What is heart failure, and how is it classified?
Heart failure (HF) is a clinical syndrome in which the heart is unable to maintain sufficient blood flow to meet the body’s metabolic needs, or can do so only at the cost of abnormally elevated filling pressures. It is a serious chronic condition that requires specialized medical care. Supportive supplements are available in the store’s cardiovascular health line.
- Classification based on ejection fraction (EF): HF with reduced EF (EFr < 40% — dilated, “floppy” heart — highly standardized drug therapy) — HF with mildly reduced EF (EFle 41–49%) — HF with preserved ejection fraction (pEF ≥ 50% — stiff heart, impaired filling — predominantly seen in older women with hypertension)
- NYHA classification (functional severity): Class I (asymptomatic on exertion) → Class II (symptoms with significant exertion) → Class III (symptoms with moderate exertion) → Class IV (symptoms at rest—dyspnea, severe edema)
- Main causes: coronary artery disease and myocardial infarction (leading cause) — chronic hypertension — valvular heart disease — dilated cardiomyopathy — diabetes — alcohol — drug-induced cardiotoxicity (chemotherapy, immunotherapy)
- Diagnostic biomarkers: BNP and NT-proBNP — elevated levels = myocardial stress — used for diagnosis, risk stratification, and treatment monitoring — interpretation by a cardiologist
What symptoms should you watch for, and when should you seek emergency care?
- Typical symptoms of HF: progressive exertional dyspnea (shortness of breath with increasingly minor exertion) — orthopnea (shortness of breath when lying down — need for pillows) — paroxysmal nocturnal dyspnea (waking up at night feeling like you “can’t breathe”) — lower extremity edema (swollen ankles and legs by the end of the day) — persistent fatigue — rapid weight gain (> 2 kg in 3 days → seek medical attention immediately)
- Signs of acute worsening — call 15: severe dyspnea at rest (acute pulmonary edema) — chest tightness — confusion or agitation — grayish or cyanotic skin tone — drop in blood pressure with weak pulse
- Organ involvement: kidneys (cardiogenic renal failure) — liver (hepatic congestion, hepatomegaly, ascites) — lungs (pulmonary congestion, pleural effusions) — HF is life-threatening in the medium term without optimal treatment
Standard of Care and Lifestyle Support
Treatment of HF with reduced ejection fraction is based on four established pharmacological pillars (ESC 2023): ACE inhibitors or sacubitril-valsartan — beta-blockers — mineralocorticoid antagonists — SGLT2 inhibitors — strictly prescribed by a cardiologist. Never modify or discontinue these medications without medical advice.
- Essential lifestyle and dietary restrictions: salt < 5 g/day (to reduce edema) — water: fluid restriction if prescribed (generally 1.5 L/day in cases of severe HF) — alcohol: complete abstinence recommended — tobacco: quit (Tobacco Info Service: 3989) — daily weight monitoring (same time, same scale — report any weight gain > 2 kg in 3 days to your cardiologist)
- Supervised physical activity: a sedentary lifestyle worsens HF — supervised cardiac rehabilitation programs — daily walking tailored to NYHA class — never start an intensive program without medical approval
- Coenzyme Q10: cardiac mitochondrial cofactor — levels are reduced in heart failure and with statin therapy — Q-SYMBIO trial: significant reduction in cardiovascular mortality at 100 mg × 3/day — does not replace prescribed medications — medical advice essential
- Omega-3 EPA-DHA: reduces cardiac electrical excitability — 1 g/day documented in heart failure (GISSI-HF trial) — EFSA claim regarding cardiac function
- See also heart and cardiovascular system disorders
