Heart Failure

What is Heart Failure?

Heart failure doesn’t mean the heart has stopped working. It means the heart can’t pump blood as effectively as it should. This can lead to symptoms like fatigue, shortness of breath, or swelling in the legs or belly.

Heart failure is very common — it affects over 750,000 Canadians, and the number is growing as people live longer and survive heart attacks and other heart conditions. Many people with heart failure live full and active lives, but the condition is also serious and progressive. It’s a leading cause of hospitalizations in older adults and carries a risk of early death if not properly managed.

Types of Heart Failure

HFrEF (Heart Failure with Reduced Ejection Fraction): The heart muscle is weak and doesn’t pump well (EF ≤ 40%)
HFpEF (Preserved Ejection Fraction): The heart pumps normally but is stiff and doesn’t fill properly
HFmrEF (Mildly Reduced EF): Ejection fraction is in the borderline range (41–49%)
Right-sided Heart Failure: Affects blood flow to the lungs; often occurs with left-sided failure

Common Symptoms

Shortness of breath (especially with activity or lying flat)
Swelling in the legs, ankles, or belly
Fatigue or reduced exercise capacity
Sudden weight gain from fluid buildup
Waking up breathless or coughing at night
Needing to urinate frequently at night

What Causes Heart Failure?

Coronary artery disease or heart attack
High blood pressure
Diabetes
Heart valve disease
Abnormal heart rhythms (e.g. atrial fibrillation)
Genetic or inflammatory conditions
Alcohol, chemotherapy, or other toxins

How is Heart Failure Diagnosed?

Common tests include:

Physical exam
Echocardiogram (ultrasound of the heart)
Blood tests (especially BNP or NT-proBNP)
Electrocardiogram (ECG)
Chest X-ray
Cardiac MRI or stress tests
Coronary angiography (if needed)

Treatment and Management

Managing heart failure is often complex and personalized. It involves a combination of lifestyle changes, medications, and sometimes procedures or devices. In general, heart failure tends to progress over time, and people may need additional treatments as the disease advances. That said, modern therapies are highly effective — they can significantly improve quality of life and help people live longer.

👟 Lifestyle

Low-sodium diet (usually <2g/day)
Limiting fluid intake (if recommended)
Daily weight tracking
Moderate physical activity as advised

💊 Medications

Most people with heart failure are on multiple medications, which:

Help the heart pump more efficiently
Reduce symptoms like swelling and breathlessness
Improve survival

These medications often require regular blood tests to check kidney function and electrolytes. They must be taken consistently, as prescribed, to be effective. Side effects can occur, and in rare cases may be dangerous — but these medications are strongly recommended by international cardiology societies because, on balance, the benefits far outweigh the risks.

Key medication classes for HFrEF (reduced EF):

Medication Class	Examples	What It Does	Common / Important Side Effects
ARNI (Angiotensin receptor–neprilysin inhibitor)	Sacubitril/valsartan (Entresto)	Lowers pressure on the heart, improves symptoms and survival	Low blood pressure, dizziness, kidney injury, high potassium, cough
ACE Inhibitors	Ramipril, Enalapril, Perindopril	Relax blood vessels, reduce strain on the heart	Cough, low BP, high potassium, kidney injury, rare allergic reaction
ARBs (used if ACE not tolerated)	Valsartan, Candesartan	Similar to ACE inhibitors, but less likely to cause cough	Dizziness, high potassium, kidney injury
Beta Blockers	Bisoprolol, Metoprolol, Carvedilol	Slow the heart rate, lower blood pressure, reduce workload on the heart	Fatigue, dizziness, low heart rate, cold hands/feet, low libido, decreased mood
MRAs (Mineralocorticoid receptor antagonists)	Spironolactone, Eplerenone	Block hormones that worsen HF; help with fluid and heart remodeling	High potassium, breast tenderness or enlargement (men), low BP, low libido
SGLT2 Inhibitors	Dapagliflozin (Forxiga), Empagliflozin (Jardiance)	Help remove excess fluid; improve survival even without diabetes	Genital infections, dehydration, low BP, rare DKA (low risk if not diabetic)
Loop Diuretics	Furosemide (Lasix), Bumetanide	Reduce fluid overload (swelling, breathlessness)	Frequent urination, low potassium, dizziness, dehydration
Hydralazine + Nitrate (used in select patients)	Hydralazine + Isosorbide dinitrate	Improves blood flow; used if ACE/ARB not tolerated or in specific groups	Headache, flushing, dizziness, low BP
Ivabradine	Ivabradine (Lancora)	Slows heart rate in selected patients with high resting HR	Slow heart rate, flashing lights (visual), dizziness
Digoxin	Digoxin	Increases heart contraction; may help symptoms or AF control	Nausea, visual changes, arrhythmia if levels too high

HFpEF is treated differently — the focus is often on controlling blood pressure, diabetes, weight, and managing symptoms.

⚙️ Devices & Procedures

Implantable defibrillators (ICDs) to prevent sudden cardiac death
Cardiac resynchronization therapy (CRT) to improve heart coordination
Valve repair or replacement
Advanced options like transplant or mechanical heart pumps (LVADs) in select cases

Living with Heart Failure

Many people with heart failure lead meaningful, active lives — but it requires regular monitoring and partnership with your care team.

Weigh yourself daily — contact your doctor if you gain >2–3 pounds over 1–2 days
Stick to your medication plan — even if you feel well
Follow sodium and fluid restrictions
Keep up with vaccines (flu, COVID, pneumococcal)
Attend regular follow-up visits with your cardiologist

📄 Helpful Tools

ℹ️ Learn More

Heart & Stroke Foundation – Heart Failure