What is heart failure?

Heart failure — or, ‘congestive heart failure’ (CHF) — occurs when your heart muscle has grown too weak to effectively pump blood throughout the body, or to fill up with blood properly. As a result, the muscles and organs in the body don’t get enough oxygen and nutrients. This may cause fluid to build up in your body and make you feel breathless or tired.

Heart failure is usually an ongoing condition (chronic) — unlike heart attacks, which occur suddenly and require immediate treatment (acute).

However, the conditions are related: a heart attack can cause ongoing muscle weakness and stiffness that leads to long-term heart failure. In some cases, symptoms of heart failure can also start suddenly.

Heart failure is common in Australia, with around 30,000 Australians diagnosed with it each year. Someone with heart failure is also likely to have lung disease, diabetes, HIV or other conditions that can contribute to the damage to their heart muscle.

Watch this video about heart failure from the Heart Foundation. It's also available in other languages, including Arabic, Greek, Italian and Mandarin.

What are the symptoms of heart failure?

A key symptom of heart failure is difficulty breathing, or shortness of breath. You may notice it in the following ways:

• You may find physical activity difficult.
• You may wake up during the night because it’s hard to breathe.
• You may find its uncomfortable to lie flat since that makes it difficult to breathe normally.

Other common signs of heart failure include:

• weakness or fatigue
• fast or irregular heartbeat (palpitations)
• swelling in your legs, ankles and feet (oedema)
• swelling or bloating in your stomach
• coughing and wheezing, with blood-tinged phlegm
• chest pain (angina), if you have previously had a heart attack
• reduced appetite
• dizziness
• nausea

These symptoms can occur due to the lack of oxygen and nutrients reaching your muscles and organs and the build-up of fluid in your body.

When should I call an ambulance?

If you have any of the symptoms below, call triple zero (000) immediately and ask for an ambulance. If calling triple zero (000) does not work on your mobile phone, try calling 112.

• chest pain that’s severe or worsening, or has lasted longer than 10 minutes
• chest pain that feels heavy, crushing or tight
• other symptoms, such as breathlessness, nausea, dizziness or a cold sweat
• pain in your jaw or down your left arm

What causes heart failure?

A healthy heart, will pump out at least half the volume of blood that fills its chambers every time the heart ‘beats’.

With heart failure, your heart does one of 2 things:

• If your heart muscle becomes weak, it fails to pump blood effectively, which causes fluid to build up and pool around your lungs and other parts of your body. This is known as systolic heart failure, or heart failure with reduced ejection fraction.


• If your heart muscle is too stiff, it can’t stretch effectively to relieve pressure in your heart as it pumps — this also causes fluid build-up. This is known as diastolic heart failure, or heart failure with preserved ejection fraction.

Damage, weakness and stiffness to your heart typically develops after a heart attack or coronary heart disease. Other causes may include:

• long-term conditions such as diabetes, obesity, hypertension (high blood pressure) and high cholesterol
• inflammation of the heart due to an infection (myocarditis)
• other heart problems such as faulty heart valves and irregular heartbeat
• certain conditions you were born with, such as congenital heart disease or thyroid disorders
• lifestyle choices, such as excessive alcohol consumption
• certain medications, such as cancer therapies
• other diseases such as HIV
• pregnancy, which may cause your heart to work harder than normal

Your healthcare provider will investigate how your heart failure developed, which may inform how it’s managed it over time.

For information on how COVID-19 affects the heart, visit this page on the Victor Chang Cardiac Research Institute website.

How is heart failure diagnosed?

Your doctor will typically begin by assessing your symptoms, asking about your family history and performing a physical examination.

There are several tests that help to confirm a diagnosis of heart failure and identify which type it is:

• echocardiogram (ECHO): high-frequency sound waves are used to examine the shape and function of your heart
• electrocardiogram (ECG): electrical leads are placed on your chest, arms and legs to record the electrical signals travelling through your heart muscle
• blood tests
• chest x-ray
• angiogram (or coronary catheterisation): fluid is inserted through a small tube (catheter) to show whether your coronary arteries are narrowed or blocked

How can I prevent heart failure?

