Heart & Stroke Conditions Explained


Heart Failure

The terms heart failure or heart insufficiency are used to describe a heart that is not working as well as it should.

This can sound quite frightening but it is important to understand that your heart is not about to stop. It can certainly cause a build up of fluid in the lungs (lung congestion) causing breathlessness or leg swelling but these symptoms can improve with suitable treatment allowing you to live well with heart failure.


Related topics: Coronary artery disease, heart attack, risk factors, ICD, pacemaker.


Heart Failure

The most common symptoms include:

  • Fatigue
  • Shortness of breath, especially with activity *
  • Shortness of breath when lying flat
  • Swollen feet and ankles
  • Weight gain, over a short period of time i.e. days
  • Loss of appetite and abdominal swelling
  • Dizziness or near fainting episodes
  • Chest pain if your heart failure is caused by a heart attack or narrowed arteries to the heart
  • Irritable cough, sometimes producing frothy sputum
  • Sudden severe breathlessness waking one from sleep, this requires urgent attention

*With worsening heart failure the breathlessness occurs with less activity and if it is severe may occur at rest – this also needs urgent attention so you need to call an ambulance

Symptoms like these happen when your heart is not pumping blood around the body efficiently, allowing excess fluid to pool in your lungs and elsewhere in your body, most usually your feet and ankles.

It is important that you recognise the early signs of fluid retention which are responsible for many of your symptoms including, sudden weight gain; swollen ankles; shortness of breath; and loss of appetite.

When you retain fluid your heart has to work harder and this causes you to feel extremely tired. People with heart failure are more likely to have rhythm disturbances in their heart and you may feel your heart beating fast in your chest. Any new palpitations or dizziness should be reported.

Sometimes the dizziness may be related to the tablets you are taking. However, you should report any dizziness to your doctor and ensure you don’t stop taking your medication without advice. As with all of your symptoms, the earlier you report them to your doctor the easier they are to treat and cause you less discomfort.


Heart Failure

Many different diseases that affect the pumping or filling of your heart can cause heart failure by damaging or weakening your heart.

This can happen suddenly or can develop over months or even years.


The most common causes are:

  • Weakened heart muscle caused by a heart attack
  • Long-term high blood pressure that has not been controlled
  • Weakened heart muscle from leaking or narrowed heart valves
  • Cardiomyopathy
  • Alcohol-related damage to the heart muscle
  • A viral infection of the heart, myocarditis
  • Uncontrolled irregular heart rhythm
  • Heart defects you are born with – Congenital heart disease
  • Other chronic diseases such as thyroid disease, diabetes, haemachromatosis (the build-up of iron ), or protein (amyloidosis) may also contribute to heart failure
  • Occasionally drugs or some medications may lead to heart failure or heart problems
  • Or sometimes there is no obvious cause.

Heart failure can also develop if the heart muscle becomes stiff affecting the way your heart fills with blood in between heartbeats. This may be called either ‘diastolic heart failure’ or ‘heart failure with preserved ejection fraction’ because the heart doesn’t fill efficiently it also leads to breathlessness.



Heart Failure

Reducing your risk factors for heart disease will help prevent heart failure, such as:


Heart Failure

The diagnosis of heart failure is based on the information the doctor gets from asking you questions and from what he or she finds when they examine you.

Then your doctor will order certain tests to confirm the diagnosis and to search for the cause of your heart failure.


These tests include:

  • Blood tests
  • ECG
  • Chest Xray
  • Echocardiogram
  • Coronary angiogram
  • CT angiogram
  • Cardiac MRI
  • Holter monitor
  • Blood pressure monitor 

When heart failure has been confirmed, your doctor will decide what class or stage it is at. This will help to decide on the most suitable treatment programme for you.

This classification system is based on your symptoms and how you are affected. In class 1 you may not have any symptoms, whilst in class 4, which is the most severe, you may have difficulty with simple everyday activities and be short of breath at rest.


Heart Failure

The aim of treatment in heart failure is to control symptoms and help people to live full and active lives.

A combination of medications and lifestyle changes will help reduce congestion (fluid build-up), ease symptoms, and help improve the pumping function of your heart.

Whatever treatment plan is agreed with your doctor, it is very important you monitor your symptoms every day and report any changes.


You will probably be prescribed a number of medications. It is important you understand what they are doing and when they should be taken. The amount of each medicine will be changed and improved over time to best help your symptoms.

Stay Active

Staying physically active can help reduce fatigue and tiredness and can help your body work more efficiently. By severely restricting physical activity you can get “out of shape” and reduce your stamina, so that even a short walk may seem like a big task.

You may feel your heart race and pound, as breathing becomes more difficult. Being out of condition places added stress on your heart. In short, it is better to keep active. By exercising regularly and keeping your body in condition, you will feel better and be able to accomplish more. You will do routine activities more easily.

This does not mean that rest is bad. Regular periods of exercise and rest should be included in your daily activities.

Resting for 30-60 minutes after meals allows the heart to use its fullest capacity for digestion. Perhaps this is what the afternoon “siesta” is all about! Extra rest also helps during periods of emotional stress or illness.

You should start off with gentle exercise, building it up gradually. If you listen to your body you will know just how much you can exercise. The important aspect is to exercise regularly not sporadically.

General Advice

  • Take an active role in the management of your condition
  • Enrol a member of your family or a friend to help you
  • Learn the signs of impending problems and contact help
  • Make sure to take your medicines regularly as prescribed
  • Exercise wisely and take rest periods during the day.
  • Ask your GP about the flu injections


Heart failure generally responds very well to a combination of medicines and lifestyle changes. Some people may need operations or pacemakers or similar devices. With modern treatment, people with heart failure can lead good quality lives. However,  some people may not get better and their heart failure worsens. It is important to understand that the progression of heart failure can be unpredictable, and varies significantly from person to person.

Some people, towards the end of their disease, need palliative care and may wish to let their families know in advance what they would like to be done if they become very ill and no longer respond to any treatment.


Heart Failure

Read our resources for further information:

See our booklet Step By Step Through Heart Failure for a more in-depth and practical guide.

To reduce your risk factors, read our articles on Your Heart Health Information that include healthy eating, getting active, high blood pressure, cholesterol, managing your weight, and stopping smoking.

View our Step by Step Through Heart Medicines booklet that guides you through the things you should know such as avoiding grape fruit juice.