Heart Failure

Heart failure means the heart isn't pumping efficiently enough — either because the pumping chamber (left ventricle) is weakened (systolic failure, low ejection fraction) or because it can't relax and fill properly (diastolic failure, preserved ejection fraction). Causes include long-standing hypertension, prior heart attack, cardiomyopathies, valve disease, and chronic uncontrolled diabetes. The term 'failure' sounds terminal but is misleading — with modern treatment, patients often live years with good quality of life.

Breathlessness on exertion, worsening breathlessness when lying flat (needing extra pillows), waking at night gasping for air, swelling in ankles and legs, unexplained fatigue, weight gain over a few days from fluid retention, reduced exercise tolerance, and sometimes cough. Any combination of these — especially breathlessness at night or leg swelling — deserves evaluation with an echocardiogram and BNP blood test. Don't dismiss these symptoms as aging or being unfit if they've changed noticeably.

Ejection fraction (EF) is the percentage of blood the left ventricle pumps out with each beat, measured on echocardiogram. Normal is 55-70%. Below 40% is reduced ejection fraction heart failure (HFrEF) — the type where four foundational medications (ACE inhibitor/ARB/ARNI, beta-blocker, MRA, SGLT2 inhibitor) genuinely prolong life. EF 41-49% is mildly reduced. Above 50% with symptoms is preserved ejection fraction (HFpEF), treated differently. EF is a key number but not the only measure — clinical status and symptoms matter equally.

Modern heart failure care uses four foundational drug classes together for HFrEF: an ACE inhibitor or ARB (or newer ARNI like sacubitril-valsartan), a beta-blocker (carvedilol, bisoprolol, metoprolol succinate), a mineralocorticoid receptor antagonist (spironolactone, eplerenone), and an SGLT2 inhibitor (dapagliflozin, empagliflozin). All four together reduce mortality significantly. Many patients in India are under-treated with only one or two of these — ask your cardiologist about the full combination. Diuretics (furosemide, torsemide) are added for fluid overload symptoms.

Salt restriction (under 2 g sodium per day, roughly 5 g of salt), fluid restriction if instructed (usually 1.5-2 L/day in advanced cases), daily weight monitoring at home (a gain of 2 kg over 2-3 days signals fluid retention needing action), regular gentle physical activity (cardiac rehab where available), influenza and pneumococcal vaccinations, no smoking, and strict control of underlying conditions (BP, diabetes, cholesterol). Alcohol should be limited or avoided depending on the cause of heart failure.