What Is Heart Failure? (Part 1/3)

Heart failure is a common but often misunderstood condition. Many people think it means the heart has “stopped,” but that’s not the case. Heart failure means the heart is pumping less efficiently than before, and it can affect anyone, often without obvious symptoms in the early stages.

Heart failure sounds dramatic — but it doesn’t mean that the heart has “stopped.”It means that the heart is not able to pump enough blood to meet the body’s needs, either because the pumping function is weakened, or because the heart muscle has become stiff and doesn’t fill properly between beats.

When the heart works less efficiently, blood can build up in the body. The result is a range of symptoms that many people recognize, but don’t always associate with the heart.

Common Symptoms

• Shortness of breath – at first during exertion, later possibly even at rest

• Swelling in the legs and ankles

• Fatigue and reduced exercise tolerance

• Weight gain due to fluid retention

• Restless sleep or the need to sleep with multiple pillows

  
  

These symptoms often appear gradually, and many people initially attribute them to aging or poor fitness. However, these are classic signs of heart failure.

What Causes Heart Failure?

There are many possible causes, but in Norway and other Western countries the most common are:

• Previous heart attack or other heart disease

• Long-standing high blood pressure

• Heart valve disease

• Abnormal heart rhythms such as atrial fibrillation

• Long-term alcohol use or certain medications

• Inherited heart muscle diseases

  
  

Often, several factors contribute at the same time.

How Is Heart Failure Diagnosed?

There is no single test that can confirm heart failure. The diagnosis is made based on a combination of symptoms, clinical findings, and test results:

1. Physical examination. The doctor listens to your heart and lungs, checks for swelling, and measures blood pressure.

2. ECG (electrocardiogram) shows the rhythm and electrical activity of the heart. A normal ECG makes heart failure less likely, but doesn’t rule it out.

3. Blood test – NT-proBNP. A simple but highly valuable test that indicates how much strain the heart is under.If the value is low, heart failure is unlikely; if high, further testing is recommended.

4. Echocardiography (heart ultrasound). The key test to confirm the diagnosis. It shows how well the heart pumps, how the valves function, and whether the heart muscle is stiff or weakened. Only after an ultrasound can doctors determine what type of heart failure is present.

Other useful tests may include kidney and thyroid function tests, hemoglobin levels, or lung function testing (spirometry), since several conditions can cause similar symptoms.

The Two Main Types of Heart Failure

International guidelines classify heart failure into three categories, but for most patients and families, it’s easiest to think of two main types:

1. Heart failure with reduced pumping ability (low ejection fraction) – the heart does not contract strongly enough.

2. Heart failure with preserved pumping ability (normal ejection fraction) – the heart pumps normally, but is stiff and fills poorly.

The term ejection fraction (EF) describes the percentage of blood pumped out of the heart with each beat. A normal EF is typically above 50–55%.

To measure EF, an echocardiogram is required — which means heart failure cannot be diagnosed with certainty without this test.

Living With Heart Failure

Heart failure can be a chronic condition, but with proper treatment and follow-up, many people live active lives. Modern medications, cardiac rehabilitation, and good self-care have greatly improved both life expectancy and quality of life.

The most important steps are:

• Regular follow-up with your doctor or cardiologist

• Taking prescribed medications consistently

• Monitoring your weight and swelling

• Staying physically active within your limits

• Avoiding smoking and limiting alcohol intake

  
  

In Summary

• Heart failure means the heart cannot pump efficiently enough

• Typical symptoms include shortness of breath, swelling, and fatigue

• The NT-proBNP blood test and heart ultrasound are key to diagnosis

• There are two main types: reduced and preserved pumping function

• With proper treatment and follow-up, many live well with heart failure