Heart failure | Manawa ngoikore

Key points about heart failure

  • Heart failure (manawa ngoikore), or congestive heart failure, is when your heart can’t pump blood properly around your body.
  • It means your heart’s pumping action is getting weaker, not that it's about to stop. 
  • Symptoms develop slowly and can vary. They include shortness of breath, swelling of your ankles, legs or tummy, tiredness and being less able to exercise. 
  • Heart failure can't be cured, but there are treatments to help manage it.
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Heart failure (manawa ngoikore) is when your heart can’t pump blood properly around your body. It's also known as congestive heart failure.

  • Heart failure means your heart’s pumping action is getting weaker. It doesn’t mean your heart is about to stop. 
  • There are many conditions that can cause heart failure.
  • Symptoms develop slowly and can vary. They include shortness of breath, swelling of your ankles, legs or tummy, tiredness and being less able to exercise. 
  • Symptoms can get worse and become particularly severe during a flare-up (exacerbation).
  • Heart failure can't be cured, but there are treatments to help manage it. 
  • There are many things that you, your whānau and your healthcare team can do to help you feel better and stay well for as long as possible.

See your healthcare provider or go to the nearest emergency department if you or someone you care for has heart failure and experiences the following:

  • sudden chest pain that lasts more than a few minutes
  • sweating and weakness
  • more shortness of breath than usual despite following action plan steps
  • feeling very unwell
  • dizziness, fainting or blackouts
  • fever (a high temperature – above 38°C)
  • increased swelling of ankles or abdomen (tummy)
  • coughing for no reason.

Your heart has 4 chambers with muscular walls. The upper chamber on each side is called an atrium (left and right atrium). The lower chambers are ventricles (left and right ventricle).

 

Image credit: Medical gallery of Blausen Medical 2014(external link)

Blood that's low in oxygen returns from your body and is collected in the right atrium and then shunted to the right ventricle. The right ventricle then pumps this blood to your lungs to pick up oxygen. Oxygen-rich blood from your lungs returns to your left atrium and passes into the left ventricle. The left ventricle then does the most work, pumping oxygen-rich blood to your entire body.

Every minute your heart pumps 4–6 litres of blood around your body. When you are active, this increases a lot.

Heart failure occurs when your heart can’t pump blood properly around your body. It doesn’t mean your heart is about to stop – it just means your heart’s pumping action is getting weaker.

Video: What goes wrong in heart failure - www.heartfailurematters.org

Watch this video about what goes wrong in heart failure. It may take a few moments to load. 
(Heart failure matters, UK, 2012)

Heart failure can affect one side or both sides of your heart. The condition gets worse over time as your heart's pumping action becomes weaker. When your heart stops pumping blood properly, fluid starts to build up in different parts of your body, causing symptoms such as swelling of your feet, shortness of breath and tiredness. If you have congestive heart failure the term ‘congestive’ means that different parts of your body collect too much fluid due to the poor circulation of blood.

Symptoms of heart failure develop slowly and can vary from person to person. They include:

  • shortness of breath with exercise or when lying flat (this is caused by a build-up of fluid in your lungs)
  • swelling (also called oedema) of your feet, legs or tummy
  • reduced ability to exercise – climbing stairs or walking may leave you tired, weak and short of breath
  • rapid heartbeat
  • tiredness or fatigue
  • weight gain due to fluid build-up
  • cough that is worse when lying down, and you may produce coloured sputum
  • loss of appetite or nausea
  • dizziness
  • a need to pee (urinate) during the night
  • confusion – this may be the only sign in older adults.

Your symptoms can get worse and be particularly severe during a flare-up or exacerbation. Read below about heart failure flare-up and how to manage it.

See your healthcare provider or go to the nearest emergency department if you or someone you care for has heart failure and experiences the following:

  • sudden chest pain that lasts more than a few minutes
  • sweating and weakness
  • more shortness of breath than usual despite following action plan steps
  • feeling very unwell
  • dizziness, fainting or blackouts
  • fever (high temperature)
  • increased swelling of your ankles or abdomen (tummy)
  • coughing for no reason.

Many conditions can cause heart failure. Most of them are conditions that affect your heart.

Heart conditions that can cause heart failure

Coronary heart disease is the most common cause of heart failure. Coronary heart disease describes the blockage of the blood vessels that supply your heart. It includes heart attack (where the blockage occurs suddenly) or angina (chest pain due to reduced blood flow to your heart muscles). Coronary heart disease can cause scarring of your heart muscles and weaken your heart’s pumping action.

