Patient information · Cardiovascular
Heart failure
a misleading name for a treatable condition
Heart failure does not mean the heart is about to stop. It means it is not pumping as efficiently as it should, so fluid accumulates and exertion becomes difficult. Modern treatment has transformed the outlook — four medicines taken together substantially reduce both symptoms and mortality.
Call 999 if you have
- severe breathlessness at rest, or unable to lie flat
- coughing pink or frothy sputum
- chest pain lasting more than 15 minutes
- fainting, or a very fast or very slow pulse with dizziness
- blue lips, confusion or drowsiness
- rapid weight gain of more than 2kg in two to three days with worsening swelling
Sudden severe breathlessness with frothy sputum indicates fluid on the lungs and needs emergency treatment. Sit upright while waiting for the ambulance. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Symptoms
- Breathlessness on exertion, then on lying flat, then at rest
- Waking at night breathless, or needing extra pillows
- Swollen ankles, legs or abdomen, worse by the end of the day
- Fatigue and reduced exercise tolerance
- persistent cough or wheeze, particularly at night
- rapid weight gain from fluid, loss of appetite, and needing to pass urine at night
The blood test that starts everything
NT-proBNP is released by a stretched heart. A normal level makes heart failure very unlikely and usually avoids further testing. A raised level prompts an echocardiogram, which shows how the heart is pumping and why. NICE sets urgency by the level — a very high result means echo and specialist assessment within two weeks. This test is the single most useful step in anyone with unexplained breathlessness or ankle swelling, and it is often not requested.
Two types
- Reduced ejection fraction (HFrEF) — the heart muscle is weakened and pumps out less than it should. This is where the four-drug treatment applies.
- Preserved ejection fraction (HFpEF) — the heart pumps normally but is stiff and does not fill well. Commoner in older people, women, and with high blood pressure, diabetes and obesity. Treatment focuses on fluid, blood pressure, weight and the SGLT2 inhibitors, which now have good evidence here too.
The four pillars
- These four together substantially reduce hospital admissions and deaths in reduced ejection fraction, and the benefit is additive — being on all four matters.
- Doses are increased gradually to target over weeks to months, with blood pressure, kidney function and potassium monitored.
- Feeling worse briefly when starting a beta-blocker is expected and is not a reason to stop — the benefit builds over months.
- Diuretics control fluid and symptoms but do not improve survival; they are adjusted around the other four.
- Devices — ICDs and cardiac resynchronisation — are considered for selected people.
Managing it day to day
Do
- Weigh yourself daily, same time, after the toilet, before breakfast
- Record it — a rise of 2kg over 2–3 days means contact us
- Reduce salt; avoid the salt cellar and check processed foods
- Stay active — exercise improves symptoms and survival
- Have flu, COVID and pneumococcal vaccination
Avoid
- Anti-inflammatories such as ibuprofen, which cause fluid retention
- Excessive fluid, but do not restrict severely without advice
- Alcohol above recommended limits, and none if alcohol caused it
- Stopping medicines because you feel well
- Ignoring gradual weight gain or increasing breathlessness
Ask about a fluid and diuretic plan
Many people with heart failure can be given a flexible diuretic regimen — agreed rules for increasing the dose for a few days if weight rises by a set amount, and when to call. This prevents a great many hospital admissions, and it is one of the most useful things to ask for. It requires knowing your own dry weight and weighing daily.
Why come to us. The bottleneck in heart failure is usually getting NT-proBNP and an echo done quickly. We take NT-proBNP, kidney function, thyroid, iron studies and full blood count in-house, perform ECG and echocardiography on site, and can complete the whole diagnostic pathway in one or two visits. Iron deficiency is common in heart failure and treating it improves symptoms — we check it routinely. Cardiology without a referral, seven days a week.
NT-proBNP and echo without waiting weeks
Bloods, ECG and echocardiography on site. Cardiology without a referral.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.