What Is Heart Failure?

Heart failure (HF) is a condition that affects approximately 6.5 million people in the US and 26 million people worldwide. Although, judging by the name, you might think that what happens is the heart’s complete failure to operate, something like a cardiac arrest or a heart attack, heart failure is, in fact, the heart’s chronic inability to pump as much blood as is needed for proper functioning of all biological systems.

The heart consists of four chambers: two atria (upper chambers) and two ventricles (lower chambers). While the right atrium and ventricle are responsible for enriching the blood with oxygen by pumping it to the lungs, the left two chambers are in charge of providing all organs with the oxygenated blood that comes from the lungs. The left ventricle is the part responsible for pumping and is bigger than the other three chambers, and it is in this part that HF most commonly develops. It is, thus, called left-sided heart failure and can be systolic or diastolic.

In case of systolic HF the cardiac muscle is not able to pump enough blood out of the heart. For a healthy person the normal proportion of blood pumped out of the heart per beat is between 50% and 70%, which means that however powerfully the heart beats, it never pushes all of the blood out. A lower percentage causes insufficient blood flow, increased blood pressure and fluid build-up in body tissues.

Diastolic HF means that the heart is incapable of filling with enough blood during its resting period. Although relatively the amount of blood pumped out of the heart will be higher than in systolic HF, the actual amount will still be as low.

Common Causes

Coronary artery disease (CAD) is the most common cause of heart failure. It is characterized by gradual build-up of fatty deposits on the walls of the coronary arteries, which are responsible for blood supply to the heart. Due to this, the opening in the arteries narrows, causing ischemia, or reduced blood and oxygen flow. This, in turn, leads to gradual damage of the cardiac muscle (myocardium), rendering it incapable of pumping blood as efficiently and forcefully as it should.

Heart attack. The fatty deposits building up in the arteries as a result of CAD can eventually block them completely, causing absence of blood supply and death of a part of myocardium. This leaves a clot of scar tissue in place of formerly functioning heart muscle cells and leads to a heart attack.

Hypertension. Because of the increased pressure in blood vessels, the myocardium has to pump blood more forcefully. This requires more muscle mass and, as a result, the walls thicken, leaving less space to fill with blood. In the end, thicker walls lead to their own damage, demanding more oxygen, but not being able to receive it.


Heart failure is a progressive condition, and the body has mechanisms of compensating for inefficient functioning of the heart. While at early stages there may be no symptoms, it is crucial to seek medical advice should you experience any of the following:

  • Shortness of breath. You may find it hard to do excessive physical activity or, in more severe cases, struggle to breath normally even in the state of rest. HF can also manifest itself in sudden onsets of breathlessness during sleep. Blood backs up in the pulmonary veins (the blood vessels that return blood from the lungs), which, due to high blood pressure, leads to fluid seeping through the walls and into the lungs. This leads to gradual fluid build-up in the lungs, hampers gas exchange and normal breathing.
  • Persistent coughing. It happens for the same reason as the previous symptom and is due to your body’s attempts to rid itself of the fluid in the lungs.
  • Swollen legs and ankles. Although it most commonly occurs in the lower limbs, fluid build-up is possible in other parts, like abdomen. Since the heart fails to pump blood properly, the flow slows, blood builds up in the veins and fluid seeps through the walls of blood vessels and into the tissues. Another reason of swelling is that the kidneys do not function properly due to insufficient oxygen supply.
  • Lack of appetite or nausea. It occurs due to insufficient blood supply to the digestive system and, as a result, problems with digestion.
  • Tiredness. You may have difficulty performing everyday tasks. It is caused by the body’s blood supply prioritization in favor of the brain and the heart, but at the cost of muscles and other peripheral functions.
  • Tachycardia or atrial fibrillation. This way the heart tries to compensate for improper blood flow through an increased heart rate.

Treatment and Prevention

Treatment of heart failure is built upon prescription of medications, which vary depending on the cause of the disease, as well as ongoing care and lifestyle changes. As with any heart condition, the core lifestyle changes are the following:

  • having a healthier diet
  • avoiding alcohol
  • quitting smoking
  • exercising regularly
  • maintaining healthy weight

All of the above, together with constant heart monitoring and regular check-ups with a physician, should be your main tools for averting the condition and living an active and healthy life.

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