual breathlessness, increasing edema, and nighttime cough.
Practical steps:
Adjust diuretic according to a prearranged plan with your team
Check adherence to medications, salt, and fluid intake
Look for triggers such as infection, arrhythmia, or blood pressure off target
Seek urgent care if there is breathlessness at rest, chest pain, confusion, or low blood pressure
In hospital, management includes intravenous diuretics, vasodilators in selected cases, ventilatory support, and treatment of the trigger.
Living well with heart failure
With a structured plan, many people maintain productive routines. Tips that make a difference:
Keep a simple medication and schedule list
Use phone reminders and pill organizers
Agree with family on warning signs that merit contacting the care team
Keep regular appointments and bring notes on symptoms and weight
Care for mental health. Anxiety and depression are common and treatable
For trips or surgeries, talk to the team in advance to adjust medications and prevent thrombosis
Quick FAQ
Is heart failure curable?
It depends on the cause. Some conditions improve substantially with treatment or valve repair. Others are managed long term with prevention of decompensations.
Is HFpEF “milder”?
Not necessarily. A normal ejection fraction does not mean mild symptoms. Management is active, with SGLT2 inhibitors, blood pressure control, diuretics, and rehabilitation.
Can I exercise?
Yes, with guidance. Cardiac rehabilitation is safe and improves fitness and quality of life.
Do diuretics cause dependence?
No. Frequent adjustment reflects clinical need. The goal is to relieve congestion without dehydration or low potassium.
Should I eliminate salt completely?
The recommendation is reduction, not total elimination. The balance is defined with your care team.
Important notice (health disclaimer)
This content is educational and does not replace medical consultation. Signs of decompensation require evaluation. Treatment must be individualized based on tests, comorbidities, and patient preferences.
References and recommended reading
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145:e895–e1032.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–3726.
NICE. Chronic heart failure in adults: diagnosis and management (NG106). London: NICE; updated 2021.
McMurray JJV, Packer M, Desai AS, et al. Angiotensin–neprilysin inhibition vs enalapril in HFrEF (PARADIGM-HF). N Engl J Med. 2014;371:993–1004.
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in HFrEF (DAPA-HF). N Engl J Med. 2019;381:1995–2008.
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in HFpEF (EMPEROR-Preserved). N Engl J Med. 2021;385:1451–1461.
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in HFpEF (DELIVER). N Engl J Med. 2022;387:1089–1098.
Cochrane Heart. Heart failure reviews: ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and intravenous iron.
