Heart failure (or heart failure) is a serious disease that after 65 years of age is the leading cause of hospitalization (Video).

Heart failure occurs when the heart becomes too weak or has a reduced ability to contract and is therefore no longer able to work optimally.

It can be caused:

  • from systolic dysfunction of the left ventricle (left ventricular dysfunction): occurs when the contraction (systole) of the ventricle that pumps blood from the heart to the rest of the body becomes weak
  • with ejection fraction preserved (the ejection fraction is the portion of blood that the heart pushes into the arteries with each beat): it occurs when the left ventricle becomes stiff, and therefore fails to fill well with blood
  • from valve damage: diseased or damaged heart valves

It is important to ascertain (diagnose) the type of heart failure that has occurred as it affects the type of treatment to be followed. To find out, various laboratory and instrumental tests such as electrocardiogram, echocardiogram, spirometry, natriuretic peptide can be used.

Heart failure does not have a single cause, but is the result of multiple problems that "converge" on the heart. There are, however, a series of conditions that increase the likelihood of developing, including heart attack, damage to the heart. heart valves, high blood pressure and obesity.

In most cases, heart failure does not heal.Treatments, therefore, aim to identify a set of measures (lifestyle changes, drugs or surgery) that can improve the functioning of the heart or disorders related to heart failure.

Resolving treatment may be possible in cases where heart failure is due to a specific cause. For example, by replacing damaged heart valves, the disease could resolve.


The disorders (symptoms) caused by heart failure vary from person to person. The main ones are: difficulty in breathing, extreme exhaustion, swollen ankles which can extend to the legs. However, these disorders can also be caused by diseases other than heart failure and sometimes have multiple causes. For example, it can happen that the same person suffers simultaneously from emphysema and heart failure and that both of these diseases cause difficulty in breathing. The treating doctor will suggest the tests to be performed to check whether it is heart failure or another disease.

Heart failure can cause difficulty breathing in a lying position and it can also happen that you wake up in the middle of the night and have to sit or stand up to catch your breath. If heart failure is severe, it may be necessary to use more than two pillows for sleeping.

Ankle swelling related to heart failure is usually less noticeable in the morning and worsens during the day. however, it is a condition that appears in various diseases.

If the ankles appear swollen in the morning, it may be useful to raise the part of the mattress that is in correspondence with the feet by about 15-30 centimeters. In this way, thanks to the force of gravity, the drainage of accumulated body fluids is favored.

Other disorders (symptoms) associated with heart failure include:

  • persistent cough
  • loss of appetite
  • unintentional weight loss
  • tachycardia (accelerated heart rate)

In case of ascertainment (diagnosis) of heart failure it is important to pay attention to the evolution of the disorders (symptoms). It is advisable to weigh yourself daily (in the morning as soon as you get up, before getting dressed) using a reliable scale: if the weight increases more than 2 kilos in a few days, there may be water retention. It is necessary to limit the amount of salt in the diet or to evaluate the administration of diuretics with the doctor.

It is also important to notify the doctor immediately if new complaints arise or worsening of existing ones occur.


Heart failure can be caused by multiple diseases:

  • hypertension, can cause heart fatigue and, over time, lead to heart failure
  • coronary heart disease, occurs when the arteries that carry blood to the heart are blocked by fatty deposits (atherosclerotic plaques) and can cause angina pectoris or myocardial infarction
  • heart muscle disease (cardiomyopathy) of genetic origin or caused by infections, alcohol abuse, or drugs used in cancer treatments
  • irregular heartbeat (atrial fibrillation) (Video)
  • reduction in the number of red blood cells blood (anemia)
  • overactive thyroid gland (hyperthyroidism)

There are other conditions that can increase the risk of developing heart failure:

Abnormal heart beat (arrhythmias)

In some diseases, if the heart beats too fast, the heart does not have enough time to fill and empty itself properly and can cause heart failure. Even a heartbeat that is too slow (less than 40 beats per minute) can reduce the amount of blood expelled in one minute (cardiac output) and highlight heart failure disorders.Healthy people who engage in intense physical activity, even in the form of athletic workouts, may have a rhythm of 40 beats per minute and not have heart failure.

An irregular heartbeat (such as atrial fibrillation) increases the risk of a blood clot forming (thrombosis) which, when detached, can pass into the bloodstream and cause stroke (Video).

