Heart failure (manawa ngoikore)

Heart failure (manawa ngoikore) is when your heart can’t pump blood properly around your body. It is also known as congestive heart failure.

Key points about heart failure

  1. Heart failure means your heart’s pumping action is getting weaker. It doesn’t mean your heart is about to stop. 
  2. There are many conditions that can cause heart failure.
  3. 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. Your sleep may be disturbed.
  4. Symptoms can get worse and become particularly severe during a flare-up (exacerbation).
  5. Heart failure can't be cured, but there are treatments to help manage it.
  6. There are many things that you, your family/whānau and your healthcare team can do to help you feel better and stay well for as long as possible.

See your doctor 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)
  • increased swelling of ankles or abdomen (tummy)
  • coughing for no reason.

What is heart failure?

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).

Blood that is 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.

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. The term ‘congestive’ means different parts of your body collect too much fluid due to the poor circulation of blood.

Take a tour of the heart and discover how amazing it is with the interactive model below from BioDigital Human.

What are the causes of heart failure?

There are many conditions that can cause heart failure, most of them conditions that affect your heart, including:

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. Coronary heart disease 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 cannot 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.

Non-heart conditions include:

Sometimes, the cause can't be found.

What are the risk factors for heart failure?

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

What are the symptoms of heart failure?

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

  • shortness of breath with exercise or when lying flat – shortness of breath when lying down flat is caused by a build-up of fluid in your lungs
  • swelling (also called oedema) of your feet, legs or tummy
  • reduced exercise tolerance – 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 during the night
  • confusion – this may be the only sign in older adults.

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

See your doctor 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.

How are heart failure and its causes diagnosed?

Your doctor or GP 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.

  • Blood tests such as testing for electrolytes, kidney function test, full blood count, thyroid function test 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 can find out if your breathlessness is caused by another lung condition.

How is heart failure treated?

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

Treatments of 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 about how can I care for myself 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. Sometimes finetuning is needed to find the right dose and combination for you. Many of the pills 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

  • Diuretics or water pills – these medicines encourage your kidneys to remove excess fluid and salt from your body by increasing the amount of urine (pee) produced. Examples include furosemide and bumetanide.
  • ACE (angiotensin-converting enzyme) inhibitors – ACE inhibitors relax your blood vessels, making it easier for your heart to pump blood around your body. This should also allow you to do more without becoming quite so breathless or tired. Examples include enalapril, lisinopril, quinapril or cilazapril.
  • Angiotensin-II receptor antagonists – these medicines are an alternative for people who have difficulty tolerating ACE inhibitors. Examples include losartan or candesartan.
  • Digoxin helps your heart beats strongly and regularly.
  • Beta-blockers help with your heart's pumping action by slowing your heart rate and reducing your blood pressure. Examples include carvedilol and atenolol.
  • Spironolactone (an aldosterone antagonist) has a diuretic effect and may help in severe heart failure.
  • Sacubitril with valsartan – this medicine includes a combination of an angiotensin-II receptor antagonist and a neprilysin inhibitor. It is more suitable for people with more severe heart failure, whose symptoms haven’t improved despite trying other medicines.
  • Blood thinners such as warfarin and dabigatran to help stop blood clots from forming.

Your doctor or nurse 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. If that occurs, your daily life can start to be affected. Read more about advanced heart failure.

How can I care for myself with heart failure?

Managing heart failure well needs the input of your GP, who knows about any other health issues you have that affect health failure. Other healthcare team members that may be involved include a heart specialist, heart failure nurse, dietitian and pharmacist.

There are also things you can do to monitor and improve your symptoms, including:

  • having a heart failure action plan
  • weighing yourself each day at the same time
  • healthy eating
  • limiting fluids
  • getting support to stop smoking
  • limiting alcohol
  • looking after your mental health
  • staying active
  • having a healthy body weight
  • getting vaccinated regularly
  • attending regular follow-ups
  • joining a cardiac rehabilitation programme.

Read more about self-care for heart failure.

What support is available with heart failure?

The Heart Foundation NZ provides resources and support for those living with a heart condition. You can also find a local support group in your area here. Contact them using their online form or visit their website here.

Learn more

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 Heart Foundation, NZ
Staying well with heart failure Heart Foundation, NZ
Heart failure – daily checks record Heart Foundation, NZ
Heart failure HealthInfo Canterbury, NZ
Your guide to heart failure British Heart Foundation, UK
Heart failure NHS, UK
Congestive heart failure Patient Info, UK
Heart failure – explained  American Heart Association, US

References

  1. Heart failure Auckland Regional HealthPathways, NZ, 2021
  2. Managing exacerbations of heart failure Auckland Regional HealthPathways, NZ, 2021
  3. Advanced or end-stage heart failure Auckland Regional HealthPathways, NZ, 2021
  4. Heart failure diagnosis and investigation Patient Info, UK

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 20 Apr 2021