heartfailure

Heart failure is a clinical syndrome in which the heart cannot pump enough blood to meet the body’s needs. It can be caused by weakened heart muscle or by problems that limit filling of the heart, and is commonly categorized as heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF). Left-sided heart failure is more common, but right-sided failure can occur, often in the setting of left failure or lung disease.

Common causes include coronary artery disease, hypertension, valvular heart disease, cardiomyopathies, and myocarditis. Arrhythmias and chronic illnesses such as diabetes can contribute. Pathophysiology involves impaired pumping, diastolic stiffness, and neurohormonal changes that promote fluid retention and further cardiac decline.

Symptoms typically include breathlessness with exertion or lying flat, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and reduced exercise tolerance. Swelling of the legs or abdomen may occur. Signs observed on examination may include rales, elevated jugular venous pressure, and peripheral edema. Diagnosis relies on clinical assessment supported by tests such as echocardiography to measure ejection fraction, natriuretic peptides (BNP or NT-proBNP), chest imaging, and electrocardiography.

Management aims to treat the underlying cause, relieve symptoms, and improve outcomes. Evidence-based medications include ACE inhibitors or ARBs, beta-blockers, mineralocorticoid receptor antagonists, and newer agents such as SGLT2 inhibitors and, in some patients, neprilysin inhibitors. Diuretics help control congestion. Device therapies like implantable cardioverter-defibrillators or cardiac resynchronization therapy may be indicated for selected individuals. Lifestyle measures, sodium restriction, appropriate vaccination, and cardiac rehabilitation support long-term management.

Prognosis is variable and generally relates to the underlying cause, degree of cardiac dysfunction, and comorbidities. With appropriate therapy, symptoms can improve and hospitalization risk can be reduced.