Heart failure means that your heart is not pumping blood around your body as effectively as it should.   Having heart failure doesn’t mean that your heart has stopped working, but that your heart needs some support to help it work better.

Heart failure a long-term condition that often gets worse over time. It can’t be cured, but with treatment and lifestyle changes, many people can have a good quality of life. It can occur at any age, but is most common in older people.

Symptoms of heart failure

The main symptoms are:

  • Shortness of breath when you are being active or at rest.
  • Swollen feet, ankles, stomach and around the lower back area.
  • Feeling unusually tired or weak.

Symptoms occur because your heart is not able to pump blood around the body efficiently. This can lead to a build-up of fluid that backs up into the lungs, which causes breathlessness. Also because the heart is not pumping properly it can cause fluid retention, leading to swelling in your legs, ankles, feet or in the small of your back or abdomen.

You may also feel extremely tired because your heart is not able to deliver enough blood and oxygen to the muscles in your body.

You should see your consultant if you begin to experience any of these symptoms.

What causes heart failure?

There are lots of reasons why you may develop heart failure. It can be sudden or it can happen slowly over months or even years.

The most common causes are:

  • heart attack – this can cause long-term damage to your heart, which can affect how well the heart can pump.
  • High blood pressure – this can put extra strain on the heart, which over time can lead to heart failure.
  • Cardiomyopathy – a disease of the heart muscle. There are different types which can either be inherited or caused by other things, such as viral infections.

Heart failure can also be caused by:

  • Damaged or diseased heart valves
  • An abnormal heart rhythm (arrhythmia)
  • Congenital heart conditions – heart problems that you’re born with
  • A viral infection affecting the heart muscle
  • Some cancer treatments such as chemotherapy
  • Excessive alcohol consumption
  • Anaemia – a lack of oxygen carrying haemoglobin or red blood cells in your blood
  • Thyroid gland disease.

Pulmonary hypertension

Heart failure can be caused by pulmonary hypertension (raised blood pressure in the blood vessels that supply your lungs). This condition can damage the right side of your heart, leading to heart failure. In some cases the pulmonary hypertension itself is caused by an existing heart condition.


Heart failure can also be caused by a rare group of conditions called amyloidosis. This is when abnormal proteins, called amyloid, build up in organs (such as the heart, kidneys and liver) and tissues, making it difficult for them to work properly. Without treatment, this can lead to organ failure.

If amyloidosis affects the heart it is called cardiac amyloidosis – or ‘stiff heart syndrome’. Cardiac amyloidosis tends to make the ventricles (the two lower pumping chambers of the heart) stiff, making it more difficult to pump blood around the body.  About 600 new cases are diagnosed in the UK every year.

How is heart failure diagnosed?

To diagnose heart failure, your doctor will ask you questions about your medical history, talk about your symptom(s) and do a physical examination. This will include checking your heart rate and rhythm, taking your blood pressure, and checking if you have fluid in your lungs, legs and other parts of your body. In most cases you will also have further tests to confirm the diagnosis and guide how your symptoms are controlled.

You may hear your doctor talk about the ‘ejection fraction’ of your heart. This refers to the amount of blood that is pushed out of your left ventricle every time your heart beats. It’s usually expressed as a percentage – over 50% is considered normal.

Some people with heart failure have a normal ejection fraction, so ejection fraction is used alongside other tests to help diagnose heart failure.


While there isn’t a cure for heart failure at the moment, the treatments available help to control symptoms leading many people to live full and active lives.
Your doctor is likely to prescribe drugs that will help to improve your symptoms, keep you as well as possible, help prevent your condition from getting worse and help to improve your life expectancy.

Some people with heart failure will benefit from a pacemaker or ICD, which help to improve the pumping action of your heart. Your consultant will talk to you about these treatments if they are the right option for you.