High blood pressure can put extra strain on your heart, as your heart needs to pump harder. Over time, your heart muscles can be damaged and your heart’s pumping action can get weaker.

Cardiomyopathy is a disease of the heart muscle itself. It commonly refers to an abnormally large, baggy heart that can't pump well enough. It can be caused by some viral infections or drinking too much alcohol.

Myocarditis is the inflammation or infection of the heart muscle. This is commonly caused by a virus (including COVID-19) and may lead to heart failure, especially of the left side of your heart.

Other conditions that can cause heart failure

Sometimes, the cause can't be found.

You are at higher risk of developing heart failure if you:

A flare-up is when your heart failure symptoms suddenly get worse. This might include increased shortness of breath, increased swelling of your ankles or tummy or worsening cough. A flare-up might be triggered by an infection, but there may be no apparent reason. A flare-up is also known as an exacerbation.

Each flare-up can make your heart weaker. It's a common cause of admission to hospital. It's important to be prepared and know how to recognise the symptoms of a flare-up and what to do when they happen.  

What are the causes of a flare-up?

A heart failure flare-up means you are retaining fluids in your body, such as in your lungs, ankles or tummy. Extra fluids can be due to a number of causes, including:

  • not taking your diuretics (water tablets) or other heart failure medicines regularly
  • recent changes in your heart failure medicines
  • an infection
  • high blood pressure
  • a heart attack 
  • a new heart rhythm problem (arrhythmia)
  • too much alcohol 
  • too much fluid and salt intake. 

Any other issue that makes your heart work harder can cause a flare-up. 

What are the signs of a flare-up?

Signs you may have a flare-up include:

  • worsening shortness of breath
  • worsening swelling of your ankles, legs and tummy
  • rapid weight gain 
  • worsening cough 
  • confusion
  • feeling very unwell generally. 

What should I do if I have a flare-up?

The best way to manage a heart failure flare-up is to have a heart failure action plan. A heart failure action plan(external link) is a written document that provides you with instructions and information on how to manage your heart failure on a daily basis, and how to recognise and cope with worsening symptoms. You can develop your heart failure action plan with your healthcare provider and fit the plan to suit how severe your heart failure is and your wishes. When you have a flare-up, follow the steps on your action plan as discussed with your healthcare provider. At each visit, you and your healthcare provider can review your plan and make adjustments as needed. 

However, having an action plan doesn't replace your healthcare provider. It means you can respond quickly and recognise symptoms that require you to seek medical attention. You should still see your healthcare provider as soon as possible after a flare-up. Tell your doctor or nurse if your symptoms don't improve after following the steps on your action plan. 

You may need to go to hospital for severe flare-ups. 

See your healthcare provider or go to the nearest emergency department if you or someone you care for has heart failure and experiences the following:

  • sudden chest pain that lasts more than a few minutes
  • sweating and weakness
  • more shortness of breath than usual despite following the action plan steps
  • feel very unwell
  • dizziness, fainting or blackouts
  • fever (high temperature)
  • increased swelling of your ankles or tummy.

How is a flare-up managed in hospital?

In hospital, your doctor will try to find out the cause of your flare-up by doing blood tests, an electrocardiogram (ECG), a chest x-ray or an echocardiogram (echo)

Treatment of a flare-up depends on the cause. It may include:

  • a higher dose of your diuretics (water pills) by mouth or you may be given the medicine through a vein instead
  • oxygen if your oxygen level is low 
  • nebulised bronchodilators to help open your airways
  • antibiotics if you have an infection 
  • pain relief medicines if you have any pain
  • treatment of heart attack such as aspirin if you have a heart attack. 

Your healthcare team will let you know what is causing your flare-up and talk to you about the best treatment option for you. 

How can I reduce the risk of a flare-up?

There are things you can to do reduce the risk of a flare-up, including:

  • getting support to quit smoking
  • getting vaccinated against the flu and pneumococcal disease
  • taking your heart failure medicines daily as prescribed by your doctor
  • monitoring symptoms such as your breathing and swelling and weighing yourself every day
  • joining a cardiac rehabilitation programme
  • attending your follow-up appointments regularly. 

Read below about self-care for heart failure. 

Your healthcare provider will ask you questions about your symptoms and your past medical history. They will also examine you, including checking your pulse and blood pressure and listening to your heart.

