Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Heart failure doesn't mean the heart has stopped — it means the heart is not pumping as efficiently as it should be, causing the body to retain fluid and struggle to meet its circulatory demands. It is a serious but manageable condition, with outcomes significantly improved by early diagnosis and treatment.
The two main types are heart failure with reduced ejection fraction (HFrEF), where the heart muscle pumps weakly (ejection fraction below 40%), and heart failure with preserved ejection fraction (HFpEF), where the muscle pumps normally but stiffens and fails to fill properly between beats. A third category — HFmrEF — falls between the two. Distinguishing types is important because treatment differs. See /conditions/ejection-fraction-explained for more on ejection fraction.
Common symptoms include breathlessness (on exertion or at rest, or waking at night unable to breathe), ankle and leg swelling, persistent fatigue, reduced exercise tolerance, and in some cases a persistent cough. Symptoms tend to be gradual in onset and are frequently attributed to 'getting older' before a diagnosis is made.
The most common causes are coronary artery disease (previous heart attack damaging the muscle), long-standing high blood pressure, valve disease, cardiomyopathy (disease of the heart muscle itself), and arrhythmias such as atrial fibrillation. In some cases no clear cause is found.
Echocardiogram is the cornerstone of heart failure diagnosis, directly measuring ejection fraction and assessing which type of heart failure is present. Blood tests including BNP confirm the degree of cardiac stress. Regular monitoring with repeat echocardiograms tracks progress and the response to treatment.
No. A heart attack is a sudden blockage of a coronary artery. Heart failure is a chronic condition where the heart gradually loses pumping efficiency, sometimes as a consequence of a previous heart attack, but often from other causes.
Depending on the cause, some cases of heart failure show significant improvement with treatment — particularly when identified early and managed with appropriate medication and lifestyle changes. Some causes are more reversible than others.
A normal ejection fraction is 55–70%. Heart failure with reduced ejection fraction is typically diagnosed below 40%, though symptoms and other findings also inform the diagnosis.
Carefully calibrated exercise under medical guidance is actually beneficial in heart failure — it improves symptoms and quality of life. Unsupervised intense exercise is not appropriate; your cardiologist will advise on safe activity levels.