What is Heart Failure?

Heart failure means that the heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff.

Heart failure does not mean your heart has stopped working. It just needs some support to help it work better.

It can occur at any age, but is most common in older people.

Heart failure is a long-term condition which cannot usually be cured, but the symptoms can often be controlled for many years.

Causes of heart failure

There are lots of reasons why you may have heart failure. It can be sudden or it can happen slowly over months or years.

The most common causes of heart failure are:

  • a heart attack– which can cause long-term damage to your heart, affecting how well the heart can pump.
  • high blood pressure – putting strain on the heart, which over time can lead to heart failure.
  • cardiomyopathy – a disease of the heart muscle. There are different types which can either be inherited or caused by other things, such as viral infections or pregnancy.

Heart failure can also be caused by:


Being aware of the symptoms and stages of heart failure can help you get the best treatment and advice.

The most common symptoms of heart failure are:

  • Breathlessness – this may occur after activity or at rest; it may be worse when you’re lying down, and you may wake up at night needing to catch your breath
  • Fatigue – you may feel tired most of the time and find exercise exhausting
  • Swollen ankles and legs – this is caused by a build-up of fluid (oedema); it may be better in the morning and get worse later in the day

Less common symptoms

Other symptoms of heart failure can include:

Some people with heart failure may also experience feelings of depression and anxiety.

Diagnosis and stages

If you have symptoms of heart failure, your GP should offer you some checks and a blood test to see how well your heart is working.

ou some checks and a blood test to see how well your heart is working.

If your blood test shows you might have heart failure, your GP should consider referring you to a specialist heart failure team and you may be offered further tests.

Tests for heart failure

Tests you may have to diagnose heart failure include:

  • blood tests (NT-proBNP) – to check whether there’s anything in your blood that might indicate heart failure or another illness
  • an electrocardiogram (ECG) – this records the electrical activity of your heart to check for problems
  • an echocardiogram – a type of ultrasound scan where sound waves are used to examine your heart
  • breathing tests – you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness; common tests include spirometry and a peak flow test
  • a chest X-ray – to check whether your heart’s bigger than it should be, whether there’s fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms

You can read more about tests for heart conditions on the British Heart Foundation website.

Stages of heart failure

When you’re diagnosed with heart failure, your doctor will usually be able to tell you what stage it is.

The stage describes how severe your heart failure is.

It’s usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:

  • class 1 – you don’t have any symptoms during normal physical activity
  • class 2 – you’re comfortable at rest, but normal physical activity triggers symptoms
  • class 3 – you’re comfortable at rest, but minor physical activity triggers symptoms
  • class 4 – you’re unable to carry out any physical activity without discomfort and may have symptoms even when resting

Knowing the stage of your heart failure will help your doctors decide which treatments they think are best for you.

Useful videos

Treatments (medications, procedures and self-care)

Choose from the medications below to find out more details:

Name and dose in milligrams

Bisoprolol: 1.25, 2.5, 3.75, 5, 7.5, 10
Carvediolol: 3.125, 6.25, 12.5, 25 (taken AM & PM)
Metoprolol: 25, 50, 75, 100 (taken AM & PM)
Mineralocorticoid antagonists are a “type of water tablets,” that counteract the adverse compensatory mechanisms, from worsening your heart failure.

Name and dose in milligrams

Spironolactone: 12.5, 25, 50
Eplerenone: 12.5, 25, 50
Name and dose in milligrams

Dapagliflozin: 10
Empagliflozin: 10
ACE Inhibitors relax blood vessels, thereby lowering your blood pressure and help the heart pump more effectively.

Name and dose in milligrams

Ramipril: 1.25, 2.5, 5, 7.5, 10
Enalapril: 32.5, 5, 7.5, 10, 15, 20, 30, 40
Lisinopril: 5, 10, 15, 20
Perindopril: 2, 4, 8
Angiotensin Receptor Blockers are alternatives to ACE inhibitors in patients who have side effects to ACE inhibitors.

Name and dose in milligrams

Candesartan: 4, 8, 12, 16
Valsartan: 340, 80, 120, 160, 320
Losartan: 25, 50, 75, 100
Diuretics prevent fluid from building up in the body and lungs by getting rid of extra fluid and sodium in the urine. These medications make you pass urine frequently.

Name and dose in milligrams

Frusemide: 40, 80, 120, 160
Bumetanide: 1, 2, 3, 4, 5, 6
Bendroflumethiazide: 2.5, 5
Name and dose in milligrams

Aspirin: 75
Clopidogrel: 75
Ticagreolor: 90
Name and dose in milligrams

Warfarin: As per INR
Apixaban: 2.5, 5 (taken AM & PM)
Edoxaban: 60
Rivaroxaban: 15, 20
Dabigatran: 60, 90
Name and dose in milligrams

Amlodipine: 5, 10
Felodipine: 5
Doxazosin: 1, 2, 4, 8, 12, 16
Name and dose milligrams

Hydralazine: 25, 50 (taken morning, afternoon and evening)
Isosorbide Mononitrate: 30, 60, 90, 120 (taken once a day)
Isosorbide Mononitrate: 10, 20, 30, 60 (taken twice a day)

Can I improve my heart failure naturally?

If your doctor prescribes you medication it’s important to take it. But making changes to your lifestyle is also going to have a big impact on improving your health.

Changes may include:

  • weighing yourself regularly and entering your weight into the Aintree Heart Failure Passport – sudden weight gain may mean too much fluid is building up in your body
  • watching the amount of fluid you have each day 
  • managing stress and mood monitoring in the Aintree Heart Failure Passport app
  • controlling your blood pressure 
  • stopping smoking
  • limiting how much alcohol you drink or stopping altogether safely if advised to do so by your clinician
  • keeping active (and taking part in rehabilitation if advised to do so) – this can help improve your energy, stamina and fitness
  • keeping to a healthy weight, which will help to prevent your heart from working too hard.

Diet changes are also essential when managing your weight and keeping your heart healthy.

You could feel healthier by eating:

  • one or two portions of fruit or veg with every meal
  • sunflower oil, olive oil, nuts and avocados instead of saturated fat options like crisps and butter
  • one or two portions of beans or pulses everyday with a meal
  • your protein in the form of fish, eggs and lean meats
  • less salt and sugar.

Other videos

What support is available?

In this section you will find both local and global support connections to help you manage and understand your condition; whether they be for physical or emotional wellbeing.

Local support

Advice services available through Citizen Advice Bureau digital and telephone channels.

National Support

Pumping Marvellous closed Facebook group for heart failure patients

For people living with heart failure and their carers. Pumping Marvellous – the UK’s patient-led Heart Failure Charity – set up and manage this group so that people with heart conditions can talk freely and share experiences in a safe environment with others that understand.

View Group

My Marvellous Big Pocket Guide to Heart Failure

This “Marvellous Pocket Guide” is as a result of the experience gained by our marvellous team of patients here at the Pumping Marvellous Foundation who started just like you, with a diagnosis of heart failure.

Open Guide

My Marvellous Guide to Travelling with Heart Failure

It is important to be prepared when travelling with heart failure and we hope this guide will give you thoughts about how you can plan your trip, whether it be to Brighton or Barbados. We hope this guide resonates with you and helps you make some of those decisions so your trip is safe and organised thoroughly.

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