Heart failure is a chronic, progressive condition in which the heart is unable to pump blood effectively to meet the body’s needs. Contrary to how it sounds, heart failure does not mean the heart has stopped working. Instead, it means that the heart is weakened or stiffened and can’t pump or fill effectively. Millions of people are affected by heart failure globally, and early diagnosis and management are essential for improving quality of life.
Symptoms of Heart Failure
Regardless of the type, most people with heart failure experience similar symptoms due to the heart’s inability to deliver enough blood to meet the body’s demands:
- Shortness of breath (especially during activity or lying flat)
- Reduced exercise tolerance
- Persistent cough or wheezing
- Fatigue and weakness
- Swelling in the legs, ankles, and feet
- Abdominal bloatedness
- Fluid retention and weight gain
- Rapid or irregular heartbeat
What is Ejection Fraction (EF)?
Source: American Heart Association. (2025). HF and Your Ejection Fraction Explained [PDF file]. Retrieved from https://www.heart.org/-/media/Files/Health-Topics/Heart-Failure/HF-and-Your-Ejection-Fraction-Explained.pdf
Ejection fraction (EF) is a key measurement used to assess how well your heart is pumping blood. It represents the percentage of blood the left ventricle pumps out with each contraction.
- A normal EF is 50–70%
- Reduced EF is below 50% — a sign of weakened heart function/ reduced heart contractility.
- Preserved EF is 50% or above — heart failure can still occur due to increased stiffness of the heart muscle, also known as “diastolic dysfunction”.
Understanding EF helps doctors determine the type of heart failure and guide treatment options.
Types of Heart Failure
1. Heart Failure with Reduced Ejection Fraction (HFrEF)
Also known as systolic heart failure, HFrEF occurs when the heart muscle becomes weakened and cannot contract effectively, reducing the amount of blood pumped out with each beat.
EF: Typically less than 40%
Common causes:
- Coronary artery disease (CAD)
- Myocardial infarction (heart attack)
- High blood pressure
- Dilated cardiomyopathy
Symptoms: (Same as listed above)
2. Heart Failure with Preserved Ejection Fraction (HFpEF)
Also called diastolic heart failure, HFpEF happens when the heart muscle becomes stiff and does not relax properly, leading to poor filling of the heart chambers between beats. Despite a normal EF, the heart fails to meet the body’s blood demands.
EF: 50% or greater
Common causes:
- Hypertension
- Diabetes
- Obesity
- Age-related changes in the heart
Symptoms: (Same as listed above)
3. Acute vs Chronic Heart Failure
Acute Heart Failure
- Due to sudden deterioration of pre-existing heart failure and requires immediate medical attention.
- Often triggered by events such as a heart attack, arrhythmia, or severe infection.
- Symptoms can be severe and life-threatening.
Chronic Heart Failure
- A long-term condition where mild to moderate symptoms persist or progress over time.
- Worsens without proper treatment.
- Management focuses on lifestyle, medication, and monitoring to slow progression.
Treatment and Management
The management of heart failure depends on the type and severity.
Common approaches include:
Medications:
- ARNI, ACE inhibitors or ARBs (e.g. sacubitril-valsartan, enalapril, candesartan etc)
- Beta-blockers (e.g. bisoprolol, carvedilol, nebivolol etc)
- Aldosterone antagonists (e.g. spironolactone, eplerenone, finerenone)
- SGLT2 inhibitors (e.g. dapagliflozin, empagliflozin)
- Diuretics (e.g. frusemide, thiazide, tolvaptan)
- Second line agents if above medications do not work adequately or cannot be taken due to other medical conditions (e.g. ivabradine, vericiguat, digoxin etc.)
Lifestyle Changes:
- Low-sodium diet
- Regular, doctor-approved physical activity
- Weight monitoring
- Managing blood pressure, diabetes, and cholesterol
Medical Procedures for Advanced Heart Failure:
- Implantable devices (e.g., pacemakers, defibrillators)
- Ventricular assist devices (artificial heart pumps)
- Heart transplant
Conclusion
Recognising the symptoms of heart failure and understanding the role of ejection fraction are critical to early diagnosis and effective treatment. Whether you or a loved one are living with HFrEF or HFpEF, proper management can help maintain quality of life and reduce complications. Speak to a heart specialist for a thorough evaluation and personalised care.
References:
- American Heart Association (n.d.) Heart failure types and symptoms. [online] Available at: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure [Accessed 25 Mar. 2025].
- European Society of Cardiology (2021) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. [online] Available at: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure [Accessed 25 Mar. 2025].
- Mayo Clinic (2023) Heart failure: Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/heart-failure [Accessed 25 Mar. 2025].
- National Health Service (n.d.) Heart failure. [online] Available at: https://www.nhs.uk/conditions/heart-failure/ [Accessed 25 Mar. 2025].
- National Heart, Lung, and Blood Institute (n.d.) What is heart failure? [online] Available at: https://www.nhlbi.nih.gov/health/heart-failure [Accessed 25 Mar. 2025].
- American Heart Association. (2025). HF and Your Ejection Fraction Explained [PDF file]. Retrieved from https://www.heart.org/-/media/Files/Health-Topics/Heart-Failure/HF-and-Your-Ejection-Fraction-Explained.pdf
