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Heart failure is not a single disease, but a clinical condition that affects how the heart functions.
It develops when the heart is unable to pump enough blood to meet the body’s needs.
Heart failure may be acute, meaning it appears suddenly and requires urgent medical care, or chronic, meaning it develops gradually over time with periods of worsening and improvement.
What Are the Common Symptoms?
Symptoms usually develop gradually.
What Is Ejection Fraction (EF)?
Ejection fraction, or EF, is the percentage of blood the heart pumps out with each heartbeat.
A normal ejection fraction is above 60 percent. This generally reflects normal contraction of the heart muscle.
Types of heart failure based on ejection fraction:
It is important to understand that even when EF is normal, the heart may still not function properly.
In these cases, the heart muscle may be stiff or may not fill adequately with blood. The symptoms can be similar to those seen in heart failure with reduced EF.
What Causes Heart Failure?
Heart failure may result from several causes, sometimes more than one at the same time.
Each underlying cause may require a different treatment approach. Identifying the cause is essential in selecting the most appropriate therapy!
Dr. Alon Kaplan, MD-PhD, is a cardiology fellow at Sheba Medical Center and a lecturer at Tel Aviv University.
If heart failure is suspected, the first step is to consult your doctor.
The doctor will review your symptoms and perform a physical examination.
Signs that may suggest heart failure include fluid in the lungs, leg swelling, or abnormal heart sounds.
Blood tests and an electrocardiogram (ECG) are usually performed.
If heart failure is suspected, patients are typically referred for an echocardiogram.
An echocardiogram is one of the most important tests for diagnosing heart failure.
It is an ultrasound examination of the heart performed through the chest wall.
It does not involve radiation, is non-invasive, and is painless.
The test allows doctors to evaluate:
An echocardiogram helps confirm or rule out the diagnosis, determine the type of heart failure, guide treatment decisions, and provide a baseline for follow-up.
Blood Test – BNP
BNP (B-type Natriuretic Peptide) is a blood test that supports the diagnosis of heart failure: when the heart muscle is under stress and stretch, it releases BNP, so elevated levels support the diagnosis. Importantly, it helps distinguish shortness of breath due to cardiac causes from non-cardiac causes (such as lung disease), and can also be used to assess disease severity and monitor response to treatment
Cardiac MRI is particularly useful when the cause of heart failure is unclear or when a more detailed assessment of the heart muscle is needed.
Cardiac catheterization is used when coronary artery disease is suspected.
Transesophageal echocardiography is used in selected cases to provide a more detailed evaluation of the heart valves and internal structures.
How Is Severity Assessed?
The severity of heart failure is determined by how much it limits daily activities.
Some people experience no limitation.
Others have mild or significant limitations.
In advanced stages, symptoms may occur even at rest.
Assessing severity helps guide treatment decisions and plan appropriate follow-up!
There is a strong reason for optimism.
Today, highly effective treatments are available. These therapies help people live longer, reduce hospital admissions, and improve quality of life.
In most cases, medical therapy is the most important and impactful component of treatment.
These medications:
Treatment is individualized and adjusted over time according to each patient’s condition.
Regular follow-up with a cardiologist is an essential part of care.
Follow-up visits allow for medication adjustments, early detection of worsening, and continued clinical stability.
Lifestyle, Nutrition, and Cardiac Rehabilitation
Lifestyle plays a crucial role in managing heart failure.
Recommendations include following a low-salt diet, maintaining an active, healthy lifestyle, quitting smoking, engaging in appropriately tailored physical activity, and participating in cardiac rehabilitation programs.
Healthy lifestyle habits and cardiac rehabilitation have been shown to prolong life and significantly improve quality of life.
A small proportion of patients may require device therapy, such as a pacemaker or an implantable cardioverter-defibrillator (ICD), which can treat life-threatening heart rhythm disturbances.
Most patients do not require such devices. The decision is made after careful evaluation by a cardiologist.
Advanced heart failure is relatively uncommon.
It occurs when symptoms are very severe and standard treatments are no longer sufficient, or when the condition is particularly severe from the outset.
In such cases, advanced therapies such as a mechanical heart support device or heart transplantation may be considered. These treatments are available only in specialized medical centers.
In Summary
Heart failure is a chronic condition, but it can be effectively treated and managed.
Accurate diagnosis, appropriate therapy, regular follow-up, and rehabilitation improve quality of life and extend survival.
Patients are the most important partners in the success of their treatment.
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