Heart failure is a condition characterized by symptoms like shortness of breath and retention of fluid in the body. These symptoms are due to an underlying heart problem, such as a malfunction of the heart muscle, a defective heart valve, a heart rhythm disorder or other heart disease.

As a result, the heart does not pump blood sufficiently to all the organs and muscles. The pressure in the heart rises and excessive pressure in the blood vessels of the lungs causes fluid accumulation in the lungs ('water in the lungs'). This causes shortness of breath, first on exertion and - as the heart failure becomes more severe - even with the slightest effort, at rest or when lying down. Sometimes a dry cough develops, which often increases when lying down, or the breathing can be crackly.

The body will also retain salt and fluid. Eventually, congestion also occurs in the right heart and the veins that supply blood to the heart. Fluid builds up in the legs or abdomen, causing them to swell. This is called edema. You can use your finger to push indentations in the skin around the ankles - which is called pitting edema.

Heart failure can cause several symptoms, especially shortness of breath and swelling of the legs.

In the treatment of heart failure, an important distinction is made between heart failure with reduced or normal (preserved) left ventricular ejection fraction (LVEF). The LVEF is the percentage of the amount of blood present in the left heart chamber (ventricle) that is pumped out each time the left ventricle contracts. This indicates whether the pumping function of the heart is still normal or not. Normally the LVEF is above 50-55%.

If a patient is short of breath with signs of heart failure and a LVEF > 50%, it is called ‘heart failure with a preserved LVEF’ (HFpEF, heart failure with preserved ejection fraction). The pumping function of the heart is still normal. Heart failure is in this case mainly caused by stiffening of the heart muscle. This can have several causes: high blood pressure, diabetes mellitus, obesity, a calcified aortic valve, cardiac arrhythmias, specific diseases of the heart muscle, etc.

If a patient is short of breath with signs of heart failure and a LVEF < 40%, it is called ‘heart failure with a reduced LVEF’ (HFrEF, heart failure with reduced ejection fraction). The pumping function of the heart is then significantly reduced. Heart failure is in this case mainly caused by a damaged heart muscle. This can have several causes: a heart attack, cardiac arrhythmias, excessive alcohol use, genetic disorders, heart muscle inflammation, chemotherapy, etc.

Various tests are performed to diagnose heart failure and determine the cause.

Fortunately, there are many good treatment options available for heart failure. The treatment of heart failure consists of different elements depending on the underlying type of heart failure and the patient's condition at that time. These medications are often started at a lower dose and gradually increased to the maximum target dose, especially if the pumping function of the left ventricle is impaired. The aim of the treatment is to reduce the discomfort and keep the heart failure under control for as long as possible. This will improve the quality of life. The treatments aim to stabilize the pumping function of the heart, prevent complications and increase life expectancy.

The treatments consist in tackling the cause of the heart failure (if possible), medication, implantable devices under the skin and following a number of lifestyle rules.

• A diuretic is only necessary if the body retains fluid. This medication will remove this fluid by making the patient urinate more.
• In patients with heart failure with reduced pump function of the left ventricle (HFrEF), the main treatment is the combination of 4 groups of drugs, namely 1) a RAAS inhibitor (ie an ACE inhibitor, ARB or an ARNI), 2) a beta-blocker, 3) a MRA and 4) a SGLT2 inhibitor.
• In patients with heart failure with a normal pump function of the left ventricle, but mainly a stiffened heart muscle (HFpEF), the most important treatment is the combination of a SGLT-2 inhibitor and, if necessary, a diuretic. The other types of medication should only be used if you have high blood pressure or a fast heart rate.
• Some patients have a device implanted. This is usually a pacemaker and/or a defibrillator (ICD). These are implanted to prevent a slow heart rate, to improve heart function and/or to normalize the heart rhythm with an electric shock in the event of sudden life-threatening cardiac arrhythmias with a very fast heart rate.
• An implanted heart pump ('Left Ventricular Assist Device' (LVAD)) or a heart transplant may be necessary as a last resort, if this is still feasible.

A correctly adapted lifestyle is essential to keep the heart and general health stable. For more information, patients and their relatives can read the other informative texts in this section.