Heart Failure

Heart failure (HF) occurs when the heart cannot pump enough blood to meet the body’s needs or cannot fill properly between beats. It often results from damage due to heart attacks, hypertension, or cardiomyopathy. Early recognition and guideline-directed therapy can dramatically improve survival and quality of life.

Types

• HFrEF (reduced EF): Left ventricular ejection fraction (LVEF) ≤ 40%
• HFmrEF: LVEF 41–49% with structural/functional abnormalities
• HFpEF (preserved EF): LVEF ≥ 50% with diastolic dysfunction
• Right-sided HF from pulmonary hypertension or lung disease

Causes & Risk Factors

• Coronary artery disease, prior myocardial infarction
• Hypertension, valvular disease, congenital heart defects
• Diabetes, obesity, CKD, sleep apnea
• Viral myocarditis, genetic cardiomyopathies
• Alcohol/drug toxicity, chemotherapy agents

Symptoms

• Shortness of breath on exertion or lying flat (orthopnea)
• Fatigue, weakness, reduced exercise tolerance
• Swollen ankles/legs, rapid weight gain
• Frequent nighttime urination, abdominal bloating
• Persistent cough or wheezing with white/pink sputum
• Palpitations, dizziness, confusion (low perfusion)

Seek emergency care for sudden severe breathlessness, chest pain, fainting, or rapid swelling.

Diagnosis

• Physical exam: jugular venous distention, crackles, edema
• BNP/NT-proBNP levels correlate with HF severity
• Echocardiogram for ejection fraction, valve function, structural issues
• ECG, chest X-ray, cardiac MRI when needed
• Stress testing/angiography to evaluate ischemia
• Blood tests for anemia, thyroid disease, renal function, electrolytes

Treatment & Management

Lifestyle

• Daily weight monitoring; report gains >2 lbs in a day or 5 lbs/week
• Low-sodium diet (1.5–2 g/day) and fluid restriction if advised
• Limit alcohol, quit smoking, maintain healthy weight
• Regular, moderate-intensity exercise or cardiac rehab

Medications (HFrEF)

• ARNI (sacubitril/valsartan) preferred over ACE/ARB
• Beta-blockers (carvedilol, metoprolol succinate, bisoprolol)
• Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
• SGLT2 inhibitors (dapagliflozin, empagliflozin) for all EF ranges
• Loop diuretics for congestion; thiazide add-on if resistant
• Hydralazine/isosorbide dinitrate in African American patients or ACE/ARB intolerance

Devices/Procedures

• ICD for primary/secondary prevention of sudden death
• Cardiac resynchronization therapy (CRT) for wide QRS + low EF
• Transcatheter valve repair/replacement for structural causes
• LVAD or heart transplant for advanced stage D

HFpEF-Specific

• Focus on blood pressure, volume control, SGLT2 inhibitors, weight management, and treating comorbidities (sleep apnea, AFib).

Living with Heart Failure

• Create a symptom diary (weight, edema, breathlessness, meds)
• Plan rest breaks, elevate legs, and sleep with extra pillows
• Vaccinate against influenza, pneumococcal, COVID-19
• Address depression/anxiety through therapy or support groups
• Keep an updated medication and contact list for emergencies

Complications

• Hospitalizations for decompensation
• Arrhythmias, sudden cardiac death
• Kidney dysfunction, electrolyte imbalances
• Muscle wasting, frailty
• Cognitive decline due to low perfusion

Research & Future Directions

Advances include gene therapy for inherited cardiomyopathies, novel myosin modulators (omecamtiv mecarbil) for systolic function, and cardio-renal digital twins that optimize therapy in real time.

Experimental & Emerging Treatments

• Cardiac Myosin Activators/Inhibitors: Drugs like aficamten or omecamtiv mecarbil fine-tune contractility for HFrEF and hypertrophic cardiomyopathy.
• Stem Cell & Exosome Therapy: Trials infusing stem cells into damaged myocardium aim to regenerate tissue and improve EF.
• Implantable Pulmonary Artery Sensors: Remote hemodynamic monitoring (CardioMEMS) helps titrate diuretics before symptoms escalate.
• Gene Editing for Titin or LMNA Mutations: Early-stage research explores CRISPR-based correction in inherited dilated cardiomyopathies.

Track Heart Failure with Diagnoza.care

Stay Ahead of Heart Failure – Log weights, vitals, diuretic doses, symptoms, and labs, schedule cardiology and device checks in the AI calendar, document side effects, and let the AI companion detect trends that require medication adjustments.

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Medical Disclaimer: Educational only. Follow your cardiologist’s plan for diagnostics, medications, and device or transplant evaluation. Sources: American Heart Association, American College of Cardiology, Heart Failure Society of America