You can prevent heart failure by preventing coronary heart disease and heart attack. The best way to do this is to reduce or eliminate the risk factors that lead to heart failure. You could:

• quit smoking
• follow a healthy diet
• see your doctor to help manage your cholesterol and blood pressure
• stay physically active and exercise regularly
• maintain a healthy weight
• drink alcohol in moderation
• reduce stress and look after your mental wellbeing

If you have had a heart attack, it’s even more important to manage your risk factors and follow your treatment plan. Make sure you check in frequently with your healthcare team.

Some risk factors — such as your age, whether you have other health conditions, or your genes — may be outside your control. Speak with your doctor if you have concerns about developing heart failure, and how you can manage it.

How is heart failure treated?

While there is no treatment to reverse or cure heart failure, there is a range of ongoing strategies to help you live longer and enjoy a better quality of life.

Lifestyle changes

Maintaining a healthy lifestyle is very important to help you manage heart failure. This includes:

• Managing fluid balance: monitor how much fluid you drink, and take diuretic medicines if prescribed by your doctor. Don’t have more than 2 drinks containing caffeine in a day.
• Limiting salt intake: salt makes your body retain fluid, so eat foods low in salt and avoid adding salt to your food.
• Becoming smoke-free: cigarette smoke damages your artery walls and reduces the amount of oxygen in your blood.
• Limiting alcohol intake: alcohol can damage your heart. Limit your drinking to 1 to 2 standard drinks a day. Or stop drinking altogether if your heart failure was caused by alcohol.
• Joining a support program: ask your doctor to recommend a program for people living with chronic heart failure. This might include specialised support from health professionals such as nurses, dietitians and exercise specialists.

Medications

Heart failure is also treated with medicines. These can help you live longer and stay out of hospital. These may include:

• medicines to lower blood pressure and reduce strain on your heart, such as ACE inhibitors and angiotensin II receptor blockers (ARBs)
• beta-blockers to help your heart pump slower and stronger
• aldosterone antagonists to help control your blood pressure
• diuretics to help reduce fluid build-up that leads to swelling in your body

You might also need medicine to treat angina, if you have it. If you think your medicine is not working, is causing you problems or you have any questions, talk to your doctor. Do not stop taking your medicines without talking to your doctor first.

Other treatments

In some cases, you may need a surgical or medical device to help maintain regular heart function, such as:

• an implantable cardioverter defibrillator (ICD), a small box that detects and corrects abnormal heart rhythms
• a pacemaker, a small device that electrically stimulates the heart to keep a regular rhythm
• bypass surgery (coronary bypass surgery), which improves blood flow to your heart
• heart valve repair or replacement

For some people with severe heart failure, the only option may be a heart transplant. After a heart transplant, you will need to be on lifelong anti-rejection medication and maintain a healthy lifestyle.

Living with heart failure

In addition to your treatment, there are things you can do to feel better:

• Maintain a healthy weight — do some physical activity each day and eat fresh, healthy food.
• Talk to your doctor about keeping your vaccinations up to date, such as the flu vaccine and others.
• Talk to your family or support person about what’s important to you, and what steps you want to take to reduce the impact of heart failure on your life.

Living with heart failure can be emotionally and physically challenging. Hearing stories from others who have experienced heart conditions may be reassuring, and can help you know what to ask your doctor or specialist.

Go to the Heart Foundation website for real-life 'heart stories'.

Resources and support

For more information and support, try these resources:

• Watch the Heart Foundation’s video series on living well with heart failure, or download its booklet.
• Call the Heart Foundation Helpline on 13 11 12 (Monday to Friday, 8:30am to 5:30pm ACST) for more information on heart health.
• Discover some of the latest Australian research on how COVID-19 impacts the heart at the Victor Chang Cardiac Research Institute.

Other languages

Do you prefer to read languages other than English? The Heart Foundation has fact sheets on heart health translated into more than 25 languages.