Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs. This disease affects approximately 64 million people worldwide, particularly affecting 10% of the population over 65 years of age. In Turkey, there are approximately 2 million heart failure patients. With modern treatment approaches, the vast majority of patients can maintain a quality life.
What is Heart Failure?#
Heart failure is a condition where the heart cannot pump enough blood to meet the body’s metabolic needs due to structural or functional abnormalities. This is not a disease in itself, but rather the final stage of various heart conditions.
Heart failure is classified according to the affected heart region:
- Left heart failure: The most common type. Causes fluid accumulation in the lungs (pulmonary edema).
- Right heart failure: Causes swelling in the legs, ankles, and abdomen.
- Biventricular failure: Affects both ventricles.
Systolic and Diastolic Heart Failure#
- Systolic heart failure (HFrEF): Left ventricular contraction strength is reduced. Ejection fraction (EF) is below 40%.
- Diastolic heart failure (HFpEF): Left ventricular contraction is normal but relaxation is impaired. EF is 50% or above.
- Heart failure with mid-range EF (HFmrEF): EF is between 40-49%.
Heart Failure Symptoms#
Heart failure symptoms can develop gradually or appear suddenly. Recognizing these symptoms is critical for early diagnosis and treatment.
Main Symptoms#
- Shortness of breath (dyspnea): Initially with exertion, later even at rest
- Orthopnea: Breathlessness when lying down, need to sleep with multiple pillows
- Paroxysmal nocturnal dyspnea: Waking suddenly at night with difficulty breathing
- Edema: Swelling in feet, ankles, and legs
- Fatigue and weakness: Difficulty with daily activities
- Palpitations: Irregular or rapid heartbeat
Additional Symptoms#
- Weight gain (due to fluid retention)
- Abdominal swelling (ascites)
- Cough, especially when lying down
- Loss of appetite and nausea
- Difficulty concentrating
- Frequent urination at night
Causes of Heart Failure#
Many different conditions can lead to heart failure:
Primary Causes#
- Coronary artery disease: The most common cause (60-70%)
- Hypertension: Long-term high blood pressure exhausts the heart muscle
- Cardiomyopathies: Dilated, hypertrophic, or restrictive
- Heart valve diseases: Aortic stenosis, mitral regurgitation
- Previous myocardial infarction: Heart muscle damage
Other Causes#
- Arrhythmia (atrial fibrillation)
- Congenital heart diseases
- Myocarditis (heart muscle inflammation)
- Thyroid diseases
- Alcohol and substance use
- Chemotherapeutic drugs
- Diabetes
Diagnostic Methods#
Heart failure diagnosis is made through a combination of clinical findings, laboratory tests, and imaging methods.
Physical Examination#
- Lung sounds (rales)
- Jugular vein distension
- Liver enlargement
- Edema assessment
- Heart sounds (S3 gallop)
Laboratory Tests#
- BNP/NT-proBNP: The most important biomarkers for heart failure
- Complete blood count
- Kidney and liver function tests
- Electrolyte levels
- Thyroid function tests
- HbA1c and lipid profile
Imaging Methods#
- Echocardiography: Gold standard diagnostic method
- Ejection fraction measurement
- Heart chamber dimensions
- Valve function
- Diastolic function assessment
- Chest X-ray: Pulmonary fluid and heart size
- ECG: Rhythm abnormalities and previous infarction findings
- Cardiac MRI: Myocardial fibrosis and detailed structural assessment
- Coronary angiography: Evaluation of ischemic etiology
Our Treatment Approaches#
Heart failure treatment is personalized according to the type and severity of the disease. The goal is to relieve symptoms, improve quality of life, and slow disease progression.
NYHA Functional Classification#
| Class | Definition |
|---|---|
| I | No limitation of physical activity |
| II | Mild limitation, symptoms with ordinary activities |
| III | Marked limitation, symptoms with less than ordinary activity |
| IV | Symptoms even at rest |
Lifestyle Modifications#
- Salt restriction: Below 2-3 grams per day
- Fluid restriction: 1.5-2 liters per day in severe cases
- Regular weight monitoring: Sudden weight gain indicates fluid retention
- Smoking cessation: Absolute necessity
- Alcohol restriction: Preferably complete cessation
- Physical activity: As tolerated, cardiac rehabilitation
Medical Treatment#
Four drug groups forming the foundation of modern heart failure treatment are known as the “pillars of therapy”:
1. ACE Inhibitors / ARB / ARNI
- Reduces heart workload
- Prevents structural remodeling
- Improves survival (ARNI particularly effective)
2. Beta-Blockers
- Slows heart rate
- Reduces myocardial oxygen consumption
- Decreases sudden death risk
3. Mineralocorticoid Receptor Antagonists (MRA)
- Reduces fluid retention
- Prevents fibrosis
- Contributes to survival
4. SGLT2 Inhibitors
- Provides benefit independent of diabetes
- Reduces hospitalization
- Newest treatment option
Additional Medications:
- Diuretics (fluid removal)
- Digoxin (in presence of atrial fibrillation)
- Ivabradine (high heart rate in sinus rhythm)
- Hydralazine + Isosorbide dinitrate
Device Therapies#
Device therapies can be life-saving for patients whose symptoms persist despite medical treatment:
ICD (Implantable Cardioverter Defibrillator)
- Prevents sudden cardiac death
- For patients with EF ≤35% and NYHA II-III despite optimal medical therapy
CRT (Cardiac Resynchronization Therapy)
- Synchronizes left and right ventricular contraction
- For patients with wide QRS (≥130 ms) and low EF
- Both improves pumping strength and relieves symptoms
CRT-D
- Combination of CRT and ICD
- Both resynchronization and sudden death protection
Advanced Heart Failure Treatments#
In end-stage heart failure:
- Left ventricular assist devices (LVAD): Bridge to transplant or destination therapy
- Heart transplantation: Most effective treatment in suitable patients
- Palliative care: Optimizing quality of life
Prognosis and Follow-up#
Heart failure is a chronic disease requiring regular monitoring. Follow-up frequency is determined by disease severity:
- NYHA I-II: Control every 3-6 months
- NYHA III: Control every 1-3 months
- NYHA IV: Frequent hospitalizations may be required
Frequently Asked Questions#
Can heart failure be cured?
Can I exercise with heart failure?
How much fluid should I consume daily?
Do I need a pacemaker or ICD?
Am I a candidate for heart transplant?
Appointment and Contact#
If you would like to schedule an appointment for heart failure diagnosis, treatment, or follow-up:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Heart Failure Treatments#
Other heart failure treatments related to heart failure:
- Biventricular Pacemaker - CRT pacemaker
- ICD - Implantable cardioverter defibrillator
- LVAD - Left ventricular assist device
- Heart Transplant - Heart transplantation
- Echocardiography - Heart ultrasound