Heart Failure

Common presenting symptoms:

Breathlessness; particularly breathless when lying flat (orthopnoea); leg swelling (oedema)


Heart failure is becoming more prevalent in the modern era. There is no doubt we are witnessing major successes in other branches of cardiology – which means more people are now surviving their heart attacks / coronary artery disease / valvular heart disease; and coupled with better pharmacological and device treatment for heart failure, more people than ever before are now living with heart failure. The British Heart Foundation estimated that as many as 920,000 people are currently living with heart failure in the UK.

Heart failure is not a single condition – rather it is a syndrome with great heterogeneity. Some are caused by primary heart muscle disorders (cardiomyopathies); whilst some are the final common pathways to end-stage coronary artery / valvular / hypertensive heart disease. Because of its heterogeneity, it is important to explore the causes (aetiology) of individual patients, rather than just treating the symptoms of heart failure – as some heart failure might have potentially reversible causes, whilst some might have inheritable traits that may benefit from family screening. Like many chronic conditions, chronic heart failure can often be successfully managed in the community and remains stable for years. However, decompensated heart failure may require hospital treatment for aggressive management often with powerful intravenous diuretics (water-losing medication).


Expert evaluation of heart failure is important as it often unmasks other correctable heart conditions – statistically commonly associated with underlying coronary artery, valvular, and hypertensive heart disease, all of which may respond to appropriate treatment.

How do we investigate?

If heart failure disorder is suspected, in addition to a detailed history and basic blood test, it is important to quantify actual heart muscle and valvular function. Our cardiologists will recommend one or more potential investigative tests such as:-

  • Echocardiography to quantify heart and valve function
  • Cardiac MRI to look for underlying heart muscle abnormality
  • Cardiac CT or invasive coronary angiography to look for any co-existing coronary artery disease

What are the treatment options?

Pharmacological therapy is the primary treatment in the majority of cases. The list of prognostically important drugs in heart failure is well described and we will titrate the dose to the maximally tolerable doses to aid heart muscle remodelling / recovery with minimal undesirable effects. If reversible causes of heart failure are identified, additional treatment may be recommended. These may include coronary artery stenting (PCI) / coronary artery bypass surgery (CABG) to revascularise the heart; or valve replacement or intervention to relieve severely diseased heart valves. In addition, in certain patients with severe heart failure, special pacemaker device (Cardiac Resynchronization Therapy, CRT) implantation may be recommended to improve heart function.