Heart failure (HF) is a complex clinical syndrome where the heart is unable to pump blood effectively to meet the body’s metabolic demands. Contrary to popular belief, heart failure does not mean the heart has stopped working. Instead, it reflects a progressive decline in the heart’s ability to function as a pump. Millions of people worldwide are affected, and it remains a leading cause of hospitalization and morbidity.
Understanding the signs, symptoms, and types of heart failure is essential for early diagnosis and timely treatment. The image above provides a structured overview of left-sided vs. right-sided heart failure symptoms, as well as distinctions between systolic and diastolic dysfunction.
Signs and Symptoms of Heart Failure
The clinical manifestations of heart failure vary depending on whether the left or right side of the heart is predominantly affected. Symptoms can be subtle in the early stages but progressively worsen over time if untreated.
Left-Sided Heart Failure: “Think Lungs”
In left-sided heart failure, blood backs up into the pulmonary circulation, causing respiratory and pulmonary symptoms. A useful mnemonic is DROWNING, representing the major clinical features:
| Mnemonic | Symptom | Clinical Relevance |
|---|---|---|
| D | Dyspnea | Shortness of breath due to pulmonary congestion |
| R | Rales (crackles) | Crackling lung sounds from fluid in alveoli |
| O | Orthopnea | Difficulty breathing when lying flat |
| W | Weakness / fatigue | Reduced cardiac output leads to poor perfusion |
| N | Nocturnal paroxysmal dyspnea | Sudden nighttime breathlessness |
| I | Increased HR | Sympathetic activation to compensate for low output |
| N | Nagging cough (frothy, blood-tinged sputum) | Pulmonary edema manifestation |
| G | Gaining weight (2–3 lbs/day) | Fluid retention and overload |
Other associated symptoms:
- Decreased urine output (↓ UOP)
- Hypotension (low blood pressure)
- Presence of an S3 gallop on auscultation
Right-Sided Heart Failure: “Think Systemic Venous Congestion”
Right-sided heart failure leads to blood pooling in the systemic venous circulation, producing systemic and peripheral symptoms. A helpful mnemonic is SWELLING:
| Mnemonic | Symptom | Clinical Relevance |
|---|---|---|
| S | Swelling of legs and hands | Peripheral edema |
| W | Weight gain | Fluid accumulation |
| E | Edema (pitting) | Classic sign of venous congestion |
| L | Large neck veins (JVD) | Jugular venous distension from right atrial pressure |
| L | Lethargy / fatigue | Reduced perfusion and oxygen delivery |
| I | Irregular heart rate | Arrhythmias due to atrial strain |
| N | Nocturia | Increased nighttime urination due to fluid shifts |
| G | Girth (Ascites) | Fluid accumulation in the abdomen |
Other associated symptoms:
- Hepatomegaly (enlarged liver)
- Splenomegaly (enlarged spleen)
- Anorexia (loss of appetite due to GI congestion)
Types of Heart Failure
Heart failure can also be classified based on how the heart muscle is functioning.
1. Systolic Heart Failure
Definition: A weakened heart muscle that cannot eject blood properly.
Pathophysiology: Reduced contractility leads to poor forward flow.
Key Feature: The ventricle does not eject blood efficiently.
Ejection Fraction (EF): Reduced (<40%).
2. Diastolic Heart Failure
Definition: A stiff, non-compliant heart muscle that cannot relax and fill properly.
Pathophysiology: Ventricles fail to fill adequately despite normal contractility.
Key Feature: The ventricle does not fill properly.
Ejection Fraction (EF): Normal or preserved (≥50%).
Understanding Ejection Fraction (EF)
Ejection fraction is a critical measurement in evaluating heart function.
Formula:Normal EF: 50–70%
Clinical Diagnosis of Heart Failure
Diagnosis of heart failure requires integrating symptoms, physical examination, and diagnostic tools.
1. History and Symptoms: Fatigue, breathlessness, swelling, orthopnea.- Chest X-ray (cardiomegaly, pulmonary edema)
- ECG (arrhythmias, LV hypertrophy)
- Echocardiography (EF, structural changes)
- BNP/NT-proBNP levels (markers of heart failure)
- Cardiac MRI or CT (detailed structural assessment)
Prognosis and Management
Heart failure is a chronic condition requiring long-term management. Early diagnosis and treatment improve quality of life and survival.
Lifestyle modifications: Salt restriction, weight management, regular exercise.
Pharmacological treatment: ACE inhibitors, ARBs, beta-blockers, diuretics, aldosterone antagonists.
Advanced therapies: Cardiac resynchronization therapy, implantable defibrillators, heart transplantation in severe cases.
Comparative Table: Left vs. Right Heart Failure
| Feature | Left-Sided HF | Right-Sided HF |
|---|---|---|
| Main cause | Hypertension, MI, valvular disease | Left-sided HF, pulmonary hypertension |
| Primary system affected | Pulmonary circulation | Systemic venous system |
| Key symptoms | Dyspnea, orthopnea, PND, cough, fatigue | Peripheral edema, JVD, ascites, hepatomegaly |
| Auscultation | Crackles, S3 gallop | No specific lung findings |
| Weight changes | Rapid weight gain due to fluid | Same, often more prominent |
| Ejection fraction | Can be reduced or preserved | Often normal initially |
FAQs on Heart Failure
Q1: What is the difference between heart failure and a heart attack?
A heart attack (myocardial infarction) occurs due to blocked blood supply to the heart muscle, while heart failure is a chronic inability of the heart to pump effectively.
Q2: Can heart failure be reversed?
Mild cases may improve with treatment and lifestyle changes, but advanced heart failure is usually progressive.
Q3: Why is weight monitoring important in heart failure?
Rapid weight gain often signals fluid retention, an early warning of worsening heart failure.
Q4: What is the role of ejection fraction in diagnosis?
Ejection fraction helps determine whether the problem is systolic or diastolic dysfunction, guiding treatment strategies.
Q5: Is heart failure only a disease of the elderly?
No, while it is more common in older adults, younger individuals with congenital heart disease, myocarditis, or genetic cardiomyopathies can also develop HF.
