Heart Failure: Symptoms, Types, and Comprehensive Management

Heart failure is a chronic condition in which the heart cannot pump blood efficiently enough to meet the body's demands. It affects millions of people worldwide and is one of the leading causes of hospitalization in adults over 65. Although the term may sound alarming, with timely diagnosis and proper management, many patients can lead active and fulfilling lives. At Dr. Elders Jimenez Iglesias's office in Hospital Galenia, Cancun, we offer comprehensive evaluation and specialized follow-up for heart failure patients.

What is heart failure

Heart failure does not mean the heart has stopped, but rather that it has lost some of its pumping capacity. It can develop gradually over years as a consequence of diseases that weaken or stiffen the heart muscle. The most common causes include coronary artery disease (blocked arteries), uncontrolled high blood pressure, heart valve diseases, cardiomyopathies, chronic arrhythmias such as atrial fibrillation, and a history of heart attack.

Types of heart failure: systolic and diastolic

There are two main types based on left ventricular function. Systolic heart failure (heart failure with reduced ejection fraction or HFrEF) occurs when the heart muscle weakens and cannot contract forcefully enough, pumping less blood with each beat. The ejection fraction, normally 55 to 70 percent, drops below 40 percent. Diastolic heart failure (heart failure with preserved ejection fraction or HFpEF) occurs when the heart muscle becomes stiff and does not relax properly, making ventricular filling difficult. The ejection fraction may be normal, but the heart does not receive enough blood between beats. This distinction is critical because treatment varies by type.

Symptoms of heart failure

Symptoms may appear gradually and are often mistaken for normal aging. Recognizing them early is essential to initiate treatment:

• ●Shortness of breath (dyspnea) during everyday activities such as climbing stairs, walking, or even lying down
• ●Persistent fatigue and weakness that limits daily activities
• ●Swelling (edema) in feet, ankles, legs, or abdomen due to fluid retention
• ●Rapid weight gain (more than 1 kg in a day or 2 kg in a week) from fluid accumulation
• ●Persistent cough or wheezing, especially when lying down, due to pulmonary congestion
• ●Need to sleep propped up on multiple pillows or sitting upright (orthopnea)
• ●Waking at night with a sensation of suffocation (paroxysmal nocturnal dyspnea)
• ●Palpitations or irregular heartbeats
• ●Decreased appetite, nausea, or feeling of abdominal fullness
• ●Difficulty concentrating or confusion in advanced cases

Diagnosing heart failure

Diagnosis is based on clinical history, physical examination, and complementary studies. The echocardiogram is the key test because it measures the ejection fraction and evaluates heart structure and function in real time. The electrocardiogram detects arrhythmias and signs of previous damage. Blood tests include B-type natriuretic peptide (BNP or NT-proBNP), a biomarker that rises when the heart is under stress. A chest X-ray shows whether there is pulmonary congestion or cardiac enlargement. In some cases, stress tests, cardiac catheterization, or cardiac MRI are added to identify the underlying cause.

Heart failure treatment

Modern treatment has significantly improved the prognosis of heart failure. Core medications include ACE inhibitors or angiotensin receptor-neprilysin inhibitors (ARNI such as sacubitril/valsartan), beta-blockers that reduce heart rate and protect the heart muscle, aldosterone antagonists (spironolactone or eplerenone), SGLT2 inhibitors (dapagliflozin or empagliflozin) which have shown benefit even in patients without diabetes, and diuretics to control fluid retention. In selected cases, devices such as an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) may be indicated.

Essential lifestyle changes

• ●Sodium restriction: limit salt intake to less than 2 grams daily to reduce fluid retention
• ●Fluid control: in advanced cases, limit intake to 1.5 to 2 liters daily as directed by your physician
• ●Weigh yourself daily on an empty stomach to detect fluid retention early
• ●Supervised physical activity: cardiac rehabilitation programs improve functional capacity and quality of life
• ●Quit smoking completely and limit alcohol consumption
• ●Annual influenza and pneumococcal vaccination to prevent respiratory infections
• ●Strict adherence to prescribed medications without skipping doses or stopping them on your own
• ●Regular home monitoring of blood pressure and heart rate

When to seek emergency care

Go to the emergency room if you experience severe shortness of breath that does not improve with rest, chest pain lasting more than 15 minutes, fainting or loss of consciousness, coughing up pink or frothy sputum (acute pulmonary edema), or weight gain exceeding 2 kilograms in 24 hours. These signs may indicate acute decompensation requiring immediate medical attention.

Dr. Elders Jimenez Iglesias

Cardiologist · Nuclear Cardiology

Professional License: 13819257 · Specialty: 12543211