Damaged heart valves

The heart contains four valves that allow blood to flow in one "direction. A constricted valve can slow blood flow and reduce the amount of blood the heart is able to excrete, thereby increasing the work it has to do to pump blood. blood in the arteries.

In addition, heart valves can be damaged by a heart attack or simply wear out.

In some cases, damaged heart valves can be repaired; in others, however, they must be replaced. To do this, we resort to so-called operations open heart, although less invasive solutions, applicable under certain conditions, are becoming available today.

Heart disease present at birth (congenital)

In the fetus, blood circulation between the right and left atrium is allowed thanks to the oval hole, which connects the left and right sides of the heart. At birth, the hole closes naturally. When this does not happen, the blood passes from one part of the heart to the other (usually from left to right), causing the right side to strain and causing heart failure. In some cases, the still open oval hole is not discovered until adulthood. The holes can be closed using minimally invasive surgery techniques, although traditional surgery is sometimes required.

Furthermore, other factors such as cigarette smoking, obesity and diabetes mellitus can also contribute to the development of heart failure.


In case of suspicion of heart failure, the attending physician after a clinical examination may recommend a series of in-depth examinations:

  • blood analysis
  • spirometry, to check for lung problems
  • electrocardiogram (ECG), to evaluate the electrical activity of the heart
  • chest x-ray, decompensation can lead to an increase in the size of the heart or an accumulation of fluid in the lungs and pleura
  • echocardiogram, to examine the heart and check its functionality and any valve problems.

Blood analysis

Blood tests can identify the presence of other diseases, such as anemia, diabetes, thyroid problems, liver and kidney disease. An elevated cholesterol level is an important risk factor for the appearance of blockages in the blood. arteries that carry blood to the heart, the coronary arteries.If blood no longer arrives in sufficient quantity, the heart suffers and heart failure can also occur.

The determination of natriuretic peptides, ANP and BNP, which are released by the heart itself, as a "defense mechanism" from high blood pressure and water and salt retention. These peptides have the ability to modify the structure and function of the heart. An increase in blood levels of these substances can indicate the presence of heart failure.


Echocardiography is a test that is used to check the structure of the heart in detail. Harmless high-frequency sound waves are passed through the chest and their "bounce" produces an image of the structure of the heart on the screen.

An echocardiogram provides a lot of valuable information, including:

  • functioning of the heart valves or the presence of damage
  • functioning of the heart as a pump (when the heart contracts, it forces blood to circulate around the body. This phenomenon is also called systolic function)
  • relaxation phase of the heart after contraction (The heart fills with blood when it relaxes after each contraction. This phenomenon is also called diastolic function)
  • presence of holes in the wall that divides the heart chambers and the consequent passage of blood from one part of the heart to the other

The most important data that emerges from an echocardiogram is the measurement of how effectively the heart chambers are functioning, in particular how the left ventricle pumps blood into the circulation. The measure called left ventricular ejection fraction it is an estimate of the amount of blood that enters the left ventricle and of that that comes out when the heart contracts. In a healthy heart, about 60% of the blood entering the left ventricle is expelled with its contraction. A value below 40% indicates that the heart is not pumping in good condition.

Sometimes several types of echocardiography are done:

  • stress echocardiogram, it is performed to ascertain whether the heart is functioning well when subjected to exertion. During the examination, the heart rate increases as fatigue increases (for example, walking on the treadmill or other) or due to the administration of medicines
  • transesophageal echocardiography, it consists in the "introduction into" the esophagus of a thin and flexible tube equipped with an ultrasound probe that allows to examine the structure of the heart in greater detail. Before the exam, a mild sedative may be given to help the person relax and an anesthetic sprayed into the back of the throat to prevent retching caused by passing the tube.

Chest X-ray

Chest X-rays can be used to check that the heart is not larger than normal and that there is no fluid in the lungs, which could indicate heart failure or other lung disease.


Common heart failure disorders (symptoms), such as difficulty breathing, swelling (edema) and fatigue, can make it difficult to lead a normal life.

Most people have ailments (symptoms) that can be controlled with long-term drug treatment. Some, however, have more severe symptoms that require surgery or a heart transplant.

