Heart failure symptoms can range from mild to severe, and may come and go, sometimes even may not have any symptoms at all. 

In general, heart failure gets worse over time without proper treatment. As it worsens, different signs or symptoms may appear, for example :

1. Breathlessness, wheezing, nocturnal cough 
2. Fatigue, tiredness
3. Palpitation
4. Ankles welling, weight gain
5. Loss of appetite, nausea
6. Depression, confusion, dizziness

Heart failure can lead to complications in different organs due to insufficient blood supply.

1. Lung problems : Damaged heart can’t pump blood from the lungs effectively, blood backs up and raises pressure in pulmonary veins and pushes fluid into the air sacs and decrease the lung function progressively.

2. Liver damage : The fluid build up that comes with heart failure puts extra pressure on portal vein, this can scar the organ and lead to cirrhosis.

3. Kidney damage or failure : Without the amount of blood the kidneys need, they won’t be able to remove enough waste from blood, this can lead to kidney failure.

Causes of heart failure can be grouped into two categories¹ :

1. Heart disease triggered : Coronary artery disease, Arrhythmias, Valve disease, Congenital heart disease, Cardiomyopathy, etc. 

2. Non-heart disease triggered : Diabetes mellitus, Hypertension, Obesity, Endocrine disease, Kidney disease, Infection, Drug Induced, etc.

Doctors will diagnose heart failure based on symptoms and patient history, the following diagnostic tests are recommended for the assessment of patients with suspected chronic HF :


1. Electrocardiogram (ECG) : The ECG may reveal abnormalities that increase the likelihood of a diagnosis of HF and also may guide therapy

2. Basic investigations : Such as serum urea and electrolytes, creatinine, full blood count and liver function test. Measurement of NPs such as BNP / NT-proBNP are recommended

3. Echocardiography : Key investigation for the assessment of cardiac function, echocardiography provides information such as chamber size, regional wall motion abnormalities and valvular function

4. Chest X-ray : A chest X-ray is recommended to investigate other potential causes of breathlessness

5. Cardiac catheterization

6. Biopsy

7. Magnetic Resonance Imaging (MRI)

The New York Heart Association (NYHA) functional classification based on severity of symptoms and physical activity :

NYHA Class I
No limitation of physical activity. Ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations.

NYHA Class II
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

NYHA Class III
Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity results undue breathlessness, fatigue, or palpitations.

NYHA Class IV
Unable to carry on any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken, discomfort is increased.

Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition. Common treatments include lifestyle changes, medicine, devices and surgery.

Prevention
Heart failure patients should :

1. Have a healthy diet, avoid food high in fat, eat fruits and vegetables, limit the intake of sodium
2. Do regular exercise and control weight
3. Relax and calm, ensure enough sleep
4. Quit smoking and excessive alcohol
5. Control hypertension, diabetes and related diseases
6. Avoid environment that is too hot or too cold
7. Visit doctors regularly for checking to monitor the situation


Treatment
1. Medications¹ :

i. Angiotensin-converting Enzyme (ACE) Inhibitors
ii. Angiotensin II Receptor Blockers (ARB)
iii. Beta-blockers
iv. Diuretics
v. SGLT-2 Inhibitors
vi. Angiotensin Receptor-Neprilysin Inhibitor (ARNI)
vii. Mineralocorticoid Receptor Antagonists (MRA)
viii. Digoxin
ix. Ivabradine
x. Nitrate + Hydralazine


2. Device¹:

i. Pacemaker
ii. Cardiac Re-synchronisation Therapy (CRT)
iii. Implantable Cardioverter Defibrillator (ICD)


3. Surgery¹ :

Coronary Artery Bypass Grafting (CABG)
Heart Valve Surgery
Left Ventricular Assist Device (LVAD)
Heart Transplantation