Heart failure and its causes

Heart failure is a complex clinical syndrome of symptoms and signs that suggest impairment of the heart as a pump to support physiological circulation. As a result, the cardiac output is insufficient to meet the demands of the body. Initially patients may tolerate small declines in cardiac output as various compensatory measures are activated to redress the balance. Over time, however, these compensatory measures become detrimental to heart function and lead to worsening cardiac output.

There are many reasons why a patient may develop heart failure. In the UK common causes include heart attacks (because of damage to heart muscle), undetected and uncontrolled high blood pressure, heart valve disease, disease of the cardiac muscle itself and sometimes-excess alcohol or toxicity from other medications.

Symptoms of heart failure

Recognition of the symptoms of heart failure will help to identify people not yet diagnosed or assess the symptom control for those known to have heart failure. Typical symptoms of heart failure include: 

• Shortness of breath (dyspnoea) at rest or on exertion 
• Cough with frothy sputum
• Swelling of the feet and legs secondary to fluid retention (oedema)
• Difficulty sleeping at night – unable to lie flat in bed and night-time waking due to breathlessness or cough (known as paroxysmal nocturnal dyspnoea)
• Chronic lack of energy
• Swollen or tender abdomen with loss of appetite
• Increased urination at night
• Confusion or impaired thinking/memory 
• Fast heart rate or palpitations.