--- title: "Heart failure: Symptoms, Causes & Treatment | HealthAnswers" description: "Heart failure — breathlessness, ankle swelling, causes, diagnosis with echocardiogram, and NHS treatment including ACE inhibitors and diuretics." url: https://healthanswers.co.uk/conditions/heart-failure/ robots: noindex --- # Heart failure: Symptoms, Causes & Treatment | HealthAnswers Health A–Z Heart failure — breathlessness, ankle swelling, causes, diagnosis with echocardiogram, and NHS treatment including ACE inhibitors and diuretics. Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026 ## Quick answer What is heart failure? Heart failure means the heart pumps less effectively — not that the heart stops. Symptoms include breathlessness on exertion or lying flat, fatigue, and ankle swelling. Common causes include heart attack damage, high blood pressure, and valve disease. Diagnosed with blood test (NT-proBNP) and echocardiogram. Treatment — ACE inhibitors or ARBs, beta-blockers, diuretics, SGLT2 inhibitors — improves symptoms and survival. See a GP if progressively worsening breathlessness or sudden severe breathlessness at rest — phone 999. ## Who is this page for? This page is for people in the UK who want a plain-English overview of Heart failure, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally. ## Who should skip this page? Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland. On this page 9 sections ## Key facts about heart failure - Heart failure affects about 1 million people in UK — prevalence rising with ageing and better heart attack survival. - Breathlessness, fatigue, and ankle oedema are classic triad — but symptoms overlap other conditions. - HFrEF (reduced ejection fraction) and HFpEF (preserved EF) treated differently but both benefit from some shared drugs. - Daily weight monitoring — rapid gain suggests fluid retention — adjust diuretics per plan. - Cardiac rehabilitation and salt moderation improve quality of life alongside medicines. ## Heart failure — when the pump weakens **Heart failure** ( **congestive cardiac failure** ) — **syndrome** where **heart cannot pump sufficiently** to meet body’s needs **OR** does so **only at elevated filling pressures**. **Not cardiac arrest** — heart **still beating** — **inefficiently**. **~1 million UK** — **rising** — **better MI survival** + **ageing**. ## Symptoms **Left-sided (pulmonary congestion):** - breathlessness — exertion → rest - orthopnoea - PND — wake gasping - dry cough **Right-sided (systemic congestion):** - peripheral oedema — ankles - ascites - JVP raised **General:** - fatigue - reduced exercise tolerance **Acute decompensation:** - pulmonary oedema — pink frothy sputum — 999 ## Types ### HFrEF — reduced ejection fraction (<40%) **Systolic failure** — **post-MI**, **cardiomyopathy** ### HFmrEF — mildly reduced (41–49%) ### HFpEF — preserved EF (≥50%) **Diastolic dysfunction** — **stiff ventricle** — **elderly, hypertensive, obese, AF common** ## Diagnosis - History and examination — bibasal crackles , oedema , JVP , displaced apex - NT-proBNP — elevated — exclude if very low in primary care - Echocardiogram — EF , valves , diastolic function - ECG — ischaemia , LVH , AF - Chest X-ray — cardiomegaly , Kerley B lines , pleural effusions ## Causes - [Heart attack](https://healthanswers.co.uk/conditions/heart-attack/) scar - [Hypertension](https://healthanswers.co.uk/conditions/high-blood-pressure/) - valve disease - [Atrial fibrillation](https://healthanswers.co.uk/conditions/atrial-fibrillation/) — tachycardiomyopathy - dilated cardiomyopathy — genetic, alcohol, viral - peripartum cardiomyopathy ## Treatment — HFrEF pillar drugs **Four pillars improve survival (NICE):** - ACEi/ARB/ARNI - Beta-blocker — bisoprolol, carvedilol, nebivolol - MRA — spironolactone/eplerenone - SGLT2 inhibitor — dapagliflozin/empagliflozin — even without diabetes **Diuretics** — **symptom relief** — **furosemide** — **not mortality benefit alone** **Titrate to target doses** — **specialist nurse support** **Devices:** - ICD — arrhythmia risk - CRT — LBBB wide QRS ## HFpEF - SGLT2i — benefit shown - diuretics - treat BP, AF, obesity - no proven ACEi mortality benefit like HFrEF ## Self-management - daily weights - fluid/salt moderation - cardiac rehabilitation - flu/pneumococcal vaccines - report deterioration early — IV diuretic outpatient some centres ## Prognosis **Variable** — **5-year mortality ~50%** historically — **improving with modern therapy** **Advanced HF** — **palliative care**, **transplant**, **LVAD** — **specialist** **Breathless climbing stairs worsening over months** — **GP + BNP + echo** — **not age alone**. ## ! When to see a GP about heart failure See a GP for progressive breathlessness, unable to lie flat (orthopnoea), waking breathless at night (PND), swollen ankles, or fatigue limiting daily activity. Phone 999 for sudden severe breathlessness at rest, chest pain, or coughing pink frothy sputum — pulmonary oedema emergency. Heart failure needs structured GP and cardiology follow-up — medicines titrated to target doses. ## Common questions about heart failure What are the symptoms of heart failure? Breathlessness on exertion progressing to rest, orthopnoea (need extra pillows), paroxysmal nocturnal dyspnoea, fatigue, ankle or leg swelling, bloating, reduced exercise tolerance. Some present with acute pulmonary oedema — medical emergency. What causes heart failure? Coronary artery disease and previous heart attack (commonest), hypertension, cardiomyopathy, valve disease, atrial fibrillation, alcohol, viral myocarditis, chemotherapy toxicity. Left ventricular damage reduces pump function — fluid backs up in lungs and periphery. Is heart failure curable? Often manageable not curable — some causes reversible (valve replacement, tachycardiomyopathy if rhythm controlled). HFrEF medicines and devices improve ejection fraction in many. HFpEF — treat comorbidities — hypertension, AF, obesity. Heart transplant selected end-stage cases. What medicines treat heart failure? HFrEF — ACE inhibitor or ARB (or ARNI sacubitril/valsartan), beta-blocker (bisoprolol, carvedilol), MRA (spironolactone), SGLT2 inhibitor (dapagliflozin), diuretics (furosemide) for congestion. Device therapy — ICD, CRT if broad QRS — specialist. HFpEF — SGLT2i, treat BP, diuretics. What should I limit with heart failure? Fluid restriction if advised (usually 1.5 to 2 litres daily in severe cases), moderate salt reduction, alcohol minimal especially if alcohol cardiomyopathy, weigh daily — report 2kg gain in 3 days. Stay active within limits — cardiac rehab programmes help. ## Sources - [NHS — Heart failure](https://www.nhs.uk/conditions/heart-failure/) - [NICE — Chronic heart failure](https://www.nice.org.uk/guidance/ng106)