Heart Failure (HF) – a condition in which a weakened heart can’t pump enough blood throughout the body. This leads to reduced quality of life, frequent hospitalization and high mortality. Although Heart Failure, like other heart ailments, has been acquiring epidemic proportions in India in the recent past, it has not received adequate public attention.

Heart Failure usually can’t be cured, but thanks to advances in technology and drug discovery, it can be effectively managed and patients’ quality of life is improved. Coupled with appropriate lifestyle changes, the inexorable progression of the disease can even be arrested. Hence the importance of early diagnosis and treatment.


Heart Failure does not mean that heart has stopped working or is about to stop working. Heart Failure is a condition in which the heart becomes so weak that it has trouble pumping a normal amount of blood carrying enough oxygen and nutrients to meet the body’s needs. While the word ‘failure’ sounds alarming as it implies that the heart has suddenly stopped working, the medical term actually describes a chronic syndrome that typically develops slowly.

By itself, Heart Failure is not a disease. Heart Failure develops either as a result of damage to the heart muscle (caused by coronary artery disease, infection or toxic exposure to chemicals such as alcohol and drugs) or when too much strain is placed on the heart because of years of untreated high blood pressure or an abnormal heart valve.
The longer the heart must overwork to compensate for its shortcomings, the more its pumping ability is impaired. The failing pump causes blood and fluid to back up throughout the circulatory system – the lungs, legs, feet and ankles – and the kidneys retain excess water and sodium. Heart Failure is also known as Congestive Heart Failure because of such fluid buildup.


In the early stages, Heart Failure may not have any symptoms. In the later stages, the patient may have severe symptoms because the weakened heart is unable to pump enough oxygen-rich blood with each contraction to satisfy the body.

The most common symptoms are –
1. Difficulty in Breathing – Fluid back up into and around the lungs can cause shortness of breath with exercise or difficulty in breathing at rest. Some people with Heart Failure must prop themselves up with extra pillows to breathe more easily.

2. Chronic Cough – The build-up of fluid in the lungs causes the lungs to work harder. Patients may have a persistent cough or wheezing (a whistling sound in the lungs, or labored breathing).

3. Edema – Less blood to the kidneys causes fluid and water retention, resulting in swollen ankles, legs and abdomen and weight gain. Symptoms may cause an increased need to urinate during the night.

4. Loss of Appetite – Bloating in the abdomen may result in loss of appetite or nausea. Patients have the feeling of being “full,” even when they have not eaten for a long time. Their abdomen may become swollen or distended.

5. Fatigue – Less blood to major organs and muscles makes one feel tired and weak. Patients find even walking difficult.

6. Rapid or Irregular Heartbeats – The heart may speed up to compensate for its failing ability to pump blood normally. Patients may feel palpitations, or a heartbeat that seems irregular or out of rhythm. Patients often experience a pounding sensation in the chest.

7. Mental Confusion or Impaired Thinking – Abnormal levels of certain substances in the blood, such as sodium, or reduced blood flow to the brain can cause memory loss, dizziness or confusion.

8. Increase in Body Weight – Also due to accumulation of fluid.

9. Extreme Fatigue and Weakness – Due to inadequate supply of oxygen and nutrients to tissues.

10. Cyanosis (blue color of skin), low blood pressure (hypotension), cold sweating and gradual loss of consciousness are late features of CHF

In addition to the above symptoms, a physician may detect signs of Congestive Heart Failure, which may include an abnormal heart murmur caused by valve-related disorder, a crackling sound of fluid in the lungs caused by pulmonary congestion, a rapid heartbeat (tachycardia) or abnormal heart rhythm (arrhythmias), swelling and fluid retention in the liver or the gastrointestinal tract, enlargement of the heart (hypertrophy) and liver malfunction.

Heart Failure is caused by many conditions that damage the heart muscle, including –
1.Coronary Artery Disease – Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked, the heart becomes starved of oxygen and nutrients.
2.Heart Attack – A heart attack may occur when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it. The damaged heart muscle does not function properly.
3.Cardiomyopathy – Damage to the heart muscle may be caused by infections or alcohol or drug abuse, pregnancy or no apparent cause.
4.Strain on the Heart – Conditions including high blood pressure (hypertension), valve disease, thyroid disease, kidney disease, diabetes or heart defects present at birth can all cause Heart Failure.
5.High Blood Pressure (Hypertension) – Increases the workload on heart muscle.
6.Diseases of Valves of Heart – Improper functioning of heart valves leads to increased work load and stress on heart muscle.
7.Diseases of Muscle of Heart – The muscle of heart is diseased and not functioning properly. It is also known as cardiomyopathy.
8.Birth Defects of Heart – Abnormal development of heart leads to variety of structural defects, which are present since birth. Also known as congenital heart disease.

Heart Failure may be of two types – left-sided Heart Failure and right-sided Heart Failure.

Left-sided Heart Failure occurs when the left ventricle cannot adequately pump oxygen-rich blood from the heart to the rest of the body. The main symptoms include shortness of breath, fatigue and coughing. There may also be lung congestion (with both blood and fluid).

Right-sided Heart Failure occurs when the right ventricle is not pumping adequately, which tends to cause fluid build-up in the veins and swelling in the legs and ankles. Right-sided Heart Failure usually occurs as a direct result of left-sided Heart Failure. It can also be caused by severe lung disease.

Heart Failure is also defined in terms of the cardiac cycle. Systolic Heart Failure means that the heart is unable to pump adequate amounts of blood during its contraction. Lung congestion and swelling (edema) of the lower extremities are typical symptoms of systolic Heart Failure. Coronary artery disease, high blood pressure and heart valve disease cause systolic Heart Failure.

Diastolic Heart Failure refers to the heart’s inability to relax between contractions and allow enough blood to enter the ventricles. Symptoms may be identical to those of systolic Heart Failure. Diastolic Heart Failure is often a precursor to systolic Heart Failure. Coronary artery disease, high blood pressure and cardiomyopathy cause diastolic Heart Failure.