Heart failure is a serious disease and can lead to sudden death. For this reason it is important to administer adequate treatments (therapies) that are able to:

  • make the heart stronger
  • decrease disturbances
  • reduce the risk of attacks or sudden worsening
  • improve the quality of life

Finding the right therapy

For most people, heart failure is a long-term disease that cannot be cured. There are, however, cases in which it is caused by a specific factor such as, for example, a damaged valve, repairing it surgically, the decompensation can heal because the factor that had determined it disappears.

A treatment is also available for an abnormally slow heartbeat (pathological bradycardia): a pacemaker.

In other cases, the correction of some conditions (such as, for example, anemia, diabetes mellitus, uncontrolled hypertension, alcohol consumption, changes in the thyroid gland) can contribute to an improvement in decompensation.

In most cases of heart failure, the goal is to find the right set of factors, lifestyle changes, suitable medications, medical or surgical devices, that can help the heart function properly.

It is necessary for the patient and the treating physician to work together to find the best combination of effective treatments, which they can continue to take in the long term, to improve the quality of life.

It is important to tell your doctor how often complaints such as tiredness or difficulty in breathing come back or get worse. In such cases, care may need to be changed. Doctors should regularly evaluate treatments to make sure they are working properly.

Heart failure increases the likelihood of developing other dangerous diseases such as stroke, myocardial infarction and the formation of blood clots in the leg veins and lungs (thrombosis). Treatments for heart failure reduce the risk of heart failure.

Lifestyle changes

If heart failure is found (diagnosed), simple changes need to be made in daily life to decrease the risk of further episodes occurring. Quitting smoking (if you are a smoker) quickly brings the risk of developing a heart attack back to the same level as a person who has never smoked.

Other lifestyle changes such as eating healthily, moderating alcoholic beverages and salt consumption, exercising regularly, reducing weight, can decrease heart ailments and risks.

Rehabilitation programs

Participation in a rehabilitation program for heart failure may be proposed. Programs of this type vary greatly from country to country, but most of them address the core themes, which include:

  • physical exercise
  • instruction
  • relaxation and emotional support

After completing the rehabilitation program, it is important to continue exercising regularly and have a healthy lifestyle to protect the heart and reduce the risk of future heart problems.


Many of the factors that increase the risk of developing heart failure can be kept under control by taking suitable medications and improving your lifestyle.

Stop smoking

Quitting smoking (if you are a smoker) is probably the best way to limit the risk of developing coronary artery disease (the arteries that carry blood to the heart) and heart failure. Tobacco can damage the heart in many ways, forcing it to work harder. Smoking also tends to thicken the blood and slow its flow, increasing the risk of thrombosis which, in turn, damages the lining of the arteries and clogs them.

Reduce blood pressure

If the blood pressure (blood pressure) is too high, the heart has to work harder to pump blood into the arteries. To make up for the extra effort, it thickens and over time becomes too stiff or weak to work properly. Keeping your blood pressure at normal levels can stop or prevent this process, so it's important to check it regularly, adopt a healthy lifestyle and, if necessary, take medications (sometimes more than one) to keep it at acceptable levels.

Reduce the cholesterol level

A high level of cholesterol in the blood is an important risk factor for the alteration of the coronary arteries (coronary heart disease), those that carry blood to the heart and, consequently, for heart failure; the risk increases if they are present at the same time , also other factors such as high blood pressure and smoking.

If the cholesterol level is too high, the doctor usually recommends dietary changes, to reduce the consumption of animal fats (saturated fats) and cholesterol, and the daily practice of physical activity.

If, after a few months of healthy eating and regular physical activity, the cholesterol level has not decreased, it may be necessary to take drugs such as statins, which can lower it.

Lose weight

Overweight and obesity increase the risk of coronary heart disease and myocardial infarction, diseases that increase the likelihood of developing heart failure.

Eat healthily

A varied and balanced diet, with modest portions, low consumption of saturated fats and cholesterol, low in salt and sugar, rich in fiber, cereals and legumes, with lots of fruit, vegetables and fish can decrease the risk of developing coronary heart disease and, consequently, heart failure.

If heart problems are already present, eating healthily can prevent the situation from getting worse, and can protect against other diseases such as diabetes.


