Heart Failure: Causes, Symptoms and Treatment

Heart failure does not mean the heart has stopped beating. It means the heart can no longer pump blood efficiently enough to meet the body's demands. As a result, blood backs up in the veins and lungs (congestion), and the body is deprived of the oxygen-rich blood it needs to function normally.

What Is Heart Failure?

Heart failure occurs when the heart muscle contracts too weakly, relaxes too stiffly, or both. It affects millions of people worldwide and is one of the leading causes of hospitalisation in adults over 65.

Doctors classify heart failure into two main types:

• Systolic heart failure (HFrEF) — the heart muscle does not contract forcefully enough; the left ventricle ejects less blood than normal (reduced ejection fraction)
• Diastolic heart failure (HFpEF) — the heart muscle stiffens and cannot fill properly between beats; ejection fraction is preserved but filling is impaired

Both types result in inadequate cardiac output and the same pattern of symptoms.

Causes of Heart Failure

Cardiac Causes

Almost any heart condition can eventually cause heart failure. The most common include:

• Coronary artery disease — reduced blood flow to the heart muscle from blocked arteries; the leading cause worldwide
• Heart attack (myocardial infarction) — permanent damage to a region of the heart muscle after a blocked coronary artery
• High blood pressure (hypertension) — forces the heart to work harder over years, causing the walls to thicken and stiffen
• Heart valve disease — narrowed or leaking valves increase the heart's workload
• Cardiomyopathy — disease of the heart muscle itself, from genetic causes, viral infection, alcohol, or chemotherapy drugs
• Abnormal heart rhythms (arrhythmias) — rapid or irregular rhythms that prevent the heart from filling or emptying properly

Non-Cardiac Causes

• Uncontrolled diabetes and obesity (contribute to ventricular stiffness)
• Severe anaemia (forces the heart to work harder)
• Thyroid disorders — hyperthyroidism overstimulates the heart; hypothyroidism weakens it
• Pulmonary hypertension (elevated lung artery pressure, straining the right side of the heart)
• Kidney failure (fluid overload)

Symptoms

Heart failure typically develops gradually. Early in the disease, the heart compensates through a series of changes — the heart muscle enlarges, beats faster, and hormonal signals cause the kidneys to retain fluid. These adaptations temporarily maintain output but ultimately worsen the condition.

Common symptoms include:

• Shortness of breath (dyspnoea) — initially on exertion, later at rest; lying flat often worsens it (orthopnoea)
• Waking at night breathless (paroxysmal nocturnal dyspnoea)
• Fatigue and weakness — reduced cardiac output means muscles receive less oxygen
• Ankle, leg, and foot swelling (oedema) — excess fluid accumulates in the tissues
• Rapid or irregular heartbeat
• Persistent cough or wheezing, sometimes producing pink-tinged mucus
• Reduced ability to exercise
• Sudden weight gain from fluid retention (more than 1–2 kg in 24–48 hours is a warning sign)
• Nausea and abdominal swelling — when fluid backs up into the liver and digestive tract (right heart failure)
• Reduced urination during the day, with increased frequency at night (as the body reabsorbs fluid when lying down)

New York Heart Association (NYHA) Classification

Diagnosis

Echocardiogram (Cardiac Ultrasound)

The cornerstone investigation. It visualises the heart in real time, measures the ejection fraction, assesses valve function, and identifies structural abnormalities. The echocardiogram determines whether heart failure is systolic or diastolic and guides treatment decisions.

Additional Investigations

• BNP / NT-proBNP blood test — elevated levels of these hormone markers strongly suggest heart failure; useful for confirming the diagnosis and monitoring response to treatment
• Electrocardiogram (ECG) — detects arrhythmias and signs of past heart attack
• Chest X-ray — reveals an enlarged heart shadow and fluid in the lung fields
• Blood tests — full blood count, kidney and liver function, thyroid hormones, iron studies
• Cardiac MRI — provides precise imaging of heart muscle damage and inflammation
• Coronary angiogram — where coronary artery disease is suspected as the underlying cause

Treatment

Heart failure requires long-term, multi-modal management. The goals are to relieve symptoms, slow disease progression, reduce hospitalisation, and prolong life.

Medications

Devices and Procedures

• Cardiac resynchronisation therapy (CRT) — a specialised pacemaker that coordinates the two ventricles, improving pump efficiency
• Implantable cardioverter-defibrillator (ICD) — prevents sudden cardiac death from dangerous arrhythmias
• Heart valve repair or replacement — if valve disease is the underlying cause
• Coronary artery bypass grafting (CABG) or PCI — if coronary artery disease is contributing
• Ventricular assist device (VAD) — a mechanical pump implanted to support the failing heart, used as a bridge to transplant or long-term therapy
• Heart transplantation — for end-stage heart failure unresponsive to all other treatments; China's major transplant centres perform a significant number of heart transplants annually

Lifestyle Modifications

• Salt restriction — typically less than 2,000 mg sodium per day
• Fluid management — usually 1.5–2 litres per day in advanced cases
• Daily weight monitoring — rapid gain signals fluid retention and prompts early intervention
• Exercise — supervised cardiac rehabilitation improves functional capacity and quality of life
• Avoiding alcohol — alcohol directly depresses cardiac muscle function
• Stopping smoking — reduces further coronary damage and hospitalisation

Heart Failure Management in China

China's top-tier cardiac centres offer:

• Diagnostic work-up: echocardiogram, BNP, cardiac MRI, 24-hour Holter monitoring and full metabolic panel
• Device implantation (CRT, ICD) with internationally trained cardiac electrophysiologists
• Minimally invasive valve procedures — transcatheter aortic valve replacement (TAVR) and MitraClip are available at leading centres
• Heart transplantation — China operates a national organ allocation system (COTRS) with transplant volumes comparable to major Western centres
• Full English coordination through diagnosis, treatment planning and follow-up

If you or a family member is living with heart failure and seeking a specialist assessment or second opinion, contact a ChinaMedicalTour care navigator to arrange an appointment.

Medical content based on MSD Manuals, authored by Nowell M. Fine MD SM (Libin Cardiovascular Institute, University of Calgary), reviewed by Jonathan G. Howlett MD. Last reviewed October 2025.