Types of heart failure

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Heart failure is a complex condition that doctors categorize into different types depending on:

• the affected areas of the heart
• the heart’s pumping ability
• underlying disease

For example, heart failure may affect the entire heart or only one side. The heart may have difficulty pumping enough blood around the body to support other organs and tissues, or the heart muscle may become stiff, blocking or reducing blood flow.

Some people may experience acute heart failure, with symptoms suddenly appearing but resolving reasonably quickly. Other individuals develop chronic heart failure with long-term symptoms that do not improve.

Understanding the types of heart failure is crucial for tailoring treatment approaches and improving a person’s outcome.

What is heart failure?

Heart failure occurs when the heart’s pumping ability has an impairment. It can result from various underlying causes, such as coronary artery disease or a heart attack.

In heart failure, the heart muscles become weakened or stiff, leading to inadequate pumping of blood to meet the body’s demands. It is a severe condition requiring immediate medical attention.

Learn more about heart disease.

The heart has two chambers on the left and two on the right. The left ventricle is responsible for most of the heart’s pumping power, supplying oxygen-rich blood to the rest of the body.

Left-sided heart failure is the most common form. When it occurs, the left side of the heart must work harder to pump the same amount of blood.

According to the American Heart Association, a healthy left ventricle pumps around 55–60% of the blood it contains with each heartbeat. Doctors call this the ejection fraction.

It states that there are two types of left-sided heart failure:

• Systolic failure: This happens when the left ventricle does not contract normally, so it cannot pump blood with enough force to circulate it correctly. Doctors also call this heart failure with reduced ejection fraction, which means the heart pumps less than or equal to 40% of the blood it holds.
• Diastolic failure: This occurs when the left ventricle loses its ability to relax properly. The muscle becomes stiff, and the heart cannot fill with blood properly during the resting period between beats. Doctors refer to this as heart failure with preserved ejection fraction, which means the heart is pumping greater than or equal to 50% of the blood it holds.

There is also a newer concept called heart failure with mid-range ejection fraction. In this type, the left ventricle pumps between 41–49% of the blood it holds.

Learn about left-sided vs. right-sided heart failure.

As the heart pumps, it moves deoxygenated blood that has circulated around the body from the right atrium to the right ventricle and back to the lungs. In right-sided heart failure, the right ventricle becomes weakened or fails to function correctly.

Right-sided heart failure typically happens due to left-sided failure, although it can occur on its own.

If the left ventricle cannot pump enough blood from the heart, this increases fluid pressure back through the lungs, damaging the heart’s right side. As a result, blood can back up in the veins, leading to fluid accumulation in organs and tissues throughout the body.

Learn more about right-sided heart failure.

Doctors may use the term “congestive heart failure” interchangeably with heart failure. It describes fluid accumulation that causes congestion in various parts of the body.

When the heart cannot pump blood effectively, blood backs up in the veins, causing fluid congestion in the tissues. A person may then develop edema or swelling. This is particularly likely to occur in the legs and ankles, although it can happen elsewhere.

Fluid collection in the lungs can interfere with breathing and cause shortness of breath. Doctors call this pulmonary edema.

Heart failure also affects the kidneys, making them unable to excrete sodium and water effectively. As a result, blood volume increases, and the retained water contributes to soft tissue swelling.

Learn more about congestive heart failure.

Biventricular heart failure, which doctors also refer to as global heart failure, occurs when both the left and right ventricles of the heart are weak or fail to function correctly.

This can lead to symptoms similar to left-sided and right-sided heart failure, including:

• fluid retention
• fatigue
• shortness of breath

Heart failure can occur due to conditions that affect the heart’s structure and function.

These include:

• coronary artery disease
• high blood pressure
• heart attacks
• cardiomyopathy, which is the weakening or stiffening of the heart muscle
• heart valve disorders such as mitral valve regurgitation or aortic valve stenosis
• congenital heart abnormalities
• arrhythmias, or atypical heart rhythms
• severe anemia
• hyperthyroidism

There is no cure for heart failure. However, the condition is manageable.

Treatment for heart failure typically involves a combination of lifestyle modifications, medications, and medical procedures. Goals involve:

• managing symptoms
• slowing disease progression
• improving quality of life
• reducing the risk of complications

Lifestyle factors

Lifestyle modifications may include:

• dietary changes
• regular exercise
• weight management
• quitting smoking, if applicable
• sodium restrictions
• fluid restrictions

Close monitoring by healthcare professionals is crucial. It is important for people to attend regular follow-up appointments to ensure optimal management of heart failure.

Medications

Doctors may prescribe the following to control symptoms and optimize heart function:

• ACE inhibitors
• beta-blockers
• diuretics
• aldosterone antagonists

Quad therapy, often used for treating heart failure, incorporates the above treatments.

It is more challenging to pinpoint treatment for heart failure with preserved ejection fraction. Doctors commonly focus on managing blood pressure and fluid control to minimize further damage to the heart.

Medical procedures

In some instances, medical procedures may be necessary. This may involve the insertion of implantable devices such as pacemakers or defibrillators or surgical interventions such as coronary artery bypass grafting or valve repair or replacement.

Doctors may consider a heart transplant for patients with severe heart failure at a very young age.

An individual’s outlook can vary depending on the severity and type of heart failure and their overall health.

The mortality rate following hospitalization for heart failure is around:

• 10% at 30 days
• 22% at 1 year
• 42% at 5 years

While heart failure is a severe and progressive condition, advancements in medical care have improved outcomes and extended life expectancy for many individuals.

Heart failure is a complex condition that refers to the heart’s inability to pump blood effectively, leading to symptoms and potential complications. It may affect either or both sides of the heart.

Managing heart failure can involve a combination of lifestyle modifications, medications, and medical procedures. Doctors will aim to improve symptoms, slow disease progression, and enhance a person’s quality of life.

Regular monitoring and follow-ups with healthcare professionals are essential for optimal management and adjusting treatment plans as needed.