Heart failure

Heart failure (also called congestive heart failure) might sound like the heart has stopped working, but it actually means the heart isn’t pumping as effectively as it should, making it harder for the body to receive the oxygen-rich blood it needs and causing fluid to build up.

1. The most common type - heart failure with reduced ejection fraction (HFrEF) - involves a weak heart muscle that can’t pump effectively, causing fluid to build up in the lungs, legs, or abdomen. In New Zealand, it's often caused by ischaemic heart disease (coronary artery blockages) damaging the heart muscle due to poor blood flow.
2. The other type - heart failure with preserved ejection fraction (HFpEF) - occurs when the main pumping chamber (the left ventricle) pumps blood properly but cannot relax properly, leading to breathlessness. It’s more common in people with long-term uncontrolled high blood pressure or in older patients.

Heart failure often develops slowly and worsens over time. It can be caused by various heart conditions that have led to damage, such as:

• coronary heart disease is the most common cause of heart failure
• heart attacks can damage the heart, leading to heart failure
• high blood pressure (hypertension) can cause damage that leads to heart failure
• myocarditis - inflammation in the heart muscle
• heart defects that the person was born with
• atrial fibrillation or flutter (a heart rhythm problem)
• infections and viruses

If you have heart failure, your heart is unable to pump enough blood to fulfil your body's requirements. Symptoms might develop gradually, but they can also appear suddenly. Starting the best treatment for heart failure early, at the time of diagnosis, can significantly improve quality of life and extend lifespan.

Common signs include:

• shortness of breath during activity or when lying down
• interrupted sleep due to breathlessness
• fatigue and weakness
• swelling in the legs, ankles, and feet, abdominal swelling, sudden weight gain due to
• fluid retention
• rapid or irregular heartbeat
• a persistent cough or wheeze
• nausea, loss of appetite
• difficulty focusing, decreased alertness
• chest pain if a heart attack caused the heart failure

Symptoms vary and depend on the type of heart failure.