Heart Failure - The Basics

What You Need to Know about Heart Failure

Mature man with chest pains
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Heart failure is a cardiac condition in which an underlying heart disease of one type or another has made the heart unable to keep up with the body's needs. Because heart failure is the end result of many kinds of heart disease, it is one of the most common cardiac problems doctors will see.

Patients with heart failure often suffer from dyspnea, extreme fatigue, and edema (swelling). They often have great difficulty with physical exertion, and their life expectancy typically is significantly reduced.

Fortunately, a lot of progress is being made in the treatment of heart failure, and with aggressive therapy both the symptoms and the risk of dying can be significantly reduced. But unfortunately, studies continue to show that many doctors fail to offer optimal treatment to their patients with heart failure. If you have heart failure it is very important to educate yourself about this condition and the available treatments, so you can partner with your doctor in getting the treatment you need.

Types of Heart Failure

The term "heart failure" itself is an imprecise one, since doctors use it to refer to several different kinds of cardiac conditions, each with its own set of causes, prognosis, and treatment.

So the first step in educating yourself is to find out which specific type of heart failure you have. You can get this information from your doctor.

There are three general categories of heart failure -- dilated cardiomyopathy (cardiomyopathy is a term that means heart muscle disease), hypertrophic cardiomyopathy, and diastolic dysfunction.

Once you know which category of heart failure you have, you can follow the links below to learn more about your condition, and the kinds of treatments that are available for it.

Dilated Cardiomyopathy

Dilated cardiomyopathy is the most common variety of heart failure; most people who are told they have heart failure have dilated cardiomyopathy.

Dilated cardiomyopathy is the end result of a large variety of heart diseases, especially coronary artery disease and valvular heart disease. It occurs when the underlying cardiac disease eventually produces a significant weakening of the heart muscle itself.

Weakened heart muscle tends to stretch, and as a result the pumping chambers of the heart (most typically, the left ventricle) become dilated. To some extent the dilation of the left ventricle “compensates” for the weakening of the heart muscle. A dilated ventricle is holding a greater volume of blood, so more blood can be ejected with even a relatively weak pumping action.

The dilation and weakening of the left ventricle is usually estimated by measuring the left ventricular ejection fraction. The ejection fraction measures the percentage of blood held by the left ventricle that is ejected with each heart beat. Typically the ejection fraction is 50% or greater. With dilated cardiomyopathy, that value is decreased.

While dilation of the ventricle offers partial compensation for heart muscle weakness, dilated cardiomyopathy tends to worsen over time - especially if aggressive therapy is not given.

Eventually, the body’s organs may not receive their full quotient of blood, and multi-organ disease begins to appear. In addition, pressures inside the heart increase, causing fluid to "back up" in the lungs, producing lung congestion -- a condition often called congestive heart failure. Cardiac arrhythmias -- including some life-threatening ones -- are common in patients with dilated cardiomyopathy.

The outcome of a patient with dilated cardiomyopathy is strongly dependent on whether they receive the therapies that have been proven to reduce symptoms and prolong survival.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is usually a genetic condition, and often runs in families. It is characterized by a thickening of the heart muscle, resulting in "stiff" ventricles. The stiffness impairs the filling of the heart, and can lead to episodes of extreme shortness of breath in some patients, especially during exercise. The thickening of the heart muscle also can cause an obstruction in the left ventricle similar to that seen with aortic stenosis. And some patients with hypertrophic cardiomyopathy have an increased risk of sudden death.

Diastolic Dysfunction

Diastolic dysfunction is similar to hypertrophic cardiomyopathy in that it is caused by a "stiffening" of the heart muscle, leading to impaired filling of the heart. But unlike hypertrophic cardiomyopathy, diastolic heart failure is often not accompanied by thickening of the heart muscle, and is not thought to be a genetic disorder. It tends to occur in older individuals, often in women, and often in people with high blood pressure. It is characterized by relatively sudden episodes of severe shortness of breath due to lung congestion.


If you have been told you have heart failure, one of the best things you can do to help yourself is to learn all you can about your condition. You can get a good start by following the links above.


McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33:1787.

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810.

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