Heart failure can be broadly divided into 2 types:
- Heart failure with reduced ejection fraction (HFrEF)
- Heart failure with preserved ejection fraction (HFpEF)
HFrEF is the commonest form of heart failure resulting from muscle damage to the main pumping chamber in the heart (the left ventricle) after a heart attack, or the strain of heart valve problems or other structural heart defects. The pumping strength of the left ventricle becomes weakened compared to normal, resulting in all the bodily organs receiving a reduced blood supply from each heart beat. The typical symptom is breathlessness due to congestion and fluid build up in the lungs, known as pulmonary oedema. But there is frequently also excess fluid in the skin around legs and sometimes abdomen, referred to as peripheral oedema.
HFpEF by contrast has normal strength heart beats – the issue in HFpEF is an inability of the left ventricle to relax fully in between each heart beat because of stiffening of the heart muscle over time due to age, high blood pressure or diabetes. This results in the connecting chamber, the left atrium (LA), needing to increase its pressure to fill the stiffer left ventricle. And because the LA is also directly connected to the lungs, high LA pressures are transmitted directly to the lung blood vessels causing congestion and breathlessness.
Breathlessness can of course be due to many causes, such as chest infections and asthma as well as heart failure, so feeling breathlessness does not always necessarily equate to a major heart problem. The diagnosis is made on either echocardiogram scans or cardiac MRI scans. Cardiac MRI is considered the gold standard measure of the heart’s pumping strength (i.e. ejection fraction, or the amount of blood ejected with each heart beat). It can also give more information than echocardiograms about the cause of heart failure and extent of damage.
If you are concerned about heart failure or would like to discuss anything above, then book in for an appointment using the link above.
Posted July 2025.
