Ask an expert: What are the most common symptoms of heart failure?

In this informative article, highly respected consultant cardiologist Dr Teresa Castiello shares expert insight on the most common symptoms of heart failure, a condition in which the heart doesn’t pump enough blood to meet the body’s needs. In this first instalment of her series on heart failure, Dr Castiello also discusses the causes and risk factors associated with the cardiac condition.

What are the common symptoms of heart failure?

Medical literature is submerged by information related to heart failure (HF) and this can be difficult to navigate. Heart disease is the leading cause of morbidity and mortality in the world and each heart disease can eventually evolve into HF. Heart failure is an ‘unbalanced’ condition in which the heart is no longer able to pump the adequate amount of blood to meet the body's needs.

Cardiology divides HF into 3 groups according to the strength of the pump (measured as 'ejection fraction'):

• HF with reduced ejection fraction (HFrEF)
• HF with mildly reduced ejection fraction (HFmrEF)
• HF with preserved ejection fraction (HFpEF)

Heart failure can cause a number of signs and symptoms, as listed below:

Shortness of breath

Shortness of breath is a common symptom of heart failure, especially during exertion or when lying down. This would initially occur under exertion, but may progressively present at rest when the condition progresses

Fatigue and weakness

People with heart failure often feel tired and weak, even after doing simple tasks. This is because the heart is not able to deliver enough oxygen and nutrients to the muscles.

Swelling in the legs, ankles, and feet

Swelling in the legs, ankles, and feet is a common sign of heart failure and requires prompt treatment with diuretics (water tablet and other key HF medications)

Rapid or irregular heartbeat

Feeling the heart beating rapidly or irregularly heartbeat is another common symptom of heart failure.

Reduced ability to exercise

People with heart failure often find that they are not able to exercise as much as they used to. This is because the heart is not able to pump enough blood to meet the body's needs during exercise.

Other symptoms or sign of heart failure can include:

• Coughing up pink or white, foamy mucus: This is a sign of fluid build-up in the lungs.
• Nausea and loss of appetite: any organ can be impacted by the suboptimal function of the heart
• Confusion: This is because the brain may not get enough oxygen.
• Sudden weight gain: Fluid retention can be mistaken with weight gain. If you rapidly put weight on and you notice leg swelling it may be caused by the inability of your heart to pump correctly.

What causes heart failure?

There are many causes of heart failure: some are linked to lifestyle, while others are related to congenital or genetic disease. In most cases there is a combination between genetic and environmental factors, including ethnicity and socio-economic factors which may increase your risk of developing HF.

Coronary artery disease

Coronary artery disease, also known as coronary heart disease, is one of the most common causes of heart failure. It occurs when fatty and or calcified deposits build up in the coronary arteries, which are the blood vessels that supply oxygen to the heart muscle. This deposit can narrow or block the arteries, reducing blood flow to the heart and causing lack of perfusion or even a heart attack.

Cardiomyopathy

The term cardiomyopathy represents a group of diseases that affect the heart muscle - from Greek, ‘cardio’ means heart, ‘myo’ means muscle, and ‘pathos’ refers to the disease. Cardiomyopathies can be acquired or inherited and can cause the heart muscle to become weak, thick, or stiff, they can also scar the heart. It is important to be seen by a cardiomyopathy specialist if this condition is suspected or it runs in the family.

Heart valve disease

The heart is divided in 4 chambers separated by valves which act as ‘doors’ and regulate the flow of blood through the heart. When a heart valve is damaged or diseased, the normal flow is altered causing structural changes of the heart muscle and impacting on its correct functioning.

High blood pressure

High blood pressure is a silent killer and it can damage the heart muscle, valves and the blood vessels, if not correctly controlled with lifestyle and medications.

Heart rhythm disorders

Irregular heartbeats, such as atrial fibrillation, or ventricular arrhythmias can prevent the heart from filling properly and pumping blood effectively. The rhythm disorders can either cause heart failure or be caused by heart failure itself - “the chicken or egg story”

Obesity

Obesity can also cause heart failure, and it is often related to other comorbidities such hypertension or diabetes. However, there are some studies suggesting that weight loss may reverse the damage occurring on the heart.

Toxicity, alcohol, and drugs

Recreational drugs such cocaine, for instance, may damage the heart. Elevated alcohol intake can also cause heart failure.

Medical treatment

Unfortunately, some medications and treatments, such some types of chemotherapy, may cause heart failure.

Other conditions

Other conditions that can increase the risk of heart failure include diabetes, kidney disease, anaemia, thyroid problems, autoimmune disease or cancer.

Am I at risk of heart failure?

There are some predisposing risk factors:

Age

Heart failure caused by coronary disease or hypertension is more common in older adults. On the contrary, HF cause by cardiomyopathies occurs normally in younger individuals.

Gender

Men are more likely to develop heart failure with reduced ejection fraction, while women are more likely to develop HF with preserved ejection fraction. Sadly, women are less likely to be treated in a timely fashion, or to receive advanced care compared to their male counterparts. The gender gap in heart failure is still quite relevant.

Family history

If you have a family history of heart failure or cardiomyopathy, you are at increased risk and it is important to have regular check-ups.

Ethnicity

Some ethnicities have an increased risk to develop health failure; for instance, Afro-Caribbean people have higher incidence of high blood pressure which often lead to HF.

Lifestyle factors

Smoking, obesity, a lack of physical activity, and a diet high in saturated and trans fats, and sugar and processed food can all increase your risk of heart failure.

If you would like the schedule a consultation with Dr Castiello to discuss your heart health, visit her Top Doctors profile today.