Heart failure

Around 300,000 Australians live with some degree of heart failure. So what is heart failure, what are some of the causes, and what are the common symptoms?

What is heart failure?

Heart failure occurs when the heart isn’t working properly. The heart is made of muscle and pumps blood around the body. When the heart muscle is damaged, your heart can’t pump blood as well as it should.

Chronic heart failure (CHF) is also known as congestive cardiac failure, and sometimes it is simply called heart failure. It’s a long-term condition that can’t be cured but can be managed through a combination of medication, surgery and lifestyle changes.

What can cause heart failure?

The main causes of heart failure are:

  • heart attacks – a heart attack results in damage to your heart muscle and it can’t work as well as it did before. People tend to develop heart failure after having more than one heart attack.

  • high blood pressure –  high blood pressure (also called hypertension) means your heart muscle needs to work harder to pump blood around your body. Your heart can become thicker and stiffer due to this extra work and as a result doesn’t work as well as it should.

Other less common causes of heart failure include heart valve disease, congenital heart disease (heart problems you’re born with), and cardiomyopathy (weakening of the heart muscle).

What are the symptoms of heart failure?

When your heart isn’t pumping blood around the body as well as it should, it leads to two common symptoms of heart failure:  

  • fluid retention - as blood isn’t circulating well, fluid starts to build up in your body around your heart and lungs, as well as in your feet, ankles, and other areas of the body causing them to swell.

  • shortness of breath – the cells in your body don’t get oxygen as efficiently and effectively as they should, so you can often feel tired and breathlessness. You may notice this particularly when you’re:

    • exercising – you may need to take a break to catch your breath when you’re taking the dog for a walk or playing with the grandkids, etc.

    • sleeping – you may have difficulty breathing when lying down and need to prop your head up with a couple of pillows, or you wake up at night coughing and gasping for air.

Other common symptoms of heart failure are dizziness, sudden weight gain, angina (chest pain and tightness) and irregular heartbeat.

During the early stages of heart failure your symptoms tend to be subtle, which is why it often goes undiagnosed at this stage. But if you notice any symptoms such as breathlessness or swelling speak to your doctor. The sooner heart failure is found the more you and your doctor can do to limit its progression and improve your quality of life.

But if you notice any symptoms such as breathlessness or swelling speak to your doctor.

Man and dogs

How is heart failure diagnosed?

Your doctor may start by asking you about any of the symptoms you’re experiencing, check your pulse and blood pressure, and also listen to your heart.  To confirm a diagnosis of heart failure your doctor might carry out or refer you to a specialist to do further tests including:

  • A chest X-ray to look at the size of the heart and if there is any fluid in the lungs 

  • An echocardiogram (a type of ultrasound) to show the structure of the heart and how well it’s pumping

  • An electrocardiogram (ECG) to look at the electrical impulses within your heart.


Heart failure stages

If you’ve been diagnosed with heart failure, your doctor will classify your condition into one of four grades of severity (I – IV). It’s based on how much physical activity you’re able to do and how you’re affected by other symptoms. People with grade ‘I’ heart failure have no limitations on the amount of physical activity they can do, while those who have grade ‘IV’ heart failure have symptoms at rest, severely limiting their ability to do any activity.

New York Heart Association (NYHA) functional classification of CHF symptoms:

  • NHYA I - No symptoms, even during moderate-intensity physical activity.

  • NHYA II - Reduced physical capacity for moderate-intensity physical activity (e.g. breathlessness when climbing stairs).

  • NHYA III - Severely reduced physical capacity for low-intensity physical activity (e.g. breathlessness except when at rest).

  • NHYA IV - Symptomatic at rest.

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