Types of Heart Failure

Heart failure is classified in several ways. The type affects which medicines are used.

By ejection fraction (how much blood the left ventricle pumps out)

• Heart failure with reduced ejection fraction (HFrEF): the heart muscle is weak, with an ejection fraction of about 40% or less. Several proven medicines improve survival.
• Heart failure with preserved ejection fraction (HFpEF): the heart squeezes normally but is stiff and fills poorly. It is common with high blood pressure, diabetes, obesity and age.
• Mildly reduced ejection fraction: an in-between group.

By side of the heart

• Left-sided: causes breathlessness and lung congestion.
• Right-sided: causes swelling of the legs and belly, often due to lung disease or following left-sided failure.
• Biventricular: both sides are involved.

By speed of onset

• Chronic: develops over months or years.
• Acute: appears quickly, for example after a heart attack or a severe infection, and needs emergency care.

Other terms

• Congestive heart failure: fluid build-up, a common way of describing the condition.
• High-output failure: due to anaemia, thyroid disease or other conditions that force the heart to work harder.

Ayurvedic view

Ayurveda uses terms such as hridroga and links symptoms to the doshas. These do not map exactly onto the modern types.

Key point

An echocardiogram identifies the type, and the type shapes the treatment plan.

Before your appointment

Bring your list of medicines and supplements, recent test reports such as echocardiogram, ECG and kidney tests, and your daily weight and blood pressure log. Note any breathlessness, swelling, night-time symptoms or reduced activity, and how much salt and fluid you take. Ask about warning signs and when to call 112 or 102.