Heart Failure: Symptoms, Diagnosis, Treatment, and Life Expectancy

Heart failure is a condition in which the heart does not function properly due to various causes. As a result, the heart can no longer pump blood through the blood vessels into the body quickly or forcefully enough.

Medical professionals classify heart failure into different forms based on various characteristics:

• acute or chronic
• left- or right-sided heart failure
• systolic or diastolic heart failure
• based on symptoms, into different degrees of severity

If heart failure begins suddenly within a few hours or days, it is considered acute heart failure.

Anatomy of the human heart © bilderzwerg | AdobeStock

Heart failure is considered chronic if the condition develops over months or even years.

In chronic heart failure, the body can compensate to a certain extent for the heart’s reduced function. For example, the heart muscle may thicken to increase its pumping capacity. An increased heart rate can also help compensate for heart failure.

Patients with compensated heart failure often experience symptoms only during strenuous physical activity. In contrast, symptoms of decompensated heart failure occur even at rest or during minimal physical exertion.

If the left side of the heart is responsible for the heart failure, it is referred to as left-sided heart failure. In this case, blood backs up in the pulmonary circulation.

In right-sided heart failure, the right side of the heart is affected. This leads to blood congestion in the systemic circulation.

Global heart failure presents with symptoms of both forms.

If the heart muscle’s pumping function is impaired, this is known as systolic heart failure (heart muscle weakness). If, on the other hand, the heart does not fill sufficiently despite normal pumping function, this is referred to as diastolic heart failure.

The New York Heart Association (NYHA) has developed criteria for classifying heart failure into stages/severity levels:

1. In Stage I, there are no symptoms during normal physical activity
2. In Stage II, there are mild symptoms (shortness of breath and weakness) during normal physical exertion, as well as reduced exercise tolerance
3. In Stage III, there is a significant reduction in exercise capacity during routine physical activity
4. In Stage IV, shortness of breath occurs even at rest

Heart failure develops as a result of conditions that cause long-term damage to the heart. 

The most common cause is coronary artery disease (CAD). It is often the cause of a heart attack, in which the heart no longer receives enough oxygen due to narrowed coronary arteries.

High blood pressure is also a common cause. In this case, the heart must work harder, which the body cannot sustain over the long term.

Other causes may include the following conditions:

• Heart valve diseases
• Heart rhythm disorders 
• Myocarditis, as well as
• Other diseases of the heart muscle and lungs

Symptoms depend on the stage and cause of heart failure.

Typical symptoms of left-sided heart failure include:

• Cough and shortness of breath, as well as
• fluid buildup (edema) in the lungs

Right-sided heart failure typically causes edema in the tissues, particularly in the legs and abdomen. 

Shortness of breath is also possible. In advanced stages, symptoms such as severe shortness of breath occur even at rest. Exercise tolerance is reduced, and frequent nighttime urination is also a typical symptom.

Through the medical history (patient interview) and physical examination, the doctor obtains initial indications of existing heart failure.

Further tests include:

• ECG (e.g., stress ECG or Holter monitoring),
• blood pressure measurement,
• blood tests,
• chest X-ray, and
• an ultrasound of the heart

A doctor performs a resting ECG. An ECG records the heart’s electrical activity and reveals pathological changes © Gennadiy Poznyakov / Fotolia

Heart failure is incurable. Therefore, the goal of treatment is to alleviate symptoms and prevent complications. Even if the patient has no symptoms, they must begin treatment for heart failure.

Treatment depends on the cause and severity of heart failure.

Depending on the underlying condition, medications are often used:

• ACE inhibitors lower blood pressure
• Beta-blockers prevent arrhythmias
• Diuretics promote fluid excretion, and
• Digitalis preparations improve the heart’s pumping power

For patients with life-threatening arrhythmias, an implantable cardioverter-defibrillator (ICD) may be used. A biventricular pacemaker can also help compensate for heart failure.

If the condition continues to worsen despite medication and invasive heart failure therapy, a heart transplant may be necessary.

The prognosis for heart failure is good in the following cases:

• If the heart muscle weakness responds to treatment
• If the patient follows the doctor’s instructions, and
• If they reduce any risk factors, for example by making lifestyle changes

Specialists in heart failure are cardiologists (doctors specializing in heart diseases). For further diagnosis or specific treatment of heart failure, it may be necessary to consult additional specialists, such as:

• Radiologists
• Vascular and cardiac surgeons, as well as
• Transplant physicians
• Specialized clinics for heart failure are usually cardiology clinics