Cardiac Condition Information

    Heart Failure

    Heart failure means the heart is no longer pumping efficiently enough to meet the body's needs. It affects approximately one million people in the UK and is one of the most common reasons for hospital admission in adults over 65.

    Dr Matthew Balerdi provides rapid assessment for heart failure in Hull, Grimsby and Scunthorpe including NT-proBNP testing, ECG, and echocardiography with same-day specialist interpretation.

    What is Heart Failure?

    Heart failure is a clinical syndrome in which the heart cannot pump blood efficiently enough to meet the body's demands. It is not a single disease but a consequence of damage or strain on the heart muscle from various causes.

    There are two main types. HFrEF (heart failure with reduced ejection fraction) occurs when the left ventricle contracts weakly, with an LVEF below 40%. HFpEF (heart failure with preserved ejection fraction) occurs when the heart muscle is stiff and does not relax properly, with an LVEF of 50% or above.

    Heart failure is classified using the NYHA functional classification, which grades symptom severity from Class I (no limitation) to Class IV (symptoms at rest). This classification helps guide treatment decisions and monitor progress.

    NYHA Functional Classification

    Class I — No limitation

    Ordinary physical activity does not cause symptoms

    Class II — Mild limitation

    Comfortable at rest; ordinary activity causes symptoms

    Class III — Marked limitation

    Comfortable at rest; less than ordinary activity causes symptoms

    Class IV — Severe limitation

    Symptoms at rest; any physical activity increases discomfort

    Symptoms of Heart Failure

    Common Symptoms

    • Breathlessness (dyspnoea)
    • Fatigue
    • Ankle swelling (oedema)
    • Weight gain
    • Persistent cough
    • Reduced urine output

    Warning Signs

    • Orthopnoea (breathless lying flat)
    • Paroxysmal nocturnal dyspnoea (waking breathless)
    • Rapid weight gain >2kg in 48 hours
    • Palpitations
    • Dizziness

    Causes of Heart Failure

    Heart failure can result from a range of conditions that damage or place excessive strain on the heart muscle.

    Coronary & Vascular

    • Ischaemic heart disease (most common cause)
    • Hypertension (major cause of HFpEF)
    • Aortic or mitral valve disease

    Heart Muscle Disease

    • Dilated cardiomyopathy
    • Hypertrophic cardiomyopathy
    • Alcohol-related cardiomyopathy
    • Chemotherapy toxicity

    Other Causes

    • Atrial fibrillation (tachycardia-mediated)
    • Thyroid disease
    • Diabetes

    How Heart Failure is Diagnosed

    Diagnosis involves clinical assessment, blood tests, and cardiac imaging to confirm heart failure, identify the type, and determine the underlying cause.

    Initial Assessment

    • Detailed history and examination
    • NT-proBNP blood test (highly sensitive)
    • 12-lead ECG

    Cardiac Imaging

    • Echocardiogram (cornerstone — measures LVEF, identifies cause)
    • Chest X-ray

    Further Tests

    • CT coronary angiography
    • Cardiac MRI
    • Blood tests (kidney, iron, thyroid, HbA1c)

    Treatment Options

    Treatment depends on the type and severity of heart failure. For HFrEF, four key drug classes — the "Fantastic Four" — each independently reduce mortality.

    The Fantastic Four (HFrEF)

    Each of these independently reduces mortality:

    • ACE inhibitors / ARNI (sacubitril/valsartan)
    • Beta-blockers
    • MRAs (spironolactone)
    • SGLT2 inhibitors (dapagliflozin)

    Symptom Management

    • Loop diuretics (furosemide) for fluid congestion
    • Daily weight monitoring
    • Fluid and salt restriction

    Device Therapy

    • ICD (LVEF <35%, prevents sudden death)
    • CRT (broad LBBB, resynchronises ventricles)
    • Advanced options: LVAD, transplant

    Living with Heart Failure

    Self-management is a cornerstone of heart failure care. The following measures help maintain stability and reduce the risk of hospital admission.

    • Daily weight monitoring — weigh yourself each morning and record it
    • Fluid and salt restriction as advised by your specialist
    • Cardiac rehabilitation — improves exercise capacity and quality of life
    • Medication adherence — take all prescribed medications consistently
    • Recognising decompensation signs — increased breathlessness, swelling, or rapid weight gain

    When to Seek Help

    Heart failure symptoms can change. Use the guidance below to decide on the appropriate level of response.

    Call 999

    • Severe breathlessness at rest
    • Acute pulmonary oedema

    Urgent Same-Day Assessment

    • Sudden worsening of symptoms
    • Rapid weight gain >2kg in 48 hours
    • New orthopnoea

    Routine Referral

    • Unexplained breathlessness
    • Elevated NT-proBNP
    • Optimising treatment

    Reviewed by Dr Matthew Balerdi, Consultant Imaging Cardiologist (FRCP) — Last reviewed: April 2026

    Concerned About Heart Failure?

    Don't wait — early assessment and optimal treatment can significantly improve outcomes. Schedule your consultation today.