Heart Failure: Symptoms, Signs and Tips

What is heart failure?

The heart acts as a pump that sends oxygen-rich blood through the arteries to the entire body, at a rate of about five litres of blood per minute. Heart failure occurs when the heart can no longer pump enough blood to the organs for the body to work properly.

Heart failure (HF) can be left-sided or right-sided.

Left-sided HF affects the left ventricle, which is the heart's primary pumping chamber. The left ventricle is responsible for pumping oxygen-rich blood to the body.

• HF with reduced ejection fraction (or systolic HF) is a type of left-sided HF where the left ventricle is too weak to push out as much blood as it should.
• HF with preserved ejection fraction (or diastolic HF) is another type of left-sided HF where the left ventricle is too stiff making it difficult to fill with enough blood.

Right-sided HF is less common. It affects the right ventricle, which pumps oxygen-poor blood from the body into the lungs. It may be caused by a heart attack, damage to heart valves or elevated pressure in the lungs, but the main cause of right-sided HF is advanced left-sided HF.

Heart failure is sometimes called “congestive heart failure,” because blood backs up in the veins.

What causes heart failure?

Coronary artery disease and uncontrolled hypertension are the two main causes of heart failure. Other causes include:

• damaged to the heart caused by a heart attack;
• heart valve disease;
• congenital heart defect;
• infection of the heart or heart valve;
• disease of the heart muscle;
• arrhythmias.

Various conditions can increase your risk of heart failure, such as:

• Being overweight or obese;
• Type 2 diabetes;
• Smoking;
• High cholesterol;
• Metabolic syndrome;
• Sleep apnea;
• Alcohol or drug abuse.

Heart Failure Symptoms

A failing heart still works but is less efficient at its job. When blood pumped into the arteries doesn’t return quickly enough to the heart through the veins, the blood accumulates in the veins and causes edema (swelling). This swelling generally occurs in the ankles and legs, although other areas of the body can swell too. Fluid also collects in the lungs, which makes it hard to breathe and can cause shortness of breath, especially when you lie down.

The main symptoms of heart failure are:

• shortness of breath, especially when lying down;
• swelling in legs, ankles or feet;
• increased heart rate;
• fatigue;
• coughing or wheezing upon exercise or lying down;
• rapid weight gain, as the kidneys can’t get rid of extra water and sodium (salt);
• Confusion, dizziness or lightheadedness.

Symptoms vary from person to person. Well-controlled heart failure has few symptoms, whereas poor control results in more symptoms.

Heart failure classification

The New York Heart Association (NYHA) functional classification system is used to assess the limitations caused by HF. It is a useful tool for assessing how well treatment is working.

• Class I: No limitation of physical activity. Normal physical activity does not cause symptoms.
• Class II: Slight limitation of physical activity. Normal physical activity causes symptoms, but no symptoms at rest.
• Class III: Severe limitation of physical activity. Less than normal activity causes symptoms that make it difficult to perform daily activities.
• Class IV: Symptoms of HF occur even at rest, making it impossible to perform daily activities.

Can heart failure be cured?

Heart failure develops when the heart muscle is irreversibly damaged or weakened. Therefore, HF cannot be cured. However, treatment can improve symptoms and quality of life.

How is heart failure treated?

The treatment of HF includes medication and lifestyle changes.

Medication

Treatment varies depending on the type of HF. In HF with reduced ejection fraction (the most common form of HF), a combination of drugs is used to lower the heart’s workload and reduce symptoms.

Medication is used to:

• relax your blood vessels and control your blood pressure, making it easier for your heart to pump blood;
• eliminate excess water and salt, reducing shortness of breath and swelling and helping your heart work less;
• reduce your risk of hospitalization due to HF;
• slow the progression of HF;
• prolong your life and improve your quality of life.

Don’t hesitate to consult your pharmacist to learn more about your prescribed medication.

Some over-the-counter (OTC) products are contraindicated for people with heart failure because they can make your disease worse or decrease the effectiveness of your prescribed medication. Always consult your pharmacist before using any OTC products, especially:

• nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen and diclofenac;
• antacids;
• laxatives;
• cold and flu medication;
• pain medication;
• natural health products.

Healthy lifestyle

In addition to taking your medications as prescribed, you can play an active role in your treatment by making lifestyle changes. This can help improve your symptoms, slow the progression of HF, and contribute to a better quality of life.

• Don’t smoke. Smoking increases the heart’s workload. Your pharmacist can prescribe a smoking cessation aid and support you through the process.
• Exercise regularly to strengthen your heart and improve your blood circulation. To make sure your exercise regimen is adapted to your heart condition, seek support from a cardiac rehabilitation centre or an exercise specialist (e.g., kinesiologist).
• Eat a healthy and balanced diet such as the DASH diet, which is low in salt and animal fats, and high in fibres, fruits and vegetables. A registered dietician can help you improve your diet.
• Limit your daily intake of sodium (salt) as directed by your healthcare team. When cooking, replace salt with herbs and spices for flavour. At the grocery store, choose products with little or no sodium and avoid processed foods.
• Limit your fluid intake (including alcohol) as directed by your healthcare team. Too much liquid can make your heart work unnecessarily and aggravate your condition.
• Good emotional health is just as important as good physical health for your heart. Don’t hesitate to ask for help if you’re having trouble managing stress or anxiety, or if you’re feeling depressed.
• Make sure you get enough sleep and rest.
• Weigh yourself every morning at the same time, with the same scale. Sudden weight gain may be from water retention, which could mean that your heart failure is getting worse. If you notice a sudden weight gain, talk to your healthcare team immediately as your medication may need to be adjusted.

HF puts you at risk for complications from viral illnesses. Get the flu vaccine every year and the COVID-19 vaccine as recommended. If you are 50 years of age or older, be sure to get the pneumococcal vaccine at least once. Talk to your pharmacist about other vaccines that may be a good option for you (e.g., shingles, respiratory syncytial virus). 

Your pharmacist can help!

If you have any questions about your medication, seek professional advice from your pharmacist. Depending on your province of residence, they may be able to adjust your treatment to improve its efficacy or manage side effects. They can also support your efforts to improve your lifestyle.