Heart failure is a condition in which the heart does not pump well. This causes the heart to lag behind in its job of moving blood throughout the body. As a result, fluid backs up in the body, and the organs in the body do not get as much blood as they need. This can lead to symptoms, such as swelling, trouble breathing, and feeling tired.

If you have heart failure, your heart has not actually "failed” or stopped beating. It just isn’t working as well as it should.

Although heart failure is a serious condition, safe and effective treatments are available. Treatment can help you feel better and live longer.

Heart failure is caused by a disease or condition that damages the heart. Fortunately, treating these conditions during the early stages can often prevent or slow development of heart failure.

The most common causes of heart failure include; longstanding poorly controlled high blood pressure, diseases of the heart such as coronary heart disease which causes narrowing of the blood vessels that supply ("feed”) the heart muscle reducing the flow of blood through these vessels causing insufficiency in heart activity and often unmanaged severe coronary heart disease can lead to a heart attack which can lead to death. Diseases of the heart valves can lead to heart failure (heart valves are parts within the heart that allows blood to move from one heart chamber to another without sipping back or mixing with blood from a different heart chamber), and a number of conditions such as having a heart attack and aging, can damage these heart valves.

If ones heart does not pump well, at first one might have no symptoms. But as the condition gets worse, it can cause symptoms such as; tiredness or weakness or feeling lightheaded or dizzy, trouble breathing, which might lead you to be less active or to need extra pillows at night to sleep, having a racing heartbeat even while resting. One usually also experiences swelling in the lower legs and feet (edema) or in the abdomen (ascites) and feeling tired quickly.

Heart failure is diagnosed based upon ones medical history, physical exam, and a series of tests are done. These tests can help the doctor to know how well ones heart is working and to determine the most probable cause of one’s heart failure.

A chest X-ray can be done to see if there is fluid in the lungs due to heart failure. It also shows the general shape of the heart and large blood vessels in the chest. Other tests include a test to measure the electrical activity in the heart, called an electrocardiogram (ECG or EKG) and ultrasound imaging scan of the heart (echocardiogram) to see the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working. Other tests which can be done include tests to know if the heart receives enough blood under stress (physical activity), called a stress test or tests to determine whether any of the arteries in one’s heart are narrowed or blocked. Blood tests are also done to look out for features of heart attacks or its risk factors.

Heart failure can be managed with medicines, although lifestyle changes play a big role in both symptom relief and limiting the progression of the disease.

The goal of treatments for heart failure is to reduce symptoms and reduce the chance of developing complications. The most common complications include; a weakened and enlarged heart muscle (called cardiomyopathy), irregular heart rhythms (called arrhythmias) which can lead to blood clots or even a stroke and having a heart attack.

Once diagnosed with heart failure, one needs to take their medicines every day or as prescribed by their physician even if they feel well. The medicines the doctor prescribes can help you feel better and live longer. But they will work only if you take them as prescribed.

One will need to weigh themselves every morning after urinating but before taking breakfast. Wear roughly the same amount of clothing every time. And make sure to write down the weight every day on a calendar and if ones weight goes up by one kg in one day, or two kg in one week one needs to seek medical assessment. When one has heart failure, sudden weight gain is a sign that their body could be holding on to too much fluid, and might need a change in their medicines.

Cut down on salt by trying not to add salt at the table, cutting weight if overweight, quitting cigarette smoking, limiting alcohol intake, and checking with ones doctor before taking any new medicines or supplements. The doctor will let you know if activities such as walking or biking on most days of the week can help reduce your symptoms, but do not exercise if your symptoms are bothering you a lot.

Dr Ian ShyakaResident in Surgery, Rwanda Military Hospital