Regular exercise helps keep you fit and healthy: it is not necessary to go to the gym or participate in competitive activities, but it is important to include regular movement in your daily habits.

Drink alcohol within limits or don't drink at all

Drinking too much and abusing alcohol can increase blood pressure and the likelihood of heart failure as well as having many other negative health effects.

Reduce your consumption of salt

Too much salt can raise blood pressure beyond normal (high blood pressure). Reducing consumption helps to keep it under control and decreases the possibility that the heart can decompensate. The World Health Organization recommends not to exceed the consumption of 5 grams per day of iodized salt (one teaspoon) including in this quantity also that contained in pre-packaged foods, cured meats, cheeses and foods in which it is naturally present The nut (glutamate) contains a high salt content, therefore its use is not recommended (Progetto Cuore).

Living with

Although the life outlook is linked to factors such as age, the severity of heart conditions and other health problems already present (kidney or lung disease, anemia and diabetes) it is positively influenced by behaviors that avoid the appearance of complications and other diseases. Among these, the following are particularly important:

Self care

Taking care of yourself means becoming responsible for your own well-being and for the care of your body with the help of the treating doctors and family members.

Take your prescribed medications, even if you feel better

It is very important to take the medications indicated by your doctor and not to stop taking therapies on your own initiative when you begin to feel better. Medicines only work if they are taken as directed by the doctor. Furthermore, before starting treatment, it is advisable to warn your doctor about any other medicines or supplements you are taking because they could negatively interact with the drugs prescribed and cause unwanted effects (side effects). It is good to ask the doctor's opinion even if, while you are following the treatment for heart failure, you want to buy so-called "over-the-counter" medicines (those that do not require a medical prescription because they are indicated for mild ailments) because they could interfere with ongoing therapies.

Of particular importance, to minimize the risk of unwanted reactions to medicines, which can sometimes be serious, is also to read the information contained in the package leaflet in the box. In fact, it contains important information on possible interactions with other drugs or supplements.

Weigh yourself every day

Weigh yourself every morning after urinating, but before breakfast. Wear about the same amount of clothes each time, and be sure to note your weight each day on a calendar.Call your doctor if your weight increases by 1 kilogram in a day, or by 2 or more kilograms in a week. When you have "heart failure," sudden weight gain is a sign that your body may be holding too much fluid. You may need to change your medications.

Influenza and pneumococcal vaccination

Those suffering from heart failure are recommended to get vaccinated annually not only against the flu but also against pneumococcus, a germ that can cause a severe lung infection.

Limit the salt

Try not to add salt to the table or during cooking. Ask your doctor how much salt you should take. Your doctor may also tell you to limit the amount of fluids you drink.

Nutrition and exercise

A healthy, varied and balanced diet, rich in fruit, vegetables and fish and with low consumption of cholesterol and saturated fats (those contained in the fat of foods of animal origin, such as red and fatty meats, sausages, butter and cream, cheeses, in palm and coconut oil), salt and sugar, combined with regular physical exercise, reduces the symptoms of heart failure, fatigue, stress and prevents other diseases, including some forms of cancer.

Not smoking

Quitting smoking (if you are a smoker) improves overall health, prevents further lung damage and reduces the risk of serious conditions such as cancer.

Periodic visits

Since heart failure is a chronic disease (that is, it persists over time), it is necessary to periodically undergo checks by the treating doctors, family or specialists. We should not hesitate to contact them to clarify any doubts and perplexities about the treatments, on activities that are not allowed or can be carried out, on the holiday places to avoid, etc.Periodic visits allow the doctor to follow the course of the disease over time, to adapt therapies or to intervene promptly in case of worsening.


Exercising regularly improves the condition of the heart. An exercise program designed by a doctor and cardiorespiratory rehabilitation specialist can help people with heart failure breathe better and improve their quality of life.

Many health facilities organize cardiac rehabilitation programs for those who have had heart surgery or have suffered a heart attack. These protocols are also useful for those suffering from heart failure. Typically, they are offered in those hospitals where there are teams of cardiac rehabilitation specialists such as nurses, physiotherapists, occupational therapists.

Exercise programs vary greatly from facility to facility, but the most common involve physical exercise, relaxation techniques, nutrition education advice, smoking cessation programs, psychological support.

In-depth link

Heart Project (ISS)

Editor'S Choice 2022