Some tests can be done to help diagnose heart failure and its possible causes. These include: 

  • Blood tests such as testing for electrolytes, kidney function, thyroid functionfull blood count, or a brain natriuretic peptide (BNP) test (a high BNP level suggests heart failure is likely).
  • An electrocardiogram (ECG) to check the electrical activity of your heart and for a heart rhythm that can cause heart failure.
  • An echocardiogram (echo) – an echo is an ultrasound scan of your heart and shows how each part of your heart is functioning, and how much blood is being pumped with each beat.
  • A chest X-ray – this can find out if there is fluid in your lungs and other lung conditions that can cause the same symptoms as heart failure.
  • Breathing tests such as spirometry – a spirometry test can find out if your breathlessness is caused by another lung condition.

Heart failure can’t be cured, but there are treatments available to manage your condition.

Treatments for heart failure include:

  • self-care
  • medicines
  • devices for heart failure
  • surgery, which may include a transplant procedure.

Self-care

You have an important role to play in your heart health. There are things you can do to monitor and improve your symptoms of heart failure, including eating well, stopping smoking, staying active and losing weight if you need to. Read more below about how to care for yourself with heart failure.

Medicines

Other than self-care and lifestyle changes, medicines are prescribed to control heart failure. These medicines work best if taken regularly. If you get side effects, talk to your doctor before stopping. It can take a while to find the right dose and combination for you. Many of the medicines you need to take to strengthen your heart start with a small dose and are built up gradually, depending on whether you have any side effects. 

Medicines used to control heart failure

Your healthcare provider will let you know which medicines are suitable for you.

Devices for heart failure

Devices such as pacemakers, cardiac resynchronisation therapy (CRT) and implantable cardioverter defibrillators (ICDs) help manage heart failure in some people. These devices are not suitable for everyone. Your healthcare team will let you know whether these are suitable for you.

Surgery

For some people with heart failure, an operation may help. The type depends on what is causing your heart failure. Your healthcare team will let you know whether surgery may help in your situation.

Coronary bypass surgery may be helpful if you have coronary artery disease as a cause of your heart failure. If you have problems with your heart valves, heart valve surgery may be suitable for you.

Treatment for advanced heart failure

Although treatment can help to control symptoms, heart failure can get worse over time, becoming more severe and getting to a point where treatment isn't that effective any more. Read more about advanced heart failure.

Managing heart failure well needs the input of your healthcare provider who knows about your other health issues that may affect your heart failure. Other healthcare team members that may be involved in your care include a heart specialist, heart failure nurse, dietitian and pharmacist. It can also help to involve your family/whānau in your decision making.

There are also things you can do yourself to monitor and improve your symptoms. In this section you can find out about them

Have a heart failure action plan

A heart failure action plan provides you with instructions and information on how to manage your heart failure on a daily basis and also how to recognise and cope with worsening symptoms, such as flare-ups (exacerbations).

You can develop your heart failure action plan with your healthcare provider and fit the plan to suit how severe your heart failure is and your wishes. At each visit with your healthcare provider, you can review the plan and make adjustments as needed. 

Here's an example of a heart failure action plan(external link) by the Heart Foundation NZ. 

 

Weigh yourself each day

Your doctor may recommend you do this to check whether you have any extra fluids. If you put on more than 2kg over a few days, your body is retaining fluid, not fat. Your doctor will help you work out your target weight – this is your weight with no extra fluid, and is the weight at which your body and heart work best. 

Weigh yourself every morning each day at the same time (after you have been to the toilet, before you eat or drink anything and before you get dressed). Use digital scales, and use these on a firm surface, eg, lino or tiles. Then record your weight on your heart failure action plan and remember to bring it with you to every appointment with your healthcare team.

Other than weighing yourself, you also need to check for swelling. Check whether your rings, waistband, socks or shoes feel tighter. You can also press firmly into the skin of your ankle, shin and knee with your finger. If your finger makes a dent that doesn’t quickly fill, you have swelling. 

You should also monitor any changes in your breathing. If you are more short of breath than usual or have more swelling, you are likely to retain more fluid.

Follow the steps in your action plan as discussed with your healthcare team or contact your doctor if you are concerned about any aspect of your health. 

Healthy eating 

Choosing healthier foods, such as whole grains, smaller portions, healthy fats, low-salt and less processed foods, can help you manage your heart failure or other health issues you may have. Avoiding or limiting salt is particularly important in heart failure as salt makes you retain fluid and makes it difficult to get rid of fluid from your body. Read more about healthy eating.

Limit fluids 

You should avoid having too much fluid, but you don’t need to restrict your fluids too much unless your doctor advises you to do so. Drink about the same amount each day. Remember other food may contain fluids, such as yogurts, soups, teas, ice cream or smoothies. If you are not sure how much fluid you need to have, contact your doctor.

Stop smoking

Smoking makes you even more breathless, continues to damage your heart and dramatically increases your chances of a heart attack. Ask your doctor or nurse to get support to help you quit smoking. 

Limit alcohol 

People with weak hearts don’t cope well with alcohol, even in moderate amounts. Drink only small amounts and don't binge drink. If your heart failure is caused by too much alcohol, you should not drink at all.

Look after your mental health 

You also need to look after your mental health. You might have lots of different feelings while coping with your symptoms, such as anxiety, stress or depression

Try to avoid stressful situations. If you get stressed, use relaxation techniques such as taking 6 slow, deep breaths. Doing something where you feel useful and gain a sense of achievement can help you regain balance in your life.

It also helps to have plenty of rest and get a good night's sleep, as this allows your body and mind to restore. Talking to family/whānau members can also help. If you need more support, ask your healthcare team for a referral to a psychologist or counsellor. 

Stay active 

Start exercising gently by doing a little, and slowly increase your activity as you manage more. Try walking gently around the house or down the road first. Ask your doctor or nurse about suitable exercises for you or about any exercise programmes available in your area.

Have a healthy body weight

Losing weight if you are overweight helps takes the strain off your heart and can help you feel better. If you are underweight or have a poor appetite, having foods that are higher in calories and protein, or high-energy drinks, can help boost your energy. Ask your doctor, nurse or dietitian for advice on how to reach a healthy weight.

Get vaccinated

Vaccination against the flu and pneumococcal disease is recommended as these infections can worsen your symptoms. Ask your healthcare team about getting these vaccinations, and the COVID-19 one.

Attend regular follow-ups

It is important to attend your follow-up appointments regularly. This allows your doctor or nurse to monitor your health and see how your condition is progressing, as well as review your medicines and answer any questions you may have. Bring your heart failure action plan with you so that your healthcare team can monitor and better understand what is happening for you.

Join a cardiac rehabilitation programme 

You may be advised to attend a cardiac rehabilitation group at your local hospital. These are excellent for learning more about ways to strengthen your heart again and supporting you to get more active. Some local gym's also have exercise classes for people with heart failure.

Read more about cardiac rehabilitation.

The following links provide further information about heart failure. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Heart failure(external link) Heart Foundation, NZ
Your guide to heart failure(external link) British Heart Foundation, UK
Heart failure(external link) NHS, UK
Congestive heart failure(external link) Patient Info, UK
Staying well with heart failure(external link) Heart Foundation, NZ
Heart failure – daily checks record(external link) Heart Foundation, NZ
Advanced heart failure(external link) HealthInfo Canterbury, NZ
My heart failure action plan(external link) Heart Foundation, NZ, 2016
Heart failure – what you need to know(external link) NPS MedicineWise and Heart Foundation, Australia
Heart failure – more than just your heart(external link) NPS MedicineWise and Heart Foundation, Australia
The management of chronic and acute heart failure – what patients need to know(external link) European Society of Cardiology 

Support

The Heart Foundation NZ(external link) provides resources and support for those living with a heart condition. Contact them using their online form(external link) or visit their website here.(external link)

They provide a range of resources including:

Resources

Staying well with heart failure(external link) Heart Foundation, NZ, 2019
Heart failure – daily checks record(external link) Heart Foundation, NZ, 2019
Heart failure medicines(external link) SafeRx, Waitematā DHB, NZ, 2016. Available in the following languages: English(external link)Chinese(external link)Korean(external link)Samoan(external link)
Why should I have a regular heart check?(external link) Heart Foundation, Department of Corrections, Ministry of Health, NZ, 2013
You and your ICD(external link) Heart Foundation, NZ
My heart failure action plan(external link) Heart Foundation, NZ

Apps

Fluid control app

References

  1. Heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  2. Managing exacerbations of heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  3. Advanced or end-stage heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  4. Heart failure diagnosis and investigation(external link) Patient Info, UK
  5. Heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  6. Managing exacerbations of heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  7. Advanced or end-stage heart failure(external link) Auckland Regional HealthPathways, NZ, 2021
  8. Acute exacerbation of congestive heart failure(external link) The BMJ, UK, 2020

 

Brochures

staying well with heart failure

Staying well with heart failure

Heart Foundation, NZ, 2019

heart failure daily checks record

Heart failure – daily checks record

Heart Foundation, NZ, 2019

my heart failure action plan poster heart foundation nz

My heart failure action plan

Heart Foundation, NZ

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Bryan Frost, FRNZCGP, Morrinsville

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