Heart failure

What is heart failure?

Heart failure is a condition in which the heart muscle is unable to pump blood around the body as efficiently as it should. Despite the name, it does not mean that the heart has stopped working or is about to stop. It means the heart needs support to do its job properly, either because it has become too weak or too stiff to fill and empty normally.

Heart failure is common, affecting more than one million people in the UK, and it becomes more likely with age. It is a serious, usually long-term condition, but modern treatment has transformed the outlook. With an early and accurate diagnosis, the right medication and targeted lifestyle changes, most people can control their symptoms, stay out of hospital and continue doing the things they enjoy.

Doctors often describe heart failure by how much blood the heart pumps out with each beat, known as the ejection fraction. In heart failure with reduced ejection fraction, the pumping chamber has become weak. In heart failure with preserved ejection fraction, the heart pumps reasonably well but is stiff and does not fill properly. The distinction matters because it guides which treatments will help you most.

Symptoms

Symptoms of heart failure develop because blood and fluid are not being moved around the body effectively. They can appear gradually over months or come on quite quickly. Common symptoms include:

• Shortness of breath, initially on exertion and, as the condition progresses, when lying flat or waking you at night
• Fatigue and finding everyday activities more tiring than they used to be
• Swelling in the legs, ankles or feet caused by fluid retention, which may be worse at the end of the day
• A persistent cough or wheeze, sometimes worse at night
• Dizziness or light-headedness
• A rapid or irregular heartbeat
• Rapid weight gain over a few days due to fluid build-up, or reduced appetite and bloating

Because these symptoms overlap with many other conditions, including asthma, anaemia and simple deconditioning, heart failure is frequently missed or diagnosed late. If you have noticed unexplained breathlessness, swelling or a step-change in your exercise tolerance, it is always worth being assessed properly.

If you experience sudden severe breathlessness, chest pain, or fainting, call 999 immediately for emergency medical attention.

Causes

Heart failure is not a single disease but the end result of anything that damages or overworks the heart muscle. The most common causes include:

• Coronary artery disease and a previous heart attack, which can leave areas of the heart muscle scarred and weakened
• High blood pressure, which forces the heart to work harder over many years until it becomes thickened or stiff
• Atrial fibrillation and other rhythm disturbances, which can both cause and worsen heart failure
• Heart valve disease, where a leaking or narrowed valve places extra strain on the pumping chambers
• Cardiomyopathy, a disease of the heart muscle itself, which may be inherited or triggered by infection, alcohol or certain treatments
• Other contributors, including diabetes, thyroid disease, obesity and sleep apnoea

Understanding the cause in your individual case is essential, because treating the underlying problem, for example restoring blood flow, controlling blood pressure or correcting a rhythm disturbance, is often the most powerful way of improving the heart's function.

Diagnosis

Diagnosing heart failure starts with listening carefully to your symptoms and your history, followed by a physical examination. We will then arrange targeted investigations to confirm the diagnosis, assess how the heart is functioning and, crucially, establish why.

Blood tests include a marker called NT-proBNP, which is released when the heart is under strain and is a key first step when heart failure is suspected. An electrocardiogram (ECG) looks for rhythm problems and evidence of previous heart damage. An echocardiogram is the cornerstone investigation: an ultrasound scan that shows the size and pumping strength of each chamber, measures the ejection fraction and examines the heart valves.

In many cases we will also recommend a cardiac MRI scan. This is Dr Assomull's particular area of expertise and provides the most detailed assessment available of the heart muscle, identifying scarring, inflammation or infiltration that other tests can miss and often revealing the underlying cause of the heart failure. Where coronary artery disease is suspected, a CT coronary angiogram may be advised.

Treatment

Treatment for heart failure has advanced enormously in the last decade. The aim is threefold: to relieve your symptoms, to keep you well and out of hospital, and to help the heart recover strength where possible.

Medication

Modern heart failure medication can substantially improve both how you feel and your long-term outlook. Depending on the type of heart failure, this may include ACE inhibitors or ARNIs, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors, a newer class of tablets with impressive results in trials. Diuretics (water tablets) relieve fluid build-up and breathlessness. Getting the combination and doses right for you, and reviewing them as your heart responds, is central to good care.

Lifestyle and daily management

Medication works best alongside targeted lifestyle changes. We will guide you on daily weight monitoring to detect fluid retention early, sensible fluid and salt intake, safe and structured physical activity, sleep quality, and reducing alcohol. Cardiac rehabilitation style exercise, tailored to your capacity, is one of the most effective treatments available for heart failure.

Device therapy and further treatment

For some people, further treatment is appropriate. This may include a special pacemaker to resynchronise the heart's contraction, an implantable defibrillator to protect against dangerous rhythms, valve intervention or coronary revascularisation. If these are relevant in your case, we will explain the options clearly and refer you to the right specialist team.

Monitoring and follow-up

Heart failure care is not a single appointment but an ongoing partnership. Regular reviews allow us to fine-tune medication, repeat imaging to track your heart's recovery and act early if anything changes.

Our integrative cardiology approach

At Cardiologist London, we treat the person, not just the pump. Alongside guideline-based medication, Dr Assomull will address the factors that drive heart failure forward: blood pressure, weight, sleep apnoea, diabetes control, alcohol, stress and inactivity. Your plan is built around your life and reviewed with you at every step, and we work closely with your GP and any other specialists involved in your care.

If you are concerned about breathlessness, swelling or a recent diagnosis of heart failure and would like a thorough, unhurried specialist assessment, book a consultation at our Harley Street clinic.