Main
- Shortness of breath on exertion and at rest, swelling of the legs and rapid fatigue — a reason to see a cardiologist or a general physician.
- Heart failure is not an independent diagnosis, but a consequence of ischaemic heart disease, hypertension, valvular defects, arrhythmias, myocarditis and diabetes.
- It is more common in older people with diseases of the heart and blood vessels; in young people it occurs with valvular defects and inflammation of the muscle.
- Examination includes electrocardiography, echocardiography, chest radiography, blood tests and 24-hour ECG monitoring.
- Severe shortness of breath at rest, chest pain, fainting and pulmonary oedema require calling an ambulance, not a routine visit.
What is heart failure
Heart failure is a condition in which the heart cannot cope with pumping the required volume of blood. Let us look at what happens in the body in this case, what causes such a condition and who is affected by it more often.
What happens in the body
The heart works as a pump that moves blood through the vessels and supplies the organs with oxygen. When the muscle weakens or meets increased resistance, the pump can no longer cope with the required volume. Blood is retained in the veins before the heart, and fluid gradually accumulates in the tissues. This causes swelling in the legs, heaviness when breathing and rapid fatigue during usual exertion. The organs receive insufficient oxygen, so a person notices weakness and reduced endurance. Over time, the congestion affects the lungs, liver and other internal organs, and their function is impaired. With the first persistent swelling and shortness of breath, it is worth seeing a doctor to find out the cause of the condition.
What causes it to develop
- Coronary heart disease and a previous heart attack: an area of the muscle is damaged and stops contracting fully, so the pumping function declines.
- Hypertension: increased pressure forces the heart to work under constant overload, and the walls gradually lose elasticity.
- Heart defects: impaired structure of the valves or septa changes the blood flow and creates additional load on the chambers.
- Arrhythmias: a disturbed rhythm prevents the chambers from filling and contracting in coordination, which reduces the volume of pumped blood.
- Myocarditis or pericarditis: inflammation affects the muscle or the lining of the heart and weakens its ability to contract.
- Diabetes mellitus and other metabolic disorders: metabolic disturbances damage the vessels and the muscle, so the risk of such a condition is noticeably higher.
Who is affected by it more often
Older people who already have heart or vascular diseases are affected by this condition more often. With age, the muscle loses elasticity, and accumulated diseases weaken it further. Men and women are affected comparably often, although the causes may differ. In people with hypertension, a previous heart attack or diabetes, the risk is noticeably higher than in their peers without such diseases. The structural features of the heart, previous inflammation, as well as a hereditary predisposition also play a role. In young people, the condition occurs less often, but sometimes develops against the background of defects or inflammation of the muscle. If close relatives have had heart disease, this should be mentioned to the doctor at the appointment.
What symptoms can occur?
The symptoms of heart failure increase gradually, so it is important to notice the first changes in time and to understand when urgent medical help is needed. Below is an analysis of how the condition manifests at different stages and in which cases one must not delay.
How it is noticed at the very beginning
Breathlessness on usual physical exertion is the first sign noticed in heart failure. A person suddenly discovers that a staircase they used to climb easily now requires stopping and catching their breath. Climbing one floor or walking quickly causes a shortness of air that was not there before. Many put this down to tiredness after work, to age, or to a lack of fitness. By the evening weakness appears, and by the end of the day their usual shoes become tight because of swelling of the feet. Over time, breathlessness begins to trouble them even in a lying position, and the person has to sleep on high pillows. If such changes repeat day after day, it is worth seeing a cardiologist or a general practitioner.
Signs that occur most often
- Breathlessness on exertion or when lying down: a shortness of air occurs when walking, climbing stairs and in a horizontal position, which prevents proper rest.
- Swelling of the feet and lower legs by the evening: fluid is retained in the lower parts of the body during the day, so shoes become tight and the skin on the lower legs becomes firm.
- Rapid fatigue and weakness: ordinary tasks are harder than before, and recovery after exertion takes noticeably longer.
- Rapid heartbeat or palpitations: the heart works under increased load, and the person feels thuds, pauses or an irregular rhythm in the chest.
- Cough, sometimes with pink sputum: fluid congestion affects the airways, so a dry cough appears, worsening in a lying position.
- Enlargement of the abdomen due to fluid congestion: the abdomen grows and becomes firm, heaviness appears, which is noticeable by the clothing and by the general well-being.
When to seek help urgently
Examinations and tests
Examination for heart failure begins with a conversation and a physical examination, and is then confirmed by instrumental and laboratory methods. Below is a description of what exactly is prescribed and what information each investigation provides.
How the examination begins
The first appointment begins with taking a history of complaints and the medical history, because it is the patient's account that sets the direction for further investigation. The doctor clarifies when breathlessness appeared, how exercise tolerance is changing and whether there is swelling of the legs towards the evening. Then he examines the person, measures blood pressure and pulse, and listens to the heart and lungs. These simple actions make it possible to notice signs of congestion and rhythm disturbance even before instrumental investigations. Next, to clarify the cause and severity, electrocardiography, echocardiography, chest X-ray and blood tests are prescribed. Twenty-four-hour ECG monitoring is connected when it is necessary to catch irregularities that are not noticeable on a standard recording. Bring all previous discharge summaries and results to the appointment: this will save you from repeat investigations and speed up the review of the situation.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: all previous doctors' conclusions and investigation results, so as not to repeat what has already been done and not to lose time.
- Observation diary: short notes about when breathlessness appears, how the pulse and weight change — this helps to see the picture over time.
- List of complaints: write down in advance what bothers you and when, so that you do not forget or miss anything at the appointment.
- Blood pressure and pulse measurements: records of home measurements over several days show how the heart works in everyday life.
- Questions for the doctor: formulate in advance what you want to clarify about your condition — this way the conversation will be meaningful.
Which doctor should I see?
In heart failure, care is provided by a cardiologist and a physician. Let us look at who manages the condition, what treatment consists of, and what depends on the patient themselves.
Which specialist manages this condition
Heart failure is managed by a cardiologist, and in their absence care is provided by a physician. The cardiologist assesses how the heart works, compares the complaints with the examination, and determines which further tests are needed. The physician manages the patient when a specialist is not available nearby and, if necessary, refers them to a cardiologist. Regular follow-up with one doctor is important because the condition changes gradually and imperceptibly to the person themselves. The doctor looks at how the patient tolerates ordinary exertion, how they sleep, and whether there is swelling or breathlessness at rest. If a person stops coming to appointments, the deterioration is noticed late, when it is harder to help. Therefore, at the first signs of difficulty, make an appointment with a cardiologist, and if there is none nearby — with a physician.
What treatment consists of
- Selection of therapy by the doctor: the specialist selects the treatment taking into account the underlying disease and the patient's condition, so making the choice independently is unacceptable.
- Follow-up with a cardiologist: regular appointments allow changes in well-being to be noticed in time and the treatment to be adjusted before severe complications develop.
- Changes in lifestyle and diet: habits in eating, exertion and rest affect how the heart works, so they are reviewed together with the doctor.
- Surgery when indicated: in some cases surgical intervention helps, and the decision about it is made based on the results of the examination.
- Relief of symptoms: a separate line of work is to reduce breathlessness, weakness and swelling so that the person finds everyday life easier.
What depends on the patient themselves
Regular follow-up is the part of the result that rests on the patient themselves, and not only on the doctor. When a person comes to appointments at the appointed time, the doctor sees the course of the condition over time and notices changes in time. Missed appointments lead to the deterioration being detected late, when breathlessness and weakness already interfere with ordinary activities. Following the recommendations on diet, exertion and rest noticeably affects well-being, although the changes do not come immediately. Notes about one's condition, complaints and tolerance of exertion help the doctor assess the picture more accurately at the appointment. If something in the recommendations is unclear or inconvenient to follow, it is worth telling the doctor about it rather than changing everything oneself. A sharp change of habits without discussion rarely does any good and often ends in a return to the previous ways. Therefore, keep in constant contact with the doctor and do not postpone the visit when there are changes in well-being.
What helps prevent an exacerbation?
Everyday lifestyle and attention to your own condition help prevent the worsening of heart failure. Below are the habits, measurements and regularity of visits that reduce the risk of deterioration.
What to change in your habits
Diet and physical activity directly affect the load the heart experiences every day. Limiting salt reduces fluid retention, which causes swelling and breathlessness. Feasible physical activity trains the heart muscle and helps it work more efficiently. Giving up smoking reduces oxygen starvation of the tissues and eases the work of the heart. Moderation in alcohol is important because alcohol retains fluid and raises blood pressure. Timely treatment of infections and heart diseases prevents them from weakening the body further. If the swelling gets worse, it is worth discussing with the doctor whether it is time to limit fluid more strictly.
What should be kept under control
- Blood pressure: it is measured regularly, because a persistent increase gradually wears out the heart and blood vessels.
- Body weight: a sharp gain over a short period often indicates fluid retention, which is noticed before the swelling.
- Swelling and breathlessness: their appearance at rest or with little exertion shows that the condition is changing for the worse.
- Salt and fluid: their amount in the diet affects the volume of circulating blood and how you feel if you are prone to swelling.
- Infections and heart diseases: a cold, tonsillitis and flare-ups are treated in time so that they do not add extra strain.
- Observation diary: records of blood pressure, weight and how you feel help the doctor see the picture over time, rather than from a single day.
How often to see the doctor
Regular visits to the doctor are needed even when you feel well and nothing is troubling you. Persistent well-being does not cancel out gradual changes that a person notices late. The doctor assesses blood pressure, weight, swelling and breathlessness over time and compares them with previous observations. When the condition is stable, visits are routine, and when new signs appear they are scheduled more often. Between visits it is useful to keep records of blood pressure, weight and how you feel, so that you can show them at the appointment. If the swelling or breathlessness gets worse, do not wait for the appointed date and do not put off talking to the doctor. Such monitoring allows recommendations to be adjusted in time and reduces the risk of worsening.
What is worth remembering
Heart failure is a condition in which the heart cannot cope with the load, and paying close attention to how you feel helps to recognise it. Below are the main points worth keeping in mind after getting to know this topic.
Key takeaways
Heart failure rarely occurs suddenly in a healthy person: it is usually preceded by other heart or vascular problems that may go unnoticed for a long time. Changes in your usual stamina help to spot trouble — breathlessness on exertion that used to be easy, swelling by the evening, rapid fatigue. These signs should not be put down to age or tiredness and you should not wait for them to pass on their own: heart failure may be behind them. The earlier a person sees a doctor, the more opportunities there are to influence the course of the disease and preserve their usual way of life. Examination for heart failure does not end with a single visit: it requires repeated check-ups and follow-up over time. Much here depends on the person themselves — on how consistently they follow the doctor's recommendations. Putting off the visit and trying to cope on your own is the most common mistake in heart failure.
