Heart failure and heart valve disease
Heart failure means the heart does not pump blood as well as it should; it does not mean the heart has stopped working. Valve disease means one or more valves are not working properly. This page explains symptoms, checks, treatment and when to act urgently.
What are these conditions?
Heart failure means the heart does not pump blood as well as it should. The NHS stresses that this does not mean the heart has stopped working. Sometimes it appears suddenly, for example after a heart attack or an infection, and sometimes it comes from long-term strain, such as high blood pressure or coronary heart disease. The NHS also lists the valves, the heart muscle, rhythm problems, kidney disease, anaemia and thyroid problems among the causes.
Heart valve disease means one of the four heart valves is not working properly. The NHS describes two main problems: stenosis, where the valve does not open fully, and regurgitation (leaking), where the valve does not close fully and blood leaks back. The aortic and mitral valves on the left side are the ones most often affected. In both cases the heart has to work harder.
Some people with valve disease have no symptoms (NHS).
Who should see a doctor?
The signs of heart failure, according to the NHS:
- Breathlessness during everyday tasks or when lying down
- More breathlessness than expected during exercise
- Weakness, tiredness or dizziness
- Swollen legs, ankles, calves or belly
- Sudden weight gain
- A cough at night
The signs of valve disease: breathlessness, tiredness or weakness, dizziness, palpitations, swollen ankles and feet, chest pain or discomfort. The NHS says these signs have many causes and are not a diagnosis, but they need to be checked.
So if you keep having breathlessness or swollen legs with no clear reason, see a doctor. The same applies if a doctor has heard a murmur or sent you for an echo. But if you have severe breathlessness, chest pain or fainting right now, do not wait for an appointment. See the last section.
How is it investigated?
The doctor examines the heart and lungs and may refer you to a heart specialist. The NHS lists these tests:
- Heart echo: the NHS lists it for diagnosing both heart failure and valve disease. An echo shows the structure and pumping strength of the heart and the blood flow through each valve. For a full description, see the page “Echocardiography”.
- ECG
- Plain chest X-ray
- Blood and urine tests
- MRI and breathing tests, in some patients
In heart failure the NHS separates two ideas: the type (why the heart is not pumping well) and the stage (how severe the symptoms are). The doctor explains both to you.
What does treatment look like in general?
Heart failure: the NHS says there is no cure, but the aim of treatment is to reduce symptoms and slow progress, and it varies with the type, the stage and your general health. Some of the approaches:
- Medicines that remove extra fluid, medicines that widen the blood vessels so the heart has less work, and medicines that slow the heartbeat. Choosing them and the amounts is for the doctor.
- Surgery or a device for some patients: opening a blocked artery, repairing or replacing a valve, a pacemaker.
- Cardiac rehabilitation: the NHS says it should be offered to everyone with the condition and includes an exercise assessment, an exercise programme, lifestyle advice and support groups.
Valve disease: the NHS says that in mild disease with no symptoms, regular check-ups are often all that is needed. With symptoms or severe disease, medicines may be used (to lower pressure, remove fluid, slow the heartbeat or reduce the risk of clots), and in severe disease surgery is usually needed: the valve is repaired if it is not too badly damaged, and if not, it is replaced with an artificial or tissue valve.
The NHS says valve disease may lead to heart failure, atrial fibrillation, stroke or a heart infection, but many people with mild disease never develop a serious problem.
If you are pregnant or planning a pregnancy and have valve disease, talk to a heart specialist before pregnancy (NHS).
What can you do yourself?
For heart failure the NHS says:
- Take your medicines as directed.
- Weigh yourself regularly. A sudden weight gain may be a sign of fluid building up. Ask your own care team how much and how often.
- Have the recommended vaccines, such as the flu vaccine.
- Stay active and ask about cardiac rehabilitation.
- Eat a balanced diet, keep a healthy weight, stop smoking and cut down on alcohol.
- Driving: the NHS says driving and insurance should be reported. Ask your own doctor about this.
For both conditions regular follow-up matters, because the situation can change gradually. Heart failure symptoms vary from one day to the next (NHS).
When to seek urgent care
Call 115 (Iran’s emergency number) and do not drive yourself if:
- You have severe breathlessness: gasping, feeling choked or unable to speak
- Your lips or skin have turned pale, bluish or grey
- Someone has fainted and is not responding normally
- You have sudden chest pain that spreads to the arm, back, neck or jaw or lasts more than 15 minutes
- Chest pain comes with breathlessness or palpitations
For heart failure, the NHS also says to get medical help without delay for these: breathlessness when lying down or during ordinary tasks, a cough with pink frothy phlegm, or sudden weight gain. In these cases do not wait for your next appointment.
Symptoms and treatment plans differ from patient to patient. Talk to a doctor about your own situation.
Frequently asked questions
Does heart failure mean my heart is failing completely?
No. The NHS states clearly that heart failure means the heart is not pumping blood as well as it should, not that the heart has stopped or is about to stop. Treatment and lifestyle changes can keep the condition stable for years.
Are my swollen legs a sign of heart failure?
They may be, but not always. Swelling of the legs, ankles or belly is one sign of heart failure (NHS), but it has other causes too. If it comes with breathlessness, tiredness or sudden weight gain, it should be checked soon. If the breathlessness is severe or you cannot speak, call 115 (Iran's emergency number).
Does a heart murmur mean I have valve disease?
Not necessarily. The NHS says a murmur is an unusual sound a doctor hears when listening to the heart, and sometimes valve disease is found by chance this way. An echo is usually needed to find the cause, and the doctor decides.
Does valve disease always need an operation?
No. The NHS says mild disease with no symptoms often needs only regular monitoring. Medicines are used to control symptoms or lower the risk of complications, and surgery is usually for severe disease: the valve is repaired or replaced. The decision rests with the doctor and depends on the echo and your situation.
Should I weigh myself every day with heart failure?
In its self-care section the NHS says to weigh yourself regularly, because a build-up of fluid can raise your weight suddenly and may need treatment. The NHS does not say exactly how often to weigh yourself or what number is worrying; ask your own care team.
Can I cut down my heart failure medicines?
Not on your own. Change or stop medicines only on a doctor's advice. If side effects bother you, tell your doctor.