Heart failure explained: symptoms, treatment and living well

What heart failure means

Heart failure happens when the heart muscle becomes too weak or too stiff to pump blood efficiently. As a result, blood and fluid can back up into the lungs and body, and organs may not get all the oxygen they need. It usually develops gradually and is often the end result of other heart problems, such as a previous heart attack, high blood pressure, heart valve disease or an abnormal heart rhythm. Sometimes the heart muscle itself is diseased. Despite the name, it does not mean the heart has stopped or is failing completely — it means the pump is not working as well as it should, which treatment can improve.

Recognising the symptoms

The three most common symptoms are breathlessness, tiredness, and swelling of the ankles, legs or tummy caused by fluid building up. Breathlessness may come on with activity, or when lying flat, and some people wake at night gasping for air. You might notice you cannot walk as far as before, or that your shoes and rings feel tight. Rapid weight gain over a few days can signal fluid building up. Some people feel their heart racing or fluttering. Symptoms can come and go and may be mistaken for ageing or being unfit. If you notice these signs, see your GP, as early diagnosis leads to better treatment.

How it is diagnosed

If your GP suspects heart failure, they will examine you and usually arrange a blood test called BNP or NT-proBNP, which rises when the heart is under strain. If this is raised, you will be referred for an echocardiogram — an ultrasound scan of the heart that shows how well it is pumping and whether the valves are working. Other tests may include an ECG to check the heart’s rhythm, a chest X-ray and further blood tests to look for causes and check your kidneys. Getting a clear diagnosis matters, because it identifies the type of heart failure and guides which treatments will help you most.

Treatment on the NHS

Treatment aims to ease symptoms, keep you out of hospital and help you live longer. Several medicines are used together, and your team will build up the combination gradually, checking blood tests along the way. Water tablets (diuretics) help clear excess fluid and ease breathlessness and swelling. Other medicines protect and support the heart over time. Some people benefit from special pacemakers or devices. A specialist heart failure nurse often coordinates care and is a valuable point of contact. Treating the underlying cause, such as high blood pressure or a rhythm problem, is also important. Regular reviews allow treatment to be adjusted as your needs change.

Living well with heart failure

Day-to-day habits make a real difference. Weighing yourself at the same time each day helps you spot fluid building up early — tell your team if you gain weight quickly. Your team may advise watching how much salt and fluid you have. Staying gently active, ideally through a cardiac rehabilitation programme, improves stamina and wellbeing. Take your medicines as prescribed, have your annual flu jab and other recommended vaccines, and avoid anti-inflammatory painkillers unless advised, as they can worsen fluid retention. Get urgent help if breathlessness suddenly worsens or you cannot lie flat. With good self-care and support, many people manage heart failure well for years.