Heart Failure

Heart failure does not mean the heart has stopped. It means the heart muscle is too weak or stiff to pump enough blood for the body's needs. It is a chronic, manageable condition — modern treatment has dramatically improved outcomes.

Common causes

• Coronary artery disease / previous heart attack.
• Long-standing high blood pressure.
• Diabetes.
• Rheumatic heart disease and other valve disease — still major causes in India.
• Cardiomyopathy — primary disease of the heart muscle.
• Viral infection of the heart (myocarditis).
• Alcohol — sustained heavy use damages heart muscle.
• Thyroid disease, severe anaemia, arrhythmias.

Symptoms

• Breathlessness — first with exertion, then lying flat, eventually at rest.
• Waking at night short of breath; needing extra pillows to breathe.
• Tiredness, reduced exercise tolerance.
• Swelling of ankles, legs, or abdomen.
• Persistent dry cough, sometimes with frothy phlegm.
• Weight gain over days from fluid retention.

Red flags — dial 112

• Severe breathlessness at rest.
• Inability to lie flat, gasping for air.
• Bluish lips or fingertips.
• Fainting or severe chest pain.
• Coughing up pink frothy sputum.

Diagnosis

Physical examination, ECG, chest X-ray, ECHO (key test — shows pump function), blood tests including BNP/NT-proBNP, and sometimes stress tests or coronary angiography.

Treatment — daily, for life

• Medicines — multiple classes, taken daily; together they reduce symptoms, admissions and deaths. Generic versions widely available.
• Salt and fluid limits — as advised; over-drinking water worsens symptoms.
• Weigh daily — a rise of more than 2 kg over 2-3 days suggests fluid build-up; call a Health Expert before it worsens.
• Low-intensity regular exercise — as tolerated; cardiac rehab programmes help.
• Vaccines — annual flu vaccine, pneumococcal vaccine.
• Devices (pacemaker, ICD, CRT) for selected patients.
• Heart transplant — end-stage disease; available in select Indian centres.

Self-management tips

• Never stop heart-failure medicines on your own — stopping usually causes rapid worsening.
• Avoid NSAID-type anti-inflammatory painkillers — they worsen fluid retention; ask a Health Expert about alternatives.
• Treat infections (including winter flu) early.
• Quit smoking and alcohol.
• Keep a list of your medicines